Recurrent Nocardia Sepsis in a Patient With Sickle Cell Anemia Receiving Continuous Deferoxamine

Nocardia species are ubiquitous soil-borne organisms that most commonly cause invasive disease in patients with defective cell-mediated immunity. We report a case of recurrent Nocardia sepsis in a patient with sickle cell disease and chronic iron overload, who was undergoing high-dose infusions of deferoxamine through a central venous catheter.

Phase I study of a Neisseria meningitidis liposomal vaccine containing purified outer membrane proteins and detoxified lipooligosaccharide

Purified outer membrane proteins and purified deacylated lipooligosaccharide (dLOS) were formulated for use as a vaccine in three formulations for clinical use. The three vaccine formulations included (1) purified outer membrane proteins (OMPs) and L8-5 dLOS adsorbed to aluminum hydroxide; (2) purified OMPs and L8-5 dLOS incorporated into liposomes; and (3) purified OMPs and L7 dLOS incorporated into proteoliposomes. The vaccines were compared for immunogenicity and safety in a phase 1clinical study. Ten adult volunteers were vaccinated with each of the three vaccine formulations. Two 50 μg doses were given six weeks apart, and serum samples were obtained at 0, 2, 6, 8 and 14 weeks. Volunteers were evaluated for reactogenicity 30 min after vaccination and at days 1, 2, and 14 after each vaccination, and laboratory safety tests were done at 0, 2 and 6 weeks. Overall, the vaccines were well tolerated. Bactericidal assays against a homologous strain showed a four-fold or greater increase in titer in 6 of 7 volunteers in group one, 9 of 10 volunteers in group two, and 5 of 10 volunteers in group three. A quantitative enzyme linked immunosorbant assay showed increases in antibody against both OMPs and LOS antigens. The liposome formulation appeared to be particularly effective in presenting the dLOS as an antigen.

A hypotonic storage solution did not prolong the viability of RBCs

BACKGROUND

Hypotonic storage solutions and WBC filtration are both reported to improve RBC viability. This study tested the ability of an investigational hypotonic storage solution (AS-24, Medsep Corp.) to extend the viability of liquid-stored RBCs to 8 weeks.

STUDY DESIGN AND METHODS

In a pair of crossover trials, 11 RBC units, WBC-reduced by filtration and stored in AS-24 for 8 weeks, were compared with units from the same donors that were stored for 6 weeks in AS-3, and 13 RBC units, WBC-reduced by filtration and stored in AS-3 for 8 weeks, were compared with units from the same donors that were stored for 6 weeks in AS-3. Viability was measured by the (51)Cr/(99m)Tc double-isotope method.

RESULTS

RBC viability at 8 weeks averaged 64 +/- 3 percent in the AS-24 units and 67 +/- 2 percent in the AS-3 units. It was equal at 77 +/- 3 percent and 77 +/- 2 percent after 6 weeks' storage in AS-3 in both trials.

CONCLUSIONS

Prestorage WBC reduction and storage in AS-24 did not extend RBC viability to 8 weeks. The improved viability previously demonstrated with storage of dilute suspensions of RBCs in hypotonic solutions is probably caused by factors other than the hypotonicity.

The viability of autologous human red cells stored in additive solution 5 and exposed to 25 degrees C for 24 hours

BACKGROUND

No data exist on the viability of red cells (RBCs) stored in modern additive solution systems and allowed to warm above 10 degrees C.

STUDY DESIGN AND METHODS

In a randomized crossover study, 3 units of blood were collected at least 8 weeks apart from 11 volunteer donors and stored in additive solution 5 (AS-5). Of 3 units from each volunteer, 1 was stored for 6 weeks at 4 degrees C, 1 for 5 weeks at 4 degrees C except for 24 hours at 25 degrees C on Day 14, and 1 for 5 weeks at 4 degrees C except for 24 hours at 25 degrees C on Day 28. Units were sampled periodically during storage; at the end of storage, viability was measured by the 99mTc/51 Cr double-label method.

RESULTS

RBC viability was not significantly different in the storage protocols. Less than 1 percent of stored cells hemolyzed. RBC ATP concentrations at the end of storage correlated with viability and were approximately equal in the warmed units after 30 days' storage and the conventionally stored units after 42 days.

CONCLUSIONS

The data suggest that RBCs stored in AS-5 and allowed to warm to 25 degrees C for 24 hours lose about 12 days of their shelf life.

Effect of 24-hour storage at 25 degrees C on the in vitro storage characteristics of CPDA-1 packed red cells

BACKGROUND

Packed red cells (RBCs) warmed above 10 degrees C are generally discarded. Few data exist on the degree of accelerated metabolism and increased hemolysis of packed RBCs allowed to warm.

STUDY DESIGN AND METHODS

Twenty-four CPDA-1 packed RBC units were combined in 3-unit pools and subdivided into 2 test units and a control unit. One test unit from each pool was warmed to 25 degrees C for 24 hours on Day 6 and the other test unit was warmed on Day 20; control units were maintained at 1 to 6 degrees C. RBC and supernatant chemistries and RBC morphology were measured weekly (Days 0, 7, 14, 21, and 28) and on the day before warming (Days 6 and 20).

RESULTS

Warming CPDA-1 packed RBCs accelerated the catabolism of glucose 10-fold and produced concentrations of glucose, lactate, and ATP after 25 days of storage that were equivalent to those in unwarmed units at 35 days. Supernatant sodium and potassium concentrations were corrected partially with warming. RBC morphology transiently normalized with warming and without increased hemolysis; no bacteria growth was detected.

CONCLUSION

One day of 25 degrees C storage of CPDA-1 packed RBCs accelerates essential metabolite break-down equivalent to 10 days of storage at 1 to 6 degrees C. It does not appear to matter whether the packed RBCs are warmed on Day 6 or Day 20. This information may be useful in determining the acceptability of blood allowed to warm above 10 degrees C.