Prospective quality control study of a novel gravity-driven whole blood separation system suitable for humanitarian crises

Centrifugation-based whole blood (WB) separation represents the worldwide standard but it depends on electricity and infrastructure. We have prospectively evaluated a novel hollow-fibre WB separation system that does not require manual priming or blood flow regulation (n = 29). RBC units contained sufficient Hb (50·4 g ± 4·3), low leucocytes (90 000 ± 0·008), exhibited low haemolysis (0·57% ± 0·49) and robust ATP content (51·47% ± 8·2) after 43 days storage. Plasma units contained low leucocytes and mean coagulation factor activities for FV, FVIII and FXI were 47%, 90% and 68%, respectively. RBC met quality specifications but plasma units exhibited reduced FV and FXI activity.

Recommendations of the ISBT Working Party on Granulocyte Immunobiology for leucocyte antibody screening in the investigation and prevention of antibody-mediated transfusion-related acute lung injury

BACKGROUND

Transfusion-related acute lung injury (TRALI) is currently one of the most common causes of transfusion-related major morbidity and death. Among the many TRALI mediators, leucocyte antibodies have been identified as important triggers of severe TRALI.

STUDY DESIGN AND METHODS

These recommendations were compiled by experts of the ISBT Working Party on Granulocyte Immunobiology, based on the results obtained in eight international granulocyte immunology workshops, their personal experiences and on published study results.

RESULTS

Leucocyte antibody screening has to include the detection of human leucocyte antigen (HLA) class I, class II and human neutrophil alloantigen antibodies using established and validated techniques. HLA class I antibody detection should be restricted to antibodies clinically relevant for TRALI. To avoid unnecessary workload, TRALI diagnosis should be assessed by consultation with the reporting clinician and thorough exclusion of transfusion-associated circulatory overload/cardiac insufficiency. In patients diagnosed with TRALI having donors with detectable leucocyte antibodies, evidence of leucocyte incompatibility should be provided by either cross-matching or typing of patient for cognate antigen.

CONCLUSION

Leucocyte antibody screening for the immunological clarification of TRALI cases as well as for identification of potentially alloimmunized blood donors is feasible and can be performed in a reasonable and quality assured manner. This practice can contribute to the prevention of antibody-mediated TRALI.

Results of glass intraocular lens insertion

Glass lenses were inserted in ten eyes. Nine eyes achieved 6/12 or better visual acuity. No complications related to the intraocular lens were encountered. Because of our satisfactory initial results we feel that glass intraocular lens implantation may be considered as an alternative, especially in eyes with corneal opacity or diabetic retinopathy.

Quantitative trabeculectomy

The technique and results of a trabeculectomy are presented where the desired final intraocular pressure (IOP) is obtained by means of adjusting the thickness of sclerocorneal tissue removed to the initial pressure. The procedure was used in 35 eyes with all types of glaucoma and pre-operative pressures of up to 50 mmHg. In 78.3% of cases one operation was sufficient to control the IOP without additional medication. Two eyes had to be reoperated on, and 7 more needed additional pressure-lowering medication. The overall success rate, therefore, rose to 97.3%. The only failure occurred in an eye with irreducible acute angle-closure glaucoma where malignant glaucoma complicated the trabeculectomy. Complications included hyphaema (3), shallow anterior chamber (7)--with or without choroidal detachment--and transient rise in the IOP. All complications subsided with conservative therapy.

[Diagnosis and treatment of lacrimal pathway lesions]

The experience of a clinic dealing exclusively with lacrimal system problems is reported. 2,002 patients (2,497 eyes) were treated over the course of eight years. The great majority of patients were children under the age of 4 years. the etiology of the lacrimal dysfunction varied according to age. In infants and children under four 98% of the cases were of congenital defects. The most frequent causes in adolescents and adults was trauma, and in the elderly, inflammation. Inflammation of the lacrimal sac was more than twice as common in females, and the right side was more often affected that the left (4:3).

Screening for refractive errors, strabismus and other ocular anomalies from ages 6 months to 3 years

There were 3,375 children between the ages of 6 months and 3 years screened for refractive errors and strabismus. In 363 children (10.7%) some kind of pathology was detected. We suggest that continued efforts should be made to lower the age of detection of defects in vision.

Intraocular pressure response to corticosteroids in children

A total of 44 children who suffered from vernal conjunctivitis were treated with topical dexamethasone 0.1% 4 times daily for 6 weeks and tested for their intraocular pressure. There was a statistically significant difference (P less than 0.01) between the responders in our group of children and a group of normal adults reported on by Armaly in 1965.

Congenital hereditary corneal dystrophy associated with esotropia

A family is described in which four of six siblings have congenital hereditary corneal dystrophy associated with esotropia. All cases had been erroneously diagnosed as and operated on for congenital glaucoma. The hereditary aspect of this association is discussed.

Pterygium and basic tear secretion

In order to investigate the correlation between the occurrence of pterygium and dryness of the eyes, a Schirmer's No. 1 test was done on both eyes in 60 patients with unilateral pterygia. No difference was found between the mean basic secretion of tears in the diseased eyes (15.33 +/- 8.09 mm) and the fellow eyes (15.65 +/- 7.89 mm), and both were in the normal range for this test. This data suggest that dryness of the eyes cannot be regarded as the cause of pterygium.

Giant papillary conjunctivitis and ptosis in a contact lens wearer

A case of ptosis due to giant papillary conjunctivitis in a 24-year-old female is described. The contact lens was removed and the ptosis disappeared. A possible etiology is discussed.

Optociliary veins, visual loss, and disc pallor in a child with a 22 year follow-up

A case of optociliary veins, disc pallor, and long-standing visual loss in an eye of a patient followed from age two to age 25 is presented. A review of the literature indicates the above triad to be usually suggestive of sphenoidal ridge meningioma. Our case, the youngest thus far reported in the literature, also developed ocular hypertension in this eye and exophthalmos. The patient has refused further diagnostic workup.

Corneal storage at room temperature

Short-term eye banking is based mainly on moist chamber and McCarey-Kaufman medium (M-K medium) preservation. Both involve a controlled 4 C temperature for storage. Warming the cornea to room temperature, however, drastically affects the endothelial viability. On enzymatic staining and histological study, the M-K medium-stored rabbit corneas had more normal endothelium than did "moist chamber" eyes when storage was prolonged for seven days at room temperature. In human corneas that were kept at 4 C for 24 hours and then exposed to a temperature of 25 C, destruction of organelles had occurred by six hours and was increased by 12 hours. Corneas that were kept in M-K medium had relatively intact endothelium after four days, but cell disruption and vacuolation was present by the seventh day. The M-K medium, therefore, affords protection to tissue warmed to room temperature, where metabolic activity is resumed.

Fluorescein pupillary flow in aphakics with intact and spontaneous openings of the vitreous face

The passage of fluorescein dye, injected into the general circulation, from the posterior to the anterior chamber was studied in 60 selected aphakic eyes between 2 days and 4 weeks after an uneventful cataract extraction. In a group of 22 eyes with intact anterior hyaloid, fluorescein was seen to pass only through the pupillary margin, mostly within 20 seconds of the beginning of the eye injection. In 24 eyes with rents in the anterior hyaloid the dye was seen percolating only through the vitreous face openings. No fluorescein passed through the pupillary margin or the peripheral iridectomy in this group of eyes. The appearance time of the dye was delayed to about twice the normal appearance time. In 8 eyes with rents in the anterior hyaloid the dye passed only through the pupillary margin. In 4 eyes with anterior vitreous rents the fluorescein appeared through the anterior vitreous face opening. From the analysis of the data it appears that the spontaneous breaks in the anterior vitreous face may represent a 'self-c,re' of pupillary and iridectomy block by the vitreous in aphakics in a high proportion of cases. It is our impression that 3 peripheral iridectomies and a very tight closure of the wound can prevent the complication of spontaneous breaks of the vitreous face.

Use of the Bausch & Lomb Soflens Plano T contact lens as a bandage

Twenty patients with corneal disease were treated with a recently released soft lens specifically designed for use as a bandage. Patients wore their lenses continuously 24 hr a day. The results were similar to those of previous studies conducted with other lens designs. Improvement was frequent (10 of 12 cases) for bullous keratopathy and corneal graft, burn, or neuroparalytic lesion; limited (1 of 4 cases) for dry-eye syndrome; and absent (4 cases) for irregular cornea and vernal keratoconjunctivitis. No difficulties were found with the concurrent use of medication.

Lymphocyte sensitivity to glucocorticoids

We evaluated the possibility of identifying patients with open-angle glaucoma based on the in vitro behavior of their lymphocytes in the presence of glucocorticoids. Our results do not support the hypothesis that lymphocytes from patients with open-angle glaucoma, as compared to those from normal subjects, are more sensitive to the presence of corticosteroids in vitro. In addition, the degree of inhibition induced by glucocorticoids was closely related to the amount of activation of the lymphocyte membrane induced by different concentrations of phytohemagglutinin. Our results indicated that this may be a general phenomenon rather than one that is specific to a particular ophthalmological condition.

Growth and transplantation of organ-cultured corneas

Calf corneal buttons were grown in medium M199 supplemented with newborn calf serum (xenogeneic to the recipient) or rabbit serum (allongeneic to the recipient) and implanted interlamellarly into rabbit recipients. Implantation of buttons, grown in medium containing calf serum were rejected sooner than noncultured buttons. The rejection was quicker as the grafts were kept longer in culture. However, corneal buttons grown in medium containing rabbit serum showed, in general, a slower rejection process.