Recovery and life span of 111 indium-radiolabeled platelets treated with pathogen inactivation with amotosalen HCl (S-59) and ultraviolet A light

BACKGROUND

A photochemical treatment (PCT) method to inactivate pathogens in platelet concentrates has been developed. The system uses a psoralen, amotosalen HCl, coupled with ultraviolet A (UVA) illumination.

STUDY DESIGN AND METHODS

Three sequential clinical trials evaluated viability of PCT platelets prepared with a prototype device. Posttransfusion recovery and lifespan of (111)Indium-labeled autologous 5 day-old platelets in healthy subjects was assessed. In the first study, 23 subjects received transfusions of autologous PCT and/or control platelets. In a second study, 16 of these subjects received PCT platelets processed with a Compound Adsorption Device (CAD) (PCT-CAD) to reduce patient exposure to residual amotosalen. In the third study, the effect of gamma-irradiation on PCT platelets was studied. Data from control transfusions from Study A were used for paired comparisons in the latter 2 studies.

RESULTS

Mean PCT-CAD platelet recovery for the 16 subjects with paired data was 42.5 +/- 8.7% versus 50.3 +/- 7.7% for control platelets, mean difference of 7.8% (p < 0.01). Mean lifespan for PCT-CAD platelets was 4.8 days (+/-1.3) versus 6.0 days (+/-1.2) for control platelets, mean difference of 1.3 days (p < 0.01). Platelet recovery and lifespan were similar to PCT-CAD for PCT without CAD treatment and PCT-CAD with gamma-irradiation.

CONCLUSION

Viability of 5 day-old PCT platelets was less than for control platelets. However, both were within ranges reported for 5 day-old platelets.

Comparison of Adsol and CPDA-1 blood preservatives during simulated massive resuscitation after hemorrhage in swine

BACKGROUND

In recent years, there has been a change from the use of blood stored in CPDA-1 to the use of red cells (RBCs) stored in electrolyte mixtures, such as Adsol (AS-1 RBCs). However, because Adsol contains mannitol, as well as increased amounts of glucose relative to CPD and CPDA-1, concerns have been expressed as to possible harmful effects (recipient hyperglycemia, inappropriate osmotic diuresis) that it might induce under conditions of massive RBC transfusion.

STUDY DESIGN AND METHODS

A hemorrhagic shock animal model was used to evaluate the effects of large-volume infusion of CPDA-1 or Adsol on glucose homeostasis and on urinary output under conditions that were devoid of extensive surgical manipulation. Hemorrhage was induced in 10 female Pitman-Moore mini-pigs to maintain mean arterial blood pressure at 55 mmHg for 90 minutes. After the return of autologous RBCs plus 1 L of 0.9-percent sodium chloride, the animals were given solution equivalent to the solute load in either 20 units of CPDA-1 whole blood (63 mL x 20 = 1260 mL) or 20 units of AS-1 RBCs (100 mL x 20 = 2000 mL) over a period of 90 minutes. Animals were monitored to determine physiologic and blood chemical responses to infusion of the solutions and to determine if there was hyperglycemia or inappropriate diuresis in the Adsol-treated group.

RESULTS

Animals that received CPDA-1 developed significant hypocalcemia, arterial hypotension, and elevated blood glucose concentrations; two of five animals died of circulatory collapse. In contrast, glucose metabolism in the Adsol recipients was well-regulated, serum ionized calcium concentration was not significantly altered, and all animals survived. No evidence of inappropriate diuresis was observed.

CONCLUSION

Administration of large amounts of Adsol was not associated with hyperglycemia or inappropriate osmotic duiresis in hemorrhaged and resuscitated minipigs. These data suggest that fewer physiologic changes may be associated with the massive transfusion of AS-1 RBCs than with that of CPDA-1 whole blood.

Effects of methylene blue-treated plasma on red cells and stored platelet concentrates

BACKGROUND

Photochemical methods can effectively inactivate extracellular viruses and bacteria found in blood components. Treatment of plasma with methylene blue (MB), a phenothiazine dye, and visible light inactivates enveloped viruses including HIV-1. The effects of MB-treated plasma on cellular components stored in vitro have not been well characterized.

STUDY DESIGN AND METHODS

MB-treated plasma (83 microg MB/250 mL plasma) was added to single-donor platelets, stored AS-1 red cells (RBCs), irradiated RBCs, and frozen-deglycerolized RBCs. In vitro platelet assays performed after 1 and 5 days of storage in MB-treated plasma included pH, pO2, pCO2, HCO3, platelet number, lactate dehydrogenase, glucose, osmotic recovery, and CD62 expression. RBC components were examined at specific intervals for leakage of potassium, plasma hemoglobin level, and percentage of hemolysis. Direct antiglobulin tests, osmotic fragilities, and RBC antigen stability tests were also performed on RBCs stored in MB-treated plasma. Components stored with autologous plasma or nontreated allogeneic plasma served as controls.

RESULTS

Similar storage-induced changes in pH, glucose, and platelet numbers, as well as increases in lactate dehydrogenase, CD62 expression, and lactate were seen in single-donor platelets stored with MB-treated and control plasma. Platelet morphology scores and osmotic recoveries were not altered. Plasma hemoglobin and potassium and percentage of hemolysis increased equally in the various RBC components stored with MB-treated or nontreated plasma. Osmotic fragility and RBC antigen stability were not appreciably altered by MB-treated plasma.

CONCLUSION

Plasma treated by MB photoinactivation can be used for in vitro resuspension and storage of platelets or RBCs, because of the lack of influence of MB-treated plasma on a variety of in vitro platelet and RBC assays.

Plateletpheresis in 90- to 110-pound donors using the CS-3000 blood cell separator

BACKGROUND

Increases in the use of single-donor apheresis components have increased the need for platelet donors. In the United States, persons must weigh 110 pounds or more to qualify as blood donors, and the same weight limitation has been placed on apheresis donors. Because automated plateletpheresis with some instruments differs considerably from whole-blood donation with respect to the volume of blood removed from the donor, the feasibility of using persons weighing between 90 and 110 pounds as platelet donors was evaluated by the use of the CS-3000 blood cell separator.

STUDY DESIGN AND METHODS

The study was performed using female subjects who met all usual donor requirements except for minimum weight. The standard platelet collection procedure of the instrument was used, except that the blood processing rate was manually selected so as to optimize the blood withdrawal and return rate in individuals. Vital signs were recorded before and after donation as were signs or symptoms of any type of donor reaction.

RESULTS

Twenty-six of 28 women completed the donation procedure; in two instances, collection was terminated prematurely because of an inability to maintain adequate venous access. An average of 4.5 x 10(11) platelets were collected during a mean donation time of 110 minutes. All donors tolerated the procedure well, and no serious adverse reactions were seen. Because of the administration of priming solution and anticoagulant during apheresis, there was a net positive fluid balance following the procedure, in spite of the removal of approximately 220 mL of platelet concentrate.

CONCLUSION

These preliminary studies suggest that 90- to 110-pound persons may serve as plateletpheresis donors. Additional studies are needed to more fully document the safety and efficacy of this approach. The use of lower-weight donors may significantly increase the number of persons available to provide single-donor platelet components.

A prospective, randomized study of the use of platelet concentrates irradiated with ultraviolet-B light in patients with hematologic malignancy

BACKGROUND

Irradiation of platelet concentrates (PCs) with ultraviolet-B (UVB) light inactivates the contaminating white cells and might be an alternative to filtration for the prevention of alloimmunization to HLA antigens and subsequent refractoriness to further platelet transfusions in multiply transfused patients with bone marrow failure.

STUDY DESIGN AND METHODS

Patients with hematologic malignancy, mainly acute myeloid leukemia, were prospectively assigned in a random manner to receive either UVB-irradiated or control, nonirradiated PCs. All patients were given red cells that were white cell reduced by filtration. Transfusion efficacy and alloimmunization were assessed by means of corrected count increments, requirement for red cells and PCs, and measurement of lymphocyte-reactive antibodies.

RESULTS

UVB-irradiated PCs had a clinical efficacy similar to controls as judged by corrected count increments at 1 to 6 and 12 to 24 hours and by the median requirement for red cell and platelet transfusions. Alloimmunization determined by measurements of lymphocyte-reactive antibodies using both conventional and antiglobulin-augmented lymphocytotoxicity techniques was not abolished in recipients of UVB-irradiated PCs (4/30, 13%) but was less than that in controls (5/20, 25%; p = NS). The mean number of platelet transfusion episodes prior to the occurrence of alloimmunization was greater in the control group (27 vs. 10; p = 0.017).

CONCLUSION

In this trial, UVB irradiation did not diminish the clinical efficacy of platelet transfusions. There was a small but nonsignificant reduction alloimmunization, but no difference in refractoriness of the two groups was observed. Larger prospective randomized studies are required to confirm these findings and to compare UVB irradiation with white cell reduction.

Effects of white cell reduction on the resistance of blood components to bacterial multiplication

BACKGROUND

While prestorage white cell (WBC) reduction by filtration may improve platelet and red cell quality, it also may remove an important anti-bacterial defense mechanism, especially if blood is WBC-reduced shortly after collection.

STUDY DESIGN AND METHODS

The question of whether WBC reduction of platelet concentrates and red cells altered bacterial proliferation kinetics in components prepared from deliberately contaminated, freshly collected blood was investigated. Two-unit pools of whole blood were inoculated, at a concentration of approximately one colony-forming unit per mL, with one of 17 bacterial species reported to have caused septicemia in transfusion recipients. Each pool was divided after inoculation, and components were prepared from the 2 units after a 7-hour room-temperature holding period. One unit of each AS-1 red cell or platelet pair was WBC-reduced, and the pairs were then stored for 42 days at 4 degrees C (red cells) or for 10 days at 22 degrees C (platelets). Quantitative bacterial cultures were performed at periodic intervals.

RESULTS

In red cells, clinically significant bacterial proliferation occurred in only one instance (Serratia marcescens), and growth was less rapid in the WBC-reduced unit than in the control. Three patterns of growth were seen in platelet concentrates. In four cases, there was rapid proliferation in both test and control units, while on 13 occasions there was minimal replication in either pair. On six occasions, substantial growth was noted in control units, while few or no bacteria could be found in the WBC-reduced units. There was no evidence in either red cells or platelets that bacteria proliferated more rapidly in units that had been WBC-reduced before storage than they did in units in which WBCs were retained.

CONCLUSION

Rather than increasing the risk of bacterial proliferation through removal of active phagocytic cells, WBC reduction by filtration before blood storage may act to reduce the likelihood of significant bacterial proliferation, possibly by removal of microorganisms along with WBCs.

Evaluation of apheresis platelet concentrates collected with a reduced (30-ml) collection chamber with resuspension and storage in a synthetic medium

Recently, the CS-3000 Plus Blood Cell Separator with the TNX-6 platelet separation chamber insert has been furnished with a small-volume (30-ml) collection chamber. In this study, a platelet synthetic medium containing glucose and bicarbonate (PSM) was used for resuspension and storage of this highly concentrated platelet product. Eighteen donors participated in a paired study design where each participant donated platelets on two occasions, once following collection in a standard chamber with resuspension and storage in plasma and once following collection in the new chamber with resuspension and storage in PSM. Substantially higher total platelet counts were obtained using platelets collected in the small chamber and stored in PSM as compared to control (4.4 +/- 0.9 x 10(11) vs. 3.5 +/- 0.9 x 10(11) platelets, p < 0.01 by paired t test). After 5 days of storage, PSM-stored platelets demonstrated higher ATP levels, less lactate dehydrogenase in the supernatant and increased lactate production with resulting lower pH at day 5 of storage (6.94 +/- 0.15 vs. 7.08 +/- 0.09, p < 0.05). There were no statistically significant differences of the survival by multiple-hit estimation of PSM-stored as compared to plasma-stored platelets as determined by 111In labeling and infusion. A slight decrease in the initial percent recovery with the additive-suspended as compared to suspended plasma cells was noted: 50 +/- 8 versus 54 +/- 9%, respectively (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect on cardiovascular function and iron metabolism of the acute removal of 2 units of red cells

BACKGROUND

The collection from a donor of 2 red cell units at one time would decrease recipient exposure to viruses and alloantigens. If the donor is a large person, the blood volume lost and the postdonation hemoglobin and/or hematocrit should be within acceptable limits. If the donor is a large person, the blood volume lost and the postdonation hemoglobin and/or hematocrit should be within acceptable limits. The effect on cardiovascular function and iron metabolism requires description.

STUDY DESIGN AND METHODS

Manual 2-unit erythropheresis was performed on eight donors, with the plasma returned. Donors had treadmill testing of maximum aerobic power (VO2max) before donation, 24 hours after, and 8 to 11 weeks after. Serial samples were drawn for iron metabolism studies.

RESULTS

Donors weighed 61.2 to 74.8 kg, and 9.6 to 11.4 percent of their blood volume was removed. Mean VO2max decreased from 84 percent of that predicted before donation to 74 percent 24 hours afterward. By 8 to 11 weeks, hemoglobin returned to acceptable donor levels and mean VO2max was 92 percent of that predicted. Mean hemoglobin fell from 14.4 to 11.7 g per dL (144 to 117 g/L) and rose to 13.9 g per dL (139 g/L) at 16 weeks. At 16 weeks, serum iron (120 +/- 47 vs. 83 +/- 33 micrograms/dL [21 +/- 8 vs. 15 +/- 6 mumol/L]), ferritin (40 +/- 24 vs. 18 +/- 10 ng/mL [40 +/- 20 vs. 20 +/- 10 micrograms/L]), and free erythroprotoporphyrin (19 +/- 5 vs. 28 +/- 5 micrograms/dL [0.34 +/- 0.09 vs. 0.50 +/- 0.09 mumol/L]) differed significantly from baseline levels. No major donor symptoms occurred.

CONCLUSION

Two-unit erythropheresis was done with blood volume loss and postdonation hemoglobin no worse than those that would occur in a 50-kg donor donating 450 mL. Cardiovascular effects and donor symptoms were mild. Two-unit red cell donations would be clinically advantageous, and they warrant further studies of both utility and donor safety.

Stability of red cell antigens and plasma coagulation factors stored in a non-diethylhexyl phthalate-plasticized container

Red cell antigen stability studies were performed to evaluate whether the storage of red cells in plastic segments made up of a new non-di-2(ethylhexyl)phthalate (DEHP)-plasticized material resulted in poststorage antigenic reactivity different from that seen in segments made from DEHP-containing plastic. Serial 1-in-2 dilutions of commercially available antisera were prepared and tested by using stored red cells obtained from segments on Days 0, 28, 42, and, in some instances, 49. Antigenic determinants tested included A, B, D, c, K, Le(a), Fya, Jka, M, and P1. To minimize variability, the same reagent lots were used throughout each study, and the same technologists performed the assays in each laboratory. No significant differences in titration scores were seen when cells stored in segments made of the test plastic were compared with cells obtained from the same donor and stored for the same length of time in segments made of control plastic. In addition, plasma coagulation factor stability was studied in fresh-frozen plasma and cryoprecipitate stored for up to 1 year in the non-DEHP-plasticized plastic containers. No significant differences were seen in prothrombin time, activated partial thromboplastin time, fibrinogen content, or factor V, VII, VIII, IX, or X activity as compared with plasma stored for equal periods of time in control plastic containers. It is concluded that the test plastic does not adversely affect red cell antigenic reactivity or plasma coagulation factor stability and that it is suitable for use in clinical transfusion practice.

Five-day storage of platelets in a non-diethylhexyl phthalate-plasticized container

A non-diethylhexyl phthalate (DEHP)-plasticized blood bag for 5-day storage of random-donor platelet concentrates has been developed. The plastic bag is composed of polyvinylchloride plastic with a butyryl trihexyl citrate plasticizer. The suitability of this plastic for the storage of platelet concentrates for use in clinical transfusion practice was evaluated. In vitro storage studies showed no significant differences at Day 5 for a series of in vitro assays (test plastic vs. control plastic) including pH (7.31 vs. 7.44), lactate dehydrogenase discharge (21.8 vs. 17.1%), pO2 (103 vs. 120 torr), osmotic recovery (52 vs. 57%), and morphology score (527 vs. 516). For paired radiolabeled recovery and survival data from autologous blood donors, results showed equivalence between the test plastic and two control plastics. A small but significant difference between test and control plastics in regard to survival was found by using a linear computer model, but not with a gamma function (multiple-hit) model. For paired transfusions to thrombocytopenic patients, the corrected count increments at 1 to 4 hours (test vs. control) were 13,534 versus 15,494 (p > 0.05, NS). Similar results were seen for corrected count increments determined at 12 to 24 hours. It can be concluded that platelets stored in the test plastic are acceptable for use in clinical practice.

Removal of Yersinia enterocolitica from AS-1 red cells

The growth of Yersinia enterocolitica in AS-1 red cells was investigated so as to study the organism's proliferation kinetics and to evaluate the effect of prestorage white cell (WBC) reduction on bacterial multiplication. Twenty-four 2-unit pools of ABO-compatible whole blood were prepared and inoculated with Y. enterocolitica to final concentrations ranging from 0.3 to 132 organisms per mL. After inoculation, pools were split equally, AS-1 red cells were prepared, and 1 unit of each pair (test unit) was WBC-reduced with a WBC-reduction filter. Quantitative bacterial cultures of both WBC-reduced and control units were performed at several points throughout preparation and storage. Less than 10 percent of the inoculated organisms was recovered from blood samples taken after a 7-hour room-temperature holding period. By the end of 42 days of storage, Y. enterocolitica was recovered from unfiltered red cells in 2 of the 6 units inoculated at the lowest levels (0.3 and 0.7 organism/mL), from 8 of the 12 units inoculated at the intermediate levels (2.8, 5.2, 30.7, and 43 organisms/mL) and from 6 of the 6 units inoculated at the highest levels (98.8 and 132 organisms/mL). Positive cultures were seen as early as Day 7. In contrast, filtered units inoculated at all levels less than or equal to 98.8 organisms per mL (21/21 units) were sterile at the end of the 42-day storage period, while 2 units (2/3) inoculated at 132 organisms per mL showed growth despite filtration.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultraviolet-B irradiation of platelets: a preliminary trial of efficacy

Prior studies established that ultraviolet-B light (UVB) irradiation of platelet concentrates (PCs) at appropriate doses can eliminate the mixed lymphocyte culture-stimulating and -responding capacity of lymphocytes in the PCs without adversely affecting in vitro platelet function. The in vivo recovery and survival and in vitro characteristics of UVB-irradiated platelets were investigated in paired studies. PCs were stored for 1 day and then exposed to UVB. Platelet recovery, survival, and function were comparable to those of nonirradiated platelets. Recovery and survival of platelets stored for 5 days before UVB exposure were decreased relative to controls, although they were considered clinically acceptable. Paired transfusion studies were also performed in seven thrombocytopenic patients by using platelets obtained by apheresis. Comparable posttransfusion platelet increments and bleeding time corrections were obtained with both irradiated and control (nonirradiated) platelets. It can be concluded that platelets survive and function relatively normally in vivo after UVB irradiation sufficient to abolish lymphocyte reactivity in mixed lymphocyte culture. Long-term studies of UVB-irradiated PCs are needed to assess their potential in reducing recipient alloimmunization.

Storage of platelet concentrates after high-dose ultraviolet B irradiation

Ultraviolet B (UVB) irradiation of platelet concentrates (PCs) may prevent the development of posttransfusion HLA alloimmunization. As irradiation performed in a blood center or a hospital will probably be associated with a variable postirradiation delay before transfusion, the ability to store PCs after UVB irradiation becomes important. The effects have been studied of a UVB dose of 10,000 mJ per cm2, the dose used in our institution for UVB clinical trials, on PCs pooled and stored for up to 96 hours after irradiation. Results showed that after 96 hours of storage, though there were no changes in pH, platelet count, white cell count, percent discharge of lactate dehydrogenase, or beta-thromboglobulin, there were significant decreases in morphology score and osmotic recovery. These changes, however, were not evident after 24 hours of storage. Similarly, there was a 60-percent decrease in immunoreactive membrane glycoprotein (GP) Ib after 96 hours of storage, but these changes were not seen after 48 hours of storage. No changes were seen in levels of GPIIb/IIIa in either group during the 96 hours of storage. On computer-analyzed two-dimensional polyacrylamide gel electrophoresis, PCs irradiated at 10,000 mJ per cm2 and stored for 72 hours had changes in over 50 platelet proteins as compared to those proteins in nonirradiated age-matched control PCs. It can be concluded that UVB irradiation of PCs at 10,000 mJ per cm2 does not lead to significant platelet deterioration after short-term storage (24-48 hours) but is likely to be deleterious after long-term (72-96 hours) storage.(ABSTRACT TRUNCATED AT 250 WORDS)

Plasma separation using a hollow fiber membrane device

A disposable hollow fiber device was evaluated by collecting approximately 550 ml of normal donor plasma (n = 43) and by performing sham (n = 10) and therapeutic (n = 12) plasma exchanges. Blood was processed at 70 ml per min, and plasma flux averaged 23 (collection) and 25 (exchange) ml per min (mean separation efficiencies of 52 and 60%, respectively). The procedures were tolerated well by all donors and patients. The plasma hemoglobin concentration in separated plasma averaged 1 mg per dl, and cell contamination was negligible (mean of 1, 3, and 6 RBCs, platelets and WBCs/microliter, respectively). There was no evidence of in vivo classical or alternative pathway complement activation as assessed by total hemolytic complement generation (CH50), alternative pathway hemolytic activity (AP50), C3 conversion, or C5 activation, nor were unexpected changes seen in the results of laboratory tests performed after the procedure. Sieving coefficients during sham plasma exchange averaged as follows: albumin, 1.03; IgM, 1.0, IgG, 1.0; IgA, 0.98; factor V, 1.07; factor VII, 0.89; factor VIII, 1.05; and factor IX, 1.19. The device appears to be useful for separation of cell-free plasma from blood during therapeutic plasma exchange procedures.

Extended storage of single-donor platelet concentrate collected by a blood cell separator

Use of a sealless blood pathway in a blood cell separator (CS-3000, Fenwal) permits collection of platelets in a "closed system" when saline and anticoagulant solutions are integrally attached; this in turn allows storage of instrument-collected platelet concentrates (PCs) beyond 24 hours. To evaluate extended storage of high yield PCs, cells collected with the instrument were stored (200 ml plasma) for 8 days (flatbed agitation) in either 3-liter polyvinylchloride (PL 146) containers (n = 6), polyolefin bags (PL 732) (n = 8), or two 1-liter polyolefin (double PL 732) containers (n = 8). A mean of 4.45, 4.09, and 3.94 X 10(11) platelets were stored in PL 146, single PL 732, and double PL 732, respectively; total white cells per container averaged 0.3, 0.2, and 0.2 X 10(9) for the three container systems. By day 1, platelet pO2 dropped to 14 and 16 torr in PL 146 and PL 732 PCs (pCO2, 127, and 82 torr). In contrast, double PL 732 maintained high pO2 (approximately equal to 80 torr) and low pCO2 (approximately equal to 30 torr) through day eight. Glucose declined at faster rates in PL 146 and single PL 732 containers, while lactate increased more rapidly (338 and 197 mg/dl of lactate on day four vs. 116 mg/dl for double PL 732 units). Morphology scores dropped from 400 to 98 (PL 146) and 216 (PL 732) at day four (pH values of 6.3 and 7.0), while a score of 330 was seen in double PL 732 PCs.(ABSTRACT TRUNCATED AT 250 WORDS)

Extended storage of platelets in a new plastic container. I. Biochemical and morphologic changes

A new polyvinyl chloride container plasticized with tri(2-ethylhexyl) trimellitate (PL 1240 plastic) was evaluated for use in extended platelet storage. Six leukocyte-rich platelet concentrates (mean, 0.6 X 10(9) white cells per bag; range, 0.3 to 1.0 X 10(9) per container) were prepared by removing as much of the platelet-rich plasma from blood as possible. The cells were stored at 22 degrees C on an end-over-end agitator. An average of 1.04 +/- 0.19 X 10(11) platelets was recovered, and the mean pH dropped from 7.23 on day 0 to 6.68 by day 5. At the completion of the storage period. PO2 averaged 80 torr, PCO2 was 35 torr, bicarbonate concentration was 0.5 mM, and lactate concentration 29.5 mM. Thirty-one additional units of platelet concentrates, not deliberately prepared to be leukocyte-rich, on day 5 had a pH of 6.75 +/- 0.39 (mean platelet yield, 0.97 +/- 0.21 X 10(11); PO2 and PCO2 averaged 50 and 48 torr, respectively). Following storage, the cells had an average phase microscopic morphology score of 244 (n = 17). Platelets appeared to be preserved well throughout storage when assessed by transmission and scanning electron microscopy. We conclude that platelets can be stored for 5 days in PL 1240 plastic containers with good preservation of pH and cell ultrastructure.

Use of Adsol preservation solution for prolonged storage of low viscosity AS-1 red blood cells

A new red cell preservation solution is described in which the red cells may be stored for 49 d with greater than 75% mean post-transfusion recovery. Blood is drawn into Anticoagulant Citrate Phosphate Dextrose Solution, centrifuged, the plasma removed and the cells resuspended in 100 ml of a solution containing saline, adenine, dextrose and mannitol (Adsol Preservation Solution, Fenwal Laboratories, Deerfield, Illinois). The final product, AS-1 Red Blood Cells, has a haematocrit of approximately 0.60 and flow properties that are similar to those of whole blood. After storage, red cell haemolysis is minimal and erythrocyte adenosine triphosphate is well preserved. This study documents that red cells may be stored in a protein-poor electrolyte medium for periods of 49 d with good post-transfusion survival.

Non-centrifugal plasma collection using cross-flow membrane plasmapheresis

A prototype of a cross-flow membrane plasmapheresis system was tested for its safety and efficacy in normal donors. 550 ml of plasma can be harvested in less than 1 h. The procedure appears to be safe for the donor. No significant alterations in donor hematological, coagulation, or biochemical values were obtained after the procedure compared to the predonation levels. Changes in the classical and alternate complement pathways were studied serially by analysis of functional hemolytic titers, C3 and C4 levels, and C3 and factor B cleavage products. No firm evidence of complement activation by the polysulfone filtration cell membrane was found.

Stability of red cell antigens during prolonged storage in citrate-phosphate-dextrose and a new preservative solution

Red cells anticoagulated with citrate-phosphate-dextrose (CPD) or a commercial preservative solution containing adenine, sodium chloride, and mannitol (ADSOL) and stored in heat-sealed segments of plastic tubing were tested for antigen stability after refrigeration at 4 degrees C for up to 56 days. Reactivity of the A, B, c, D, K, Lea, Fya, M, and P1 antigens was maintained adequately during the storage period in both solutions. Heat-sealed segments containing red cells suspended in either CPD or ADSOL preservation solutions for up to 56 days appear acceptable for use in compatibility testing.

Stability of red cell antigens and plasma coagulation factors stored in new formulation plastic blood containers

The stability of red blood cell antigens and plasma coagulation factors stored in new plastic blood packs containing either citrate-phosphate-dextrose (CPD) or citrate-phosphate-dextrose-adenine (CPDA-2) was studied. The containers were made of either polyolefin (PL 732TM) plastic without a plasticizer, or polyvinyl chloride with a non-diethylhexyl phthalate (non-DEHP) plasticizer (PL 1240). All studies were done in parallel using standard polyvinyl chloride (PL 146) bags containing DEPH plasticizer as controls. Red blood cell antigen scoring was performed for the A, B, c, D, K, Fya, Lea, Jka, M, and P antigens using cells obtained from both the blood container and tubing segments. Units of fresh frozen plasma and cryoprecipitate were prepared, and age and donor-matched sets of each of these blood components were stored in both test and control plastic containers. The red blood cell antigens showed no decrease in reactivity over 21 (CPD) or 35 (CPDA-2) days of storage in either test plastic compared with controls. For fresh frozen plasma (factors V, VIII, IX) and cryoprecipitate (factor VIII) the factor activity found for the test plastics ranged from 94 to 115 percent of that recorded for the age and donor-matched control plastic. The concentration of fibronectin found in cryoprecipitate stored in the test plastics averaged 90 to 99 percent of the activity found in PL 146 plastic. We conclude that the red blood cell antigens and coagulation factors tested remain stable in the plastic-anticoagulant combinations studied.

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).

Evaluation of gravity leukapheresis and comparison with intermittent centrifugation leukapheresis

Fifteen normal donors underwent gravity leukapheresis using a prototype collection and reinfusion harness after receiving dexamethasone for leukocyte stimulation. A mean of 4.6 units of blood were processed, producing a mean granulocyte yield of 10.8 X 10(9), with an average donation time of 261 minutes. Granulocyte collection efficiency was 79.9 per cent, but yield was only 2.5 X 10(9) granulocytes/hour. Granulocytes obtained by gravity leukapheresis were normal morphologically and had normal bactericidal capacity. Serial determinations showed no changes before and after donation of coagulation profile and serum chemistries in the donors. Seven donors underwent leukapheresis using intermittent centrifugation the day following gravity leukapheresis without further leukocyte stimulation. Mean granulocyte yield (16.1 X 10(9)), and yield/hour (5.37 X 10(9)) of donation were significantly greater for the mechanical method (p less than 0.0005). Gravity leukapheresis required considerable blood bag handling and bag entries, even with the prototype harness. Considering the amount of blood handling, the expense of the sedimenting agent, the probable dose response phenomenon of granulocyte transfusions, and the low yield resulting from the limited volume of blood processed, this technique should not be made widely available, especially where regional centers can provide granulocytes obtained by more productive methods.

Long-term granulocyte transfusion in patients with malignant neoplasms

Thirty-eight episodes of culture-documented antibiotic-resistant bacterial or fungal infection in patients with malignant neoplasms were treated with daily granulocyte transfusions until the infection improved or the patient died. Cumulative summation temperature plotting allowed easier interpretation of recipient fever response. Seventy-one percent of recipients had a favorable response to transfusion. There was no difference in mortality between patients treated with cells collected by filtration (FL) or intermittent flow centrifugation (IFCL) leukapheresis techniques. Transfusion reactions were more than twice as common with FL than IFCL collected cells. Seventy-four percent of recipients were alive 21 days after completion of transfusions; of the ten deaths, five could be classified as granulocyte transfusion failures. This study suggests that long-term granulocyte transfusion may be required in infected recipients when autologous granulocytes do not return after chemotherapy.

Plasmapheresis using the IBM 2991 blood cell processor

The IBM 2991 Blood Cell Processor, normally used to wash or deglycerolize red blood cells, has been modified to permit serial plasmapheresis using a small roller pump, an adapter line and the disposable processing set usually used for cell washing. Blood is withdrawn from the donor, pumped into the plastic centrifuge bag and the plasma removed after centrifugation. Donor erythrocytes are pumped from the processing bag to a reservoir bag from which they are returned to the donor by gravity. Multi-unit plasmapheresis to harvest plasma for transfusion or to remove plasma as a therapeutic measure is possible using the modified system. A four-unit plasmapheresis can be done in 65 to 75 minutes at a cost of $27.61, including disposables and technologist labor. This modification allows the IBM 2991 to function for red blood cell washing and as an efficient instrument for plasmapheresis.

Frozen autologous platelets in the supportive care of patients with leukemia

Multiple units of platelet concentrate obtained by intensive plateletpheresis of patients with leukemia in remission were pooled and frozen using 4 to 5 per cent dimethylsulfoxide and retransfused during periods of thrombocytopenia. Plateletpheresis was well tolerated by all donors and an average platelet yield per unit of 0.99 X 10(11) (n = 155) was obtained. The results of 107 transfusions to 36 patients are presented. An average of 32.4 per cent of the platelets were lost during the freeze-thaw process. Freezing loss was lowest at a freezing rate of one degree C per minute, at a lower final concentration of platelets, and when polyolefin bags were used. The mean corrected posttransfusion count increment was 6,400/mul (range 600-19,000 xm2/10(11) platelets transfused). In vivo results did not correlate with freezing rate but were statistically significantly better at lower platelet (approximately 0.16 X 10(11) platelets/10 ml) concentrations. Eleven patients, including some who were refractory to random donor platelets were supported entirely with autologous platelets during reinduction therapy for leukemia. When administered prophylactically the autologous platelets seemed to prevent hemorrhage during periods of thromobocytopenia although in most patients bleeding times were not corrected posttransfusion. This study demonstrates that frozen autologous platelets can be used in the supportive care of thrombocytopenic patients. Further technical improvements are necessary before platelet freezing becomes practical for widespread use.

Unusual response to ABO incompatible blood transfusion

Three units of group A blood were inadvertently administered to a group O recipient during surgery without evidence of hemoglobinemia, hemoglobinuria, hypotension, disseminated intravascular coagulation, acute renal tubular necrosis, or other signs and symptoms of transfusion reaction. The recipient had normal concentrations of IgG, IgA, and IgM as well as complement (C3) prior to transfusion and anti-A agglutinins titered to 64 (titer of 128 by the antiglobulin technic). Seventeen hours following the transfusion, 28 per cent of the circulating red blood cells were group A (equivalent to 475 ml of packed cells); they were eliminated by day 5 without evidence of hemoglobinuria, hemoglobinemia or hyperbilirubinemia. Anti-A titers (antiglobulin) had risen from a posttransfusion low of 4 to 4,096 by day 10. After treatment of serum with 2-mercaptoethanol, however, hemolytic activity which was first noted on day 5 was lost and the antiglobulin titer dropped to 24 which suggested that most of the anti-A produced in response to the transfusion was IgM rather than IgG. The anti-A titer had dropped to essentialyy pretransfusion levels and the majority of anti-A present was IgM by day 91. The recipient suffered no untoward effects from the transfusion and was in good health three months following the transfusion.

Granulocyte harvest for transfusion: donor response to repeated leukapheresis

Leukapheresis of normal donors with the NCI-IBM Continuous Flow Blood Cell Separator was compared with the method of filtration leukapheresis. An average of 5.7 times 10-9 (range 1.4 to 10.9 times 10-9) granulocytes were collected on 25 occasions with the blood cell separator compared with an average of 36.6 times 10-9 (range 20.1 to 61.3 times 10-9) obtained by filtration leukapheresis on 85 occasions. Donor platelet counts decreased following donation by an average of 29,000/mul (14%) with continuous flow centrifugation (CFC) and an average of 40,000/mul (17%) with filtration leukapheresis (FL). Estimated donor packed red blood cell loss, including blood obtained for investigative purposes, was 80 ml per donation with CFC and 67 ml per donation when FL was used. FL resulted in at least a 25 per cent increase in the granulocyte count of donors by donation completion in 61 per cent of donors, although postdonation granulocytosis did not correlate with increased cell harvest. CFC donors generally displayed a postdonation decrease in granulocyte count. Normal numbers of granulocytes were maintained in donors undergoing frequent leukapheresis and no donor's health was compromised by the removal of large numbers of granulocytes. Repeated donations were possible with both systems. Although platelet counts dropped more with FL, the procedure was performed as frequently as eight times in a ten-day period without development of severe donor thrombocytopenia. Donor red blood cell loss appears to be the limiting factor in the repeated use of either system. Blood loss could be significantly decreased under routine conditions if fewer samples were obtained for investigational purposes. Filtration leukapheresis offers the advantage of significantly greater granulocyte yields than is possible with CFC unless modifications such as arterio-venous shunts or the use of steroids and/or rouleaux-inducing agents are employed.

Clinical experience with transfusion of granulocytes obtained by continuous flow filtration leukopheresis

Granulocytes obtained by continuous flow filtration leukopheresis (CFFL) were transfused to 21 patients on 131 occasions. An average of 28.2 times 10-9 granulocytes were administered per transfusion. These cells were more than 90 per cent viable by dye exclusion, ingested latex particles normally and had almost normal bactericidal activity. Migration to skin windows was demonstrated on four of six attempts, but 51-Cr-labeling studies failed to show localization in infected areas on six occasions. Post-transfusion granulocyte count increments averaged 225/mul and were transient. Significant transfusion reactions occurred during 35 transfusions to 13 patients. Reactions occurred in some patients without demonstrable alloimmunization and after six infusions of HL-A identical or compatible cells. Definite clinical improvement was noted in three recipients. Stabilization of infection with patient survival occurred nine times, and progression of infection with death eight times. Granulocytes obtained by CFFL are viable and functional. Their transfusion is not without risk and must still be considered an investigative procedure of suggestive but as yet unproved clinical efficacy.

Unusual Variant of Lactate Dehydrogenase Isoenzymes

Thirteen electrophoretic bands of lactate dehydrogenase isoenzyme activity were detected in the serum of a 69-year-old Negro woman who died of pseudomonas pneumonia. No evidence of tumor was found at necropsy, and additional studies of the enzymatic activity of crude extracts of liver, lung, spleen, kidney, brain, skeletal muscle, lymph node, and heart revealed 1, 2, 3, 4, and 5 separate isoenzyme bands for lactate dehydrogenase isoenzymes 1, 2, 3, 4, and 5, respectively (a total of 15 isoenzyme bands). Serum and erythrocyte hemolysate from one of two healthy daughters displayed a similar pattern of multiple isoenzyme bands in isoenzymes 2 and 3. The observed pattern is consistent with the heterozygous form of a mutation of the genetic locus controlling synthesis of the M monomer such that two differently charged monomeric proteins are produced, each of which apparently combines with H chains with equal facility, leading to the multiband enzymatic specificity seen.