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  • The lipid composition of platelets and the impact of storage: an overview
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2020-01-08
    Sarah M. Green; Matthew P. Padula; Denese C. Marks; Lacey Johnson

    Lipids and bioactive lipid mediators are essential for platelet function. The lipid profile of platelets is highly dynamic due to free exchange of lipids with the plasma, release of extracellular vesicles, and both enzymatic and non-enzymatic lipid conversion. The lipidome of platelets changes in response to activation to accommodate the functional requirements of platelets, particularly for maintenance of hemostasis. Further, when stored at room temperature as a component for transfusion, the lipid profile of platelets is altered. While there is a growing interest in alternate storage conditions, such as refrigeration and cryopreservation, few contemporary studies have examined the impact of these storage modes on the lipid profile. However, evidence exists that bioactive lipid mediators produced over the storage of blood products may have functional implications once these products are transfused. As such, there is a need to determine the changes occurring to the lipid profile of these products over storage. This review outlines the role of lipids in platelets and discusses the current state of lipidomics for studying platelet components for transfusion, in an effort to highlight the necessity for additional transfusion-focused investigations.

    更新日期:2020-01-23
  • Evaluating the Clinical Effect of Female Blood Donors of Child-Bearing Age on Maternal and Neonatal Outcomes: A Cohort Study
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2019-12-02
    Michaël Chassé, Alan Tinmouth, Mindy Goldman, Sheila O'Brien, Steven Hawken, Malia Murphy, Mark Walker, Ann E. Sprague, Kumanan Wilson, Carl van Walraven, Dean A. Fergusson

    Iron deficiency is a global problem in women of child bearing age and is associated with adverse maternal and newborn outcomes. Repeated blood donations deplete iron stores and decrease hemoglobin levels. However, the clinical impact of iatrogenic iron deficiency on mothers and neonates due to blood donation is uncertain. The objective of this study was to assess the association between repeated blood donations in female donors of child-bearing age and the associated risk of adverse maternal and neonatal outcomes. We undertook an observational cohort study of all females who delivered a live or stillborn infant in Ontario, Canada between 1 January 2010 and 31 March 2012 using birth record data from the Better Outcomes Registry & Network, Canadian Blood Services and the Institute of Clinical Evaluative Sciences. Only a woman's first pregnancy within the study time frame was included for analysis. We excluded women <18 years or> 50 years of age at the time of delivery and multiple birth pregnancies. Data on all female donors who made whole blood donations between 1 January 2007 and 31 March 2012 were obtained from Canadian Blood Services. The primary newborn outcome was diagnosis of a small for gestational age neonate (less than 10th centile). Secondary outcomes were preterm birth, stillbirth, APGAR <4 at 5 minutes, cord pH <7, neonatal death, maternal transfusion, infection, pre-eclampsia, gestational hypertension, gestational diabetes, placental abruption and maternal death. Regression models evaluated the effect of repeated donation and the time interval between donations and conception on neonatal and maternal outcomes while adjusting for important clinical and demographic risk factors. A total of 260 037 women delivered live or stillborn singleton infants between 1 January 2010 and 31 March 2012. A total of 7919 (3.0%) women were blood donors, with a mean of 2.43 ± 2.10 lifetime donations. Mean maternal age at the time of delivery for non-donors and donors was 30.30 ± 5.38 yrs. and 29.74 ± 4.94 yrs., respectively. Small for gestational age occurred in 23 706 (9.4%) of neonates born to non-donors, and 526 (6.6%) born to donors. There was a reduction in the risk of small for gestational age with increasing number of lifetime donations (adjusted OR 0.89 [0.86, 0.92] per additional donation). For the prespecified secondary outcomes, we observed a reduction in the risk of low birthweight (adjusted OR 0.95 [0.91, 0.98] per additional donation). There was no association with other secondary neonatal or maternal outcomes except for maternal hypertension. Proximity of donation to conception had no effect on risk of a small-for-gestational age neonate. Our data suggest that there is no increased risk of deleterious neonatal and maternal outcomes associated with repeated blood donations prior to pregnancy. Although possibly a result of a healthy donor effect, our findings are reassuring to female donors and their children as well as to clinicians and blood system stakeholders seeking to inform policy decisions.

    更新日期:2019-12-02
  • Hepatitis E Virus Infection in Blood Donors and Risk to Patients in the United States and Canada
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2019-06-20
    Gilles Delage, Margaret Fearon, Yves Gregoire, Boris M Hogema, Brian Custer, Vito Scalia, Gordon Hawes, France Bernier, Megan L Nguyen, Susan L Stramer

    Hepatitis E virus (HEV) is the most common cause of acute hepatitis worldwide including large water-borne outbreaks, zoonotic infections and transfusion transmissions. Several countries have initiated or are considering blood donor screening in response to high HEV-RNA donation prevalence leading to transfusion-transmission risk. Because HEV transmission is more common through food sources, the efficacy of blood donor screening alone may be limited. HEV-nucleic acids in 101 489 blood donations in the United States and Canada were studied. A risk-based decision-making framework was used to evaluate the quantitative risks and cost–benefit of HEV-blood donation screening in Canada comparing three scenarios: no screening, screening blood for all transfused patients or screening blood for only those at greatest risk. HEV-RNA prevalence in the United States was one per 16 908 (95% confidence interval [CI], 1:5786–1:81987), whereas Canadian HEV-RNA prevalence was one per 4615 (95% CI, 1:2579–1:9244). Although 4-fold greater, Canadian HEV-RNA prevalence was not significantly higher than in the United States. Viral loads ranged from 20 to 3080 international units per mL; all successfully typed infections were genotype 3. No HEV-RNA false-positive donations were identified for 100 percent specificity. Without donation screening, heart and lung transplant recipients had the greatest HEV-infection risk (1:366962) versus kidney transplant recipients with the lowest (1:2.8 million) at costs of $225 546 to $561 810 per quality-adjusted life-year (QALY) gained for partial or universal screening, respectively. Higher cost per QALY would be expected in the United States. Thus, HEV prevalence in North America is lower than in countries performing blood donation screening, and if implemented, is projected to be costly under any scenario.

    更新日期:2019-11-18
  • Transfusion-Transmitted Hepatitis E Virus Infection in France
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2019-06-20
    Pierre Gallian, Elodie Pouchol, Rachid Djoudi, Sébastien Lhomme, Lina Mouna, Sylvie Gross, Philippe Bierling, Azzedine Assal, Nassim Kamar, Vincent Mallet, Anne-Marie Roque-Afonso, Jacques Izopet, Pierre Tiberghien

    There is growing concern regarding the risk of transfusion- transmitted (TT) hepatitis E. Since the first described case in 2006, several TT hepatitis E have been reported to the French hemovigilance network. We performed a retrospective analysis of all cases of TT hepatitis E reported between 2006 and 2016. Transfusion-transmitted hepatitis E with high imputability according to phylogenetic analysis occurred in 23 patients aged 8 to 88 years and involved mostly solid organ recipients (n = 9) or patients with malignant hematological diseases (n = 9, including 4 hematopoietic allograft recipients). Involved blood products were plasma (n = 7), among which 6 had undergone pathogen reduction with solvent/detergent (n = 4) or amotosalen + ultra-violet A (UVA) (n = 2 from 1 donation) treatments, red blood concentrates (n = 7), apheresis platelets concentrates (n = 3) and whole blood pooled platelets concentrates (n = 6), among which one had underwent amotosalen + UVA treatment. Median hepatitis E virus (HEV) RNA dose infused was 5.79 [4.36–10.10] log IU. HEV infection progressed to chronic hepatitis E in 14 (61%) immunocompromised patients, 2 of whom had advanced liver fibrosis at diagnosis. Chronic hepatitis E patients cleared HEV with ribavirin treatment (n = 10), after immunosuppressive drug reduction (n = 3), or spontaneously (n = 1). One additional organ transplant recipient with associated co-morbidities died with ongoing HEV infection and multiple organ failure. The other 8 (34.8%) patients with TT hepatitis E cleared HEV within 6 months with ribavirin treatment (n = 3), reduced immunosuppression (n = 1) or spontaneously (n = 4). Red cells, platelets, and plasma transfusions may be associated with TT hepatitis E that can evolve to chronic hepatitis E in immunocompromised patients. Hepatitis E virus has emerged in France as a clinically significant TT infection risk.

    更新日期:2019-11-18
  • Red Blood Cell Alloimmunization in Transfused Patients With Sickle Cell Disease in Sub-Saharan Africa; a Systematic Review and Meta-Analysis
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2019-06-20
    Lilian Antwi Boateng, Alain Mayindu Ngoma, Imelda Bates, Henk Schonewille

    Sickle cell disease (SCD) is the most common monogenic disorder in sub-Saharan Africa (SSA). Blood transfusion to increase the oxygen carrying capacity of blood is vital in the management of many patients with SCD. However, red blood cell (RBC) alloimmunization is a major challenge to transfusions in these patients. Commonly in SSA, pretransfusion tests only involve ABO D grouping and compatibility without RBC antibody testing. Data on the frequency of RBC alloimmunization in patients with SCD in SSA are limited. We performed a systematic review and meta-analysis on available data on alloimmunization in transfused patients with SCD to determine the published prevalence of RBC alloimmunization in SCD patients in SSA. Six databases were systematically searched to identify relevant studies, without year or language restrictions. In all, 249 articles were identified and 15 met our selection criteria. The overall proportion of alloimmunization was 7.4 (95% confidence interval: 5.1-10.0) per 100 transfused patients. Antibodies against E, D, C, and K antigens accounted for almost half of antibody specificities, and antibodies to low- and high-frequency antigens were also common and represented almost 30% (20% to low-frequency antigens and 9% to high-frequency antigens) of specificities. Heterogeneity between studies was moderate, and meta-analysis found region of Africa as the major contributor to the heterogeneity. We also observed inconsistencies across studies in reporting of factors that may influence alloimmunization. This review provides an overview of the extent of the alloimmunization problem in SSA and provides a baseline against which to compare the effect of any interventions to reduce the alloimmunization risk.

    更新日期:2019-11-18
  • Impacts of Aging on Anemia Tolerance, Transfusion Thresholds, and Patient Blood Management
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2019-04-05
    Geoff I Simon, Alison Craswell, Ogilvie Thom, Michelle S Chew, Chris M Anstey, Yoke Lin Fung

    Evidence-based patient blood management guidelines commonly recommend restrictive hemoglobin thresholds of 70 to 80 g/L for asymptomatic adults. However, most transfusion trials have enrolled adults across a broad age span, with few exclusive to older adults. Our recent meta-analysis of transfusion trials that focused on older adults paradoxically found lower mortality and fewer cardiac complications when these patients were managed using higher hemoglobin thresholds. We postulate that declining cardiac output with age contributes to deteriorating oxygen delivery capacity which impacts anemia-associated outcomes in older adults and propose a model to explain this age-related difference. We reviewed evidence concerning the pathophysiology of aging to explore the disparity in transfusion trial outcomes related to hemoglobin thresholds in different age groups. The literature was searched for normative cardiac output values at different ages in healthy adults. Using normative peak cardiac output data, we modeled oxygen delivery capacity in young, middle-aged, and older adults at a range of hemoglobin levels. Cardiovascular and pulmonary systems are impacted by age-related pathophysiological changes. Diminishing peak cardiac output associated with aging reduces the maximal oxygen delivery achievable under metabolic stress. Hence, at low hemoglobin levels, older adults are more susceptible to tissue hypoxia than younger adults. Our model predicts that an older adult with a hemoglobin of 100 g/L has a similar peak oxygen delivery capacity to a young adult with a hemoglobin of 70 g/L. Age-related pathophysiological changes provide some explanation as to why older adults have a lower tolerance for anemia than younger adults. This indicates the need for patient blood management hemoglobin thresholds specific to older as distinct from younger adults. The primary application of this model is in the consideration of patients rehabilitating to life outside hospital. It is important to note that pathophysiological changes associated with critical illness and major surgery are more complex than can be described in a simple model based on cardiac output and hemoglobin concentration. However, our review of oxygen transport and delivery in health and disease states allows the model to be considered in the context of treatment decisions for anemic adults in a range of hospital and community settings.

    更新日期:2019-11-18
  • Myocardial Iron Overload in Sickle Cell Disease: A Rare But Potentially Fatal Complication of Transfusion
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2019-05-02
    Alvaro Henrique Junqueira Tavares, Bruno Deltreggia Benites, Kleber Yotsumoto Fertrin

    Sickle cell disease (SCD) is a frequent indication for chronic transfusion, which can cause iron overload. Excess iron often affects the liver, but not the heart in SCD. Magnetic resonance (MR) is recommended to detect myocardial iron overload (MIO) but its elevated cost requires optimized indication. We aimed to compile all published data on MIO in SCD upon the description of a fatal case of severe MIO in our institution, and to determine associated risk factors. We performed a systematic review using the PRISMA guidelines in two databases (PubMed and Web of Science). Inclusion criteria were publication in English, patients diagnosed with SCD, and reporting ferritin and MIO by MR. Twenty publications reported on 865 SCD adult and pediatric patients, with at least 10 other cases of MIO. The prevalence of MIO in chronically transfused SCD patients can be estimated to be 3% or less, and is associated with high transfusion burden, top-up transfusions, and low adherence to iron chelation. Cardiac siderosis in SCD is rarely reported, and increased awareness with better use of the available screening tools are necessary. Prospective studies should define the recommended chelation regimens depending on the severity of MIO.

    更新日期:2019-11-18
  • Segmenting Active Blood Donors According to Their Barriers to Develop Retention Programs
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2019-06-20
    Laura Romero-Domínguez, Josefa D. Martín-Santana, Asunción Beerli-Palacio

    Given the lack of a consensus on a catalogue of donation barriers, this study proposes a holistic scale of barriers which was used to segment Spanish active blood donors to define specific retention and loyalty strategies. A sample of 26 626 active donors from 14 of the 17 Spanish blood transfusion centers assessed a total of 25 barriers through an online survey. This scale was validated and 4 barrier categories were defined: Informative, Intrinsic, Time-space and Procedural. Segmentation was performed through k-means clustering. Four active donor clusters were created: (1) “Very Inhibited” (13.2%), who experienced a high number of barriers in all categories; (2) “Uninhibited” (46.9%), which was the largest cluster with fewer barriers; (3) “Apprehensive” (16.9%), whose most prevalent barriers were Informative and Intrinsic in nature; and (4) “Busy” (23.0%), who experienced mainly Time-space and Informative barriers. Afterward, depending on the size of the cluster, the presence of barriers, and the greater ease or difficulty to act on them, the attractiveness of each cluster was established to propose specific marketing actions.

    更新日期:2019-11-18
  • Anemic Disease of the Newborn With Little Increase in Hemolysis and Erythropoiesis Due to Maternal Anti-Jra: A Case Study and Review of the Literature
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2019-04-26
    Shinji Katsuragi, Hitoshi Ohto, Atsushi Yoshida, Akiko Otake, Hatsue Tsuneyama, Kenichi Ogasawara, Kazumi Isa, Tomoaki Ikeda

    The severity of the hemolytic disease of the fetus and newborn (HDFN) due to Jra mismatch ranges from no symptoms to severe anemia that requires intrauterine and exchange transfusions. We encountered a newborn, born to a healthy mother having anti-Jra at 38 weeks of pregnancy, who had moderate anemia, a positive direct antiglobulin test (DAT) result, no increased erythropoiesis, and no jaundice at birth. Flow cytometry revealed that the Jra antigen of red cells in the infant was nearly negative at birth, biphasic at 5 weeks, and lowly expressed at 7 months of life. We searched online for previous case reports on HDFN due to Jra incompatibility. Among 63 reported cases, excluding 25 cases, 38 were included with the present case for analysis. Of 39 newborns, 10 developed clear anemia (hemoglobin <10.0 g/dL), and 1 died, 5 developed hydrops fetalis, 4 needed intrauterine transfusion and/or exchange transfusion, and 3 received red cell transfusion after birth; overlaps were included. Among 29 neonates with no anemia, 8 needed interventions including phototherapy and γ-globulin infusion, and the remaining 21 received conservative supports only. The maternal anti-Jra titer, ranging between 4 and 2048, did not correlate with the severity of anemia, levels of bilirubin, or any interventions required. The DAT of red cells was positive in 29 of 36 fetuses/newborns tested, whereas it was often negative among anemic neonates (4 of 9) (P < .05). Hematopoiesis did not increase effectively, as indicated by reticulocyte ratios between 1.7% and 22.3%, even with the increase in reticulocytes in anemic neonates compared with nonanemic neonates (P < .05). Total bilirubin levels ranged broadly between 0.2 and 14.3 mg/dL but were generally low. The maternal anti-Jra titer and IgG3 subclass did not correlate with the morbidity of the newborns. Being identical/compatible between mothers and their infants may possibly enhance infants' morbidity, as a weak tendency was observed (P = .053). Maternal anti-Jra may suppress erythropoiesis in fetuses via a mechanism different from the established HDFN, such as anti-D, as evidenced by the lower reticulocyte count and small increase in bilirubin in neonates. As the anti-Jra titer, IgG subclass, and DAT were not correlated with the severity, the mechanism of anti-Jra–induced HDFN remains to be elucidated.

    更新日期:2019-11-18
  • Transfusion Medicine Equations Made Internet Accessible
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2019-11-16
    Ronald George Hauser, Rachel J. Kwon, Alex Ryder, Caleb Cheng, Ahmad Charifa, Christopher Tormey

    Multiple mathematical equations inform the practice of transfusion medicine. These equations apply to a wide range of topics: dosage of blood products, calculation of fluid volumes, and even specific treatment decisions (e.g. corrected count increment for determination of platelet refractoriness). The calculation of these equations can be complicated, prone to error, and time-consuming. A trusted source is needed to accurately perform these calculations 24 hours a day without error and without monetary cost. We sought to build internet-enabled calculators relevant to the practice of transfusion medicine. We partnered with MDCalc, an online host of medical calculators with one million monthly users in 196 countries, to design and host the calculators. The calculators guide users in the application of transfusion medicine equations by providing indications for use, inputs for the equations variables, error-checking, warnings for bad inputs, and interpretive guidance of the result. The following calculators were built: blood volume, corrected count increment (CCI), plasma dosage, cryoprecipitated antihemophilic factor dosage, approximate number of units for compatibility testing, maternal-fetal hemorrhage Rh(D) immune globulin dosage, intrauterine RBC transfusion dosage, neonatal polycythemia partial exchange, theoretical removal of a substance by plasmapheresis, sickle cell RBC exchange volume, peripheral blood stem cell collection, and a calculator relevant to donor lymphocyte infusion. Clinicians can now utilize this reputable and highly visible online source to access these common transfusion medicine equations at any time with an internet-enabled device (https://www.mdcalc.com/search?filter=transfusion+medicine).

    更新日期:2019-11-18
  • The Potential Impact of Chikungunya Virus Outbreaks on Blood Transfusion
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2019-06-20
    Hatsadee Appassakij, Khachornsakdi Silpapojakul, Charuporn Promwong, Pairaya Rujirojindakul

    Chikungunya virus (CHIKV) is responsible for large periodic epidemics in both endemic and nonendemic areas where competent mosquitoes are present. Transmission of CHIKV by transfusion during explosive outbreaks has never been documented, and the true impact of CHIKV infection on blood transfusion during an outbreak is unknown. Considerations include not only transfusions in the active outbreak areas but also returning travelers to nonendemic areas. Because there are no documented cases of transfusion-transmitted CHIKV, there are no standard guidelines regarding transfusion policies during a chikungunya fever outbreak. We review current information from studies during outbreaks with the goal of estimating the potential effect of different blood safety interventions (eg, querying donors for possible CHIKV exposure, chikungunya fever–related symptoms, screening for CHIKV RNA).

    更新日期:2019-11-18
  • Selection of Blood, Blood Components and Blood Products as Essential Medicines in 105 Low and Middle Income Countries
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2019-11-09
    Washington T. Samukange, Helga Gardarsdottir, Hubert G.M. Leufkens, Aukje K. Mantel-Teeuwise

    Blood products of human origin are essential treatment options for several diseases, for example, hemophilia. We studied the alignment of national essential medicines lists (NEMLs) of low and middle-income countries (LMICs) with the WHO Model list for the selection of blood products of human origin. The most recent versions of NEMLs from all LMICs were studied for the inclusion of blood products of human origin (blood and blood components, plasma products, and immunoglobulins). Data obtained from 105 NEMLs were compared to the 2017 WHO Model list. The median number of blood products of human origin on the NEMLs was four (range: 0–10). Immunoglobulins were most frequently included (73%). Blood and blood components were the least selected products (15%). The uptake of plasma products was around 50%. Nine countries did not have any blood products of human origin on their NEMLs. Some NEMLs included blood products not listed on the WHO Model list (Albumin, Hepatitis A Immunoglobulin, and Cryoprecipitate). We observed variation in selection according to WHO region, income level and year of NEML update. Alignment of NEMLs with the WHO Model list varied greatly for different groups of blood products ranging from good uptake for immunoglobulins, reasonable uptake for plasma products to poor uptake for blood and blood components. This heterogeneity in selection and inclusion of blood products of human origin on NEMLs may be partly explained as being due to specific country characteristics, but some of it may not be explained. Policy makers need to rely on evidence in making decisions about which blood products to select, include and remove on their NEMLs.

    更新日期:2019-11-11
  • Donor Deferral Due to Low Hemoglobin – An Updated Systematic Review
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2019-10-31
    Andrew Browne, Sheila A. Fisher, Katya Masconi, Graham Smith, Carolyn Doree, Ryan Chung, Mana Rahimzadeh, Akshay Shah, Silvia Alonso Rodriguez, Thomas Bolton, Stephen Kaptoge, Angela Wood, Michael Sweeting, David J. Roberts

    Blood donors attending a donation session may be deferred from donating blood due to a failure to meet low hemoglobin (Hb) thresholds. This costs the blood donor service, and donors, valuable time and resources. In addition, donors who are deferred may have more symptoms and as a direct and/or indirect effect of their experience return rates of donors deferred for low Hb are reduced, even in repeat donors. It is therefore vital that low Hb deferral (LHD) is minimized. The aim of this updated systematic review is to expand the evidence base for factors which affect a donor's risk of deferral due to low Hb. Studies were identified by searching MEDLINE, Embase, The Cochrane Library and the WHO International Clinical Trials Registry to March 2019. Demographic data, donor history, hematological/biological factors and the primary outcome of deferral due to low Hb were extracted. Our primary outcome was deferral due to low Hb. Analyses were descriptive and quantitative; pooled odds ratios (ORs) and 95% confidence intervals (CIs) were obtained by meta-analysis using random effects models. A total of 116 studies met the inclusion criteria. Meta-analysis showed a significantly greater risk of LHD in females compared with males in studies applying universal Hb thresholds for males and females (OR 14.62 95%CI 12.43–17.19) and in those which used sex-specific thresholds (OR 5.73, 95%CI 4.36–7.53). Higher rates of LHD were also associated with increasing age in men, low body weight, shorter inter-donation interval, donors of Hispanic or African descent, higher ambient temperature, donors with low ferritin levels and donation in a fixed donor center. There was conflicting evidence on the effect of new and repeat donor status, and blood group. This work has strengthened the evidence of the previous review in identifying factors that should be considered in studies of donor deferral and highlighting areas in need of further study, including ABO and Rh blood groups, previous platelet donation, diet, smoking, time of day, and genetic data. These factors may lead to individually tailored donation criteria for safe and efficient donation in the future.

    更新日期:2019-11-01
  • Emerging Research in Transfusion Medicine: What to Expect in 2020.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2019-11-25
    Sunny Dzik,Mike Murphy,

    更新日期:2019-11-01
  • Parviz Lalezari: an autobiography.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2007-05-11
    Parviz Lalezari

    Doctor Parviz Lalezari, currently a clinical professor of Medicine and Pathology at Albert Einstein College of Medicine in New York, describes highlights of his research career since 1958. He became the director of the blood bank at Montefiore Hospital in New York City in 1961, director of the Division of Immunohematology until 1996, and then until 2001, was President and chief executive officer of the Bergen Community Regional Blood Center in New Jersey. Doctor Lalezari was born in Iran in 1931, and after graduation from Medical School, he came to the United States in 1956. His initial research was on leukocyte antibodies. After modifying the available antibody detection techniques, he discovered that like hemolytic disease of the newborn and neonatal immune thrombocytopenia, fetal-maternal neutrophil incompatibility can cause neonatal neutropenia. He identified the targets of these antibodies and showed that they were expressed only on peripheral blood neutrophils. Doctor Lalezari also discovered that a common form of neutropenia in early childhood was caused by development of autoantibodies, which surprisingly were directed against the same neutrophil-specific antigens involved in fetal-maternal incompatibility. In 1959, a heparin-neutralizing drug (Polybrene) was introduced to be used after open-heart surgery. Lalezari discovered that Polybrene, a quaternary ammonium polymer, reacted with sialic acid molecules on the red blood cell (RBC) surface, causing the RBCs to aggregate. Later, realizing that the repelling forces generated by the RBC surface membrane charges were responsible for failure of the small IgG antibody molecules to agglutinate the RBCs, he used Polybrene to neutralize the RBC surface negative charge to allow the IgG antibody molecules to induce hemagglutination. This became The Polybrene test, which is to be used in RBC antibody detection.

    更新日期:2019-11-01
  • Frederic Duran-Jorda: a transfusion medicine pioneer.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2007-01-30
    Miguel Lozano,Joan Cid

    更新日期:2019-11-01
  • Sir John Dacie, MD, FRCP, FRCPath, FRS (1912-2005).
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2007-01-30
    George Garratty

    Sir John Dacie would be accepted by most of us as the father of modern hematology in the UK, and many would argue that this could be extended to other countries because so many people of other nationalities were trained in his laboratory in London. In his specialty of hemolytic anemia, he dominated the field, and his book (5 volumes) set the standard for investigators in this area. Luckily, he lived for 92 years (1912-2005) and kept a sharp mind up to his death, continuing to contribute to the medical literature into his 80s.

    更新日期:2019-11-01
  • Back to the beginnings: an autobiography.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2006-10-28
    Eloise R Giblett

    After receiving BS and MS degrees from the University of Washington in Seattle, I entered its new medical school in 1947, receiving an MD degree in 1951. After internship and residency, I obtained a 2-year postdoctoral fellowship in hematology under the guidance of Dr Clement Finch. The last 6 months of the fellowship were spent in London, England, at Dr Patrick Mollison's Blood Transfusion Research Unit. There I met and worked with Marie Cutbush (later Crookston) who has been a long-term friend. On returning to Seattle, I joined the faculty of the medical school and became the associate director of the Puget Sound Blood Center. There, I supervised the blood typing and cross-matching laboratory, introducing methods I had learned in London and measuring the effectiveness of various cross-matching procedures. My own research was largely directed toward human genetic polymorphism, and I wrote a textbook published in 1969, describing the biochemical structure, function, inheritance, and geographic distribution of the genetic markers. Subsequently, I discovered that 2 forms of inherited immunodeficiency disease were due to deficiencies of the enzymes adenosine deaminase and purine nucleoside phosphorylase. In 1979, I became the director of the blood center and was shortly afterwards elected to the National Academy of Sciences. I retired in 1987 and have spent most of the intervening years relearning to play the violin and exploring the wonders of chamber music.

    更新日期:2019-11-01
  • Blood transfusionist extraordinaire: Marie Cutbush Crookston.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2006-10-28
    Kathy Burnie

    After receiving her BSc from the University of Melbourne, Australia, Marie set sail for England to pursue a career. In London, she worked with Dr P.L. Mollison for 10 years, and together they published many articles in the areas of hemolytic disease of the newborn, red cell survival, red cell preservation, and the identification of new antibodies. In 1957, she married Dr John Crookston and moved to Toronto. In Toronto, she directed and participated in various research projects while acting as a consultant to the Blood Transfusion Laboratory at Toronto General Hospital. Her enthusiasm for the field of Transfusion Medicine, her keen eye, and intellect resulted in many discoveries, both on her own or in collaboration with others. Marie is now retired but is fondly remembered by Blood Transfusionists in Canada and elsewhere.

    更新日期:2019-11-01
  • Joseph R. Bove, MD: Autobiography.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2006-04-22
    Joseph R Bove

    更新日期:2019-11-01
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  • A brief history of the early years of blood transfusion at the Mayo Clinic: the first blood bank in the United States (1935).
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2005-07-13
    S Breanndan Moore

    At the Mayo Clinic in 1914, Francis McGrath modified an existing aspiration-injection apparatus and adapted it for arm-to-arm blood transfusions. Separately, in 1919, both Pemberton and Sanford described in detail the Mayo Clinic experience with more than 1000 transfusions between January 1915 and January 1918. Most transfusions were by the indirect citrate method from freshly drawn blood. In 1935, John Lundy established a bank of refrigerated blood for transfusions at Mayo Clinic and reported on the activity in that and subsequent years. The functioning clinical blood bank established by Lundy at Mayo Clinic predated that of Bernard Fantus in Chicago by almost 2 years.

    更新日期:2019-11-01
  • The current status and potential role of laboratory testing to prevent transfusion-transmitted malaria.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2005-07-13
    Clive R Seed,Alan Kitchen,Timothy M E Davis

    Malaria remains a rare but serious complication of transfusion because of the asymptomatic persistence of parasites in some donors. In nonendemic countries, the predominant strategy of deferral or cellular component discard from "risk" donors is effective in minimizing the incidence but is wasteful. In endemic countries where recipients are commonly immune, transfusion strategies focus on chemoprophylaxis for the donor and recipient or ensure that blood collected in highly endemic regions is not transfused to patients from areas of low endemicity. Donors implicated in transfusion-transmitted malaria are predominantly "semi-immune" with very low parasite loads. Their detection by even the most sensitive antigen or polymerase chain reaction (PCR) assays cannot be guaranteed and, in a number of cases, is unlikely because the infectious dose is estimated to be 1 to 10 parasites in a unit of blood. Retrospective analysis of implicated donors has confirmed the presence of high titer antibodies in such individuals. In regions of low immunity, serological assays offer an efficient method to identify such infectious donors. The recent development of enzyme immunoassays (EIAs) with improved sensitivity to Plasmodium falciparum and Plasmodium vivax , the predominant transfusion threats, has heightened the appeal of serological testing. Although universal serological screening in nonendemic regions is not cost-effective, targeted screening of donors identified at risk by travel-based questioning can significantly reduce wastage through reinstatement. Importantly, transfusion safety does not appear to be compromised by this approach as evidenced by the lack of a documented transmission in France between 1983 and September 2002, where such a strategy has been used since 1976. The development of automated protein microarray-based technology has the potential to further enhance antibody/antigen sensitivity; however, its application to donor screening is likely to be some years off. There is also the potential that pathogen inactivation techniques currently under development to address the bacterial contamination of blood components may also be effective against malaria parasites to make malarial testing redundant or at least reduce its cost/benefit ratio. Nonetheless, there are still significant problems to be solved in respect of validating and licensing these systems. Assuming that they are successfully marketed, their high cost may also impact their cost-effectiveness in comparison with targeted malaria testing strategies already in place in some jurisdictions.

    更新日期:2019-11-01
  • The Minnesota Molecular and Cellular Therapeutics Facility: a state-of-the-art biotherapeutics engineering laboratory.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2005-07-13
    David H McKenna,Diane M Kadidlo,Jeffrey S Miller,Paul J Orchard,John E Wagner,Jeffrey McCullough

    Molecular-, gene-, cellular-, and tissue-based therapies have become increasingly acceptable modes of clinical therapy. Regulatory requirements and oversight have increased, and the need for facilities suited for production of such therapies has become more apparent. The Minnesota Molecular and Cellular Therapeutics Facility is a state-of-the-art laboratory at the University of Minnesota, Saint Paul, Minn, that was designed to support production of biologic products for use in clinical trials. A talented staff experienced in the medical, scientific, technical, and regulatory aspects of the development, production, and administration of such products complements the special design and construction of the facility. Hematopoietic stem cells (HSCs) are manipulated for transplant, and current clinical trials involving novel therapies include the use of allogeneic natural killer (NK) cells and tumor vaccines for the treatment of various malignancies and suicide gene-transduced T cells for the prevention of graft-vs-host disease (GVHD) after bone marrow transplantation. Other therapies, including marrow-derived multipotent adult progenitor cells (MAPCs), umbilical cord blood (UCB) stem cells, regulatory T cells, skeletal myoblasts, and monoclonal antibodies, will be used to treat a spectrum of disease and are in various phases of development. Here we provide an overview of the Minnesota Molecular and Cellular Therapeutics (MMCT) Facility, detailing our approach to the manufacture of novel therapeutics and highlighting current and future activities.

    更新日期:2019-11-01
  • The importance of disordered loops in ABO glycosyltransferases.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2005-07-13
    Mark H Yazer,Monica M Palcic

    The human ABO antigens are carbohydrates that differ from each other by the immunodominant sugar. The O phenotype is characterized by the absence of the A- or B-defining carbohydrate. The glycosyltransferases that create the A and B antigens share a considerable amino acid sequence and a structural homology and feature 2 series of amino acids whose exact location within the enzymes' structure cannot be determined. One series is 16 amino acids in length and probably lies next to the catalytic center, whereas less is known about the other 10-amino acid disordered loop located at the C-terminus of the protein. These "disordered" segments of amino acids can be found in other glycosyltransferases from disparate species. The precise role of these amino acids is unclear although recent evidence suggests that they are involved in substrate binding and turnover. A more complete understanding of its function will provide fundamental insights into the activity of glycosyltransferases and a potential target for novel therapeutics in the case of pathogens. In this review, we describe the nature of various disordered regions in glycosyltransferase structures from bacteria to human beings.

    更新日期:2019-11-01
  • What a difference 2 nucleotides make: a short review of ABO genetics.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2005-07-13
    Mark H Yazer

    ABO is the most important blood group system for transfusion and solid organ transplantation, but it is only over the past 15 years that the techniques for studying its molecular basis became mainstream. Many of its common and rare alleles are now well characterized and by using various expression systems, their effects on the resulting glycosyltransferases are being appreciated. As progress has been made in genetics and glycobiology, so too do reagents used to routinely type red blood cells in the clinical laboratory evolve. Monoclonal reagents are now widely used. This has created difficulties in nomenclature to describe subtype phenotypes as the names of some of these uncommon phenotypes were based on the red blood cell agglutination pattern using polyclonal reagents. In this brief review a discussion of the wild-type ABO allele and the enzymes it encodes is followed by a description of a selection of unusual and fascinating alleles-some that encode enzymes that create both A and B antigens and others that result from hybridization events. A short section on the techniques of ABO allele investigation describes some of the current methodologies used in both research and clinical laboratories.

    更新日期:2019-11-01
  • Is white blood cell reduction equivalent to antibody screening in preventing transmission of cytomegalovirus by transfusion? A review of the literature and meta-analysis.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2005-07-13
    Eleftherios C Vamvakas

    The question whether the use of cytomegalovirus (CMV)-seronegative versus white blood cell (WBC)-reduced blood components is equally efficacious in preventing transfusion-acquired CMV infection remains unresolved. A total of 829 recipients of CMV-seronegative components were followed in 11 studies, and a total of 878 recipients of WBC-reduced components were followed in 12 studies. Twelve (1.45%) of 829 recipients of CMV-seronegative components and 24 (2.73%) of 878 recipients of WBC-reduced components developed CMV infection in these studies. Among bone marrow transplant (BMT) recipients, the risk of CMV infection was, respectively, 1.63% (11/674) and 3.01% (21/697). Four of 7 controlled studies of CMV-seronegative components and 1 of 3 controlled studies of WBC-reduced components indicated benefit from these special components compared with CMV-unscreened/non-WBC-reduced components. One of 3 controlled studies indicated benefit from CMV-seronegative components, as compared with WBC-reduced components. Across a subset of studies whose results were integrated in a meta-analysis, CMV-seronegative or WBC-reduced components were virtually equivalent to each other when they were compared with CMV-unscreened/non-WBC-reduced components. CMV-seronegative components were associated with a 93.1% reduction in the risk of CMV infection; WBC-reduced components were associated with a 92.3% reduction in risk (summary odds ratio [OR] = 0.069; 95% confidence interval [CI], 0.037-0.128; P < .05; and summary OR = 0.077; 95% CI, 0.031-0.190; P < .05, respectively). However, across 3 studies that compared CMV-seronegative and WBC-reduced components to each other, CMV-seronegative components were associated with a 58% reduction in risk (summary OR = 0.42; 95% CI, 0.22-0.79; P < .05). Thus, a meta-analysis of the available controlled studies indicates that CMV-seronegative blood components are more efficacious than WBC-reduced blood components in preventing transfusion-acquired CMV infection.

    更新日期:2019-11-01
  • Out of the box: an autobiography.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2005-04-27
    Harold T Meryman

    更新日期:2019-11-01
  • The influence of various hematology analyzers on component platelet counts.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2005-04-27
    Gary Moroff,Samuel O Sowemimo-Coker,Stephen Finch,Scott Murphy,Harvey Brandwein,John Whitbread,Barry Wenz

    Hematology analyzers designed to count platelets in samples of whole blood are used to enumerate the total number of platelets in components prepared for transfusion. This report addresses the issue of variability in platelet counts obtained with different models of hematology analyzers. The influence of a common calibration procedure, involving one level of porcine platelets, on the extent of variability was also evaluated. Identical sets of samples of simulated and apheresis-derived human platelets were counted by multiple laboratories in 3 separate studies. In the first 2 exercises, 7 samples of both porcine platelets and modified goat erythrocytes with targeted platelets counts from 0.2 to 4.0 x 10(12)/L were counted without prior dilution. In both exercises, the samples were counted multiple times after routine calibration using instructions provided by the manufacturers of the various hematology analyzers used. In the second exercise, the samples were recounted after the hematology analyzers were recalibrated with a common calibrant consisting of porcine platelets at a targeted concentration of 0.5 x 10(12)/L. In the first and second exercises, 20 and 18 hematology analyzers were used, respectively. In the third exercise, 6 samples prepared from a single unit of apheresis platelets with targeted counts from 0.2 to 1.64 x 10(12)/L were shipped by an overnight courier and counted in triplicate on the day of arrival. Eleven hematology analyzers were used. The influence of recalibration was evaluated statistically by using the 95% prediction interval for the mean of a future set of observations. The platelet counts measured with a specific type of hematology analyzer provided the data to calculate the 95% prediction interval. With routine calibration, a wide variability in platelet counts was observed with all levels of both simulated and apheresis-derived human platelets. For example, with porcine platelets at a targeted level of 0.4 x 10 (12)/L, the platelet counts ranged from 0.31 to 0.47 x 10(12)/L. Recalibration reduced the extent of variability observed with all levels of simulated and apheresis-derived human platelets by increasing the observed platelet counts determined with a subset of hematology analyzers that produced platelet counts in the lower portion of the range. With recalibration, the mean platelet counts obtained with most hematology analyzers, especially with samples having targeted platelet levels no greater than 1.0 x 10(12)/L, were within or near the 95% prediction interval determined with the instruments that provided the highest platelet counts with routine calibration. With recalibration, the reproducibility of the platelet counts was considered to be good for all hematology analyzers with all levels of simulated and apheresis-derived human platelets for most of the instruments. The coefficient of variance did not exceed 6%, with most of the values ranging from 1% to 3%. This study therefore found that the platelet counts of platelet concentrates can be markedly influenced by the type of hematology analyzer used. A common calibration procedure designed specifically for the range of platelet counts in platelet products may be beneficial considering that many different hematology analyzers are being used to count platelets.

    更新日期:2019-11-01
  • Coagulation disorders and blood product use in patients undergoing thoracoabdominal aortic aneurysm repair.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2005-04-27
    Claudio S Cinà,Catherine M Clase

    Repair of thoracoabdominal aortic aneurysms (TAAA) is associated with major blood loss, often exceeding the patient's intravascular volume, and complex intraoperative and postoperative coagulopathies necessitating large-volume transfusion of blood products. Abnormalities sufficient to cause thrombocytopenia or clinically important prolongation of clotting parameters are rarely present before surgery in elective aneurysms but are more common with ruptured aneurysms. The finding of intraoperative and postoperative deficiencies of clotting factors, along with thrombin generation and activation of the thrombolytic system, is reflective of massive blood losses, visceral ischemia, and massive transfusions. An aggressive strategy of transfusion of blood products is critical to the prevention of clinically significant coagulopathy during surgery. Adjuncts to reduce blood losses and blood product use include low-dose aprotinin or epsilon -aminocaproic acid, intraoperative blood salvaging, and acute normovolemic hemodilution. In TAAA repair, an average blood loss of 5000 to 6000 mL and average transfusion of allogeneic blood products of 50 to 60 U are to be anticipated.

    更新日期:2019-11-01
  • Biopreservation of red blood cells: past, present, and future.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2005-04-27
    Kirby L Scott,Jelena Lecak,Jason P Acker

    Preservation and long-term storage of red blood cells (RBCs) is needed to ensure a readily available, safe blood supply for transfusion medicine. Effective preservation procedures are required at various steps in the production of a RBC product including testing, inventory, quality control, and product distribution. Biopreservation is the process of maintaining the integrity and functionality of cells held outside the native environment for extended storage times. The biopreservation of RBCs for clinical use can be categorized based on the techniques used to achieve biologic stability and ensure a viable state after long-term storage. This paper will review the history, science, current practices, and emerging technologies of current RBC biopreservation approaches: hypothermic storage, cryopreservation, and lyophilization.

    更新日期:2019-11-01
  • Protecting the blood supply from emerging pathogens: the role of pathogen inactivation.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2005-04-27
    Jean Pierre Allain,Celso Bianco,Morris A Blajchman,Mark E Brecher,Michael Busch,David Leiby,Lily Lin,Susan Stramer

    Although the risk of infection by blood transfusion is relatively low, breakthrough infections still occur, Transfusion-related fatalities caused by infections continue to be reported, and blood is not tested for many potentially dangerous pathogens. The current paradigm for increasing the safety of the blood supply is the development and implementation of laboratory screening methods and restrictive donor criteria. When considering the large number of known pathogens and the fact that pathogens continue to emerge, it is clear that the utility of new tests and donor restrictions will continue to be a challenge when considering the cost of developing and implementing new screening assays, the loss of potential donors, and the risk of testing errors. Despite improving the safety of blood components, testing remains a reactive approach to blood safety. The contaminating organisms must be identified before sensitive tests can be developed. In contrast, pathogen inactivation is a proactive strategy designed to inactivate a pathogen before it enters the blood supply. Almost all pathogen inactivation technologies target nucleic acids, allowing for the inactivation of a variety of nucleic acid-containing pathogens within plasma, platelets, or red blood cells thus providing the potential to reduce transfusion-transmitted diseases. However, widespread use of a pathogen inactivation technology can only be realized when proven safe and efficacious and not cost-prohibitive.

    更新日期:2019-11-01
  • Physiology, pharmacology, and rationale for colloid administration for the maintenance of effective hemodynamic stability in critically ill patients.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2005-04-27
    Andre Vercueil,Michael P W Grocott,Michael G Mythen

    The semisynthetic colloid solutions (gelatins, dextrans, and hydroxyethyl starches) are complex drugs. Their principal role in the care of the critically ill is as plasma volume expanders, but they may also affect hemorrheology, hemostasis, and inflammatory processes. The pattern of beneficial and detrimental effects varies between products. Understanding of the physiology of plasma volume expansion, as well as the nature and magnitude of these additional pharmacological qualities, is necessary for rational prescription of these commonly used products. The composition of the solute carrier solution can influence the clinical effects of colloid solutions. A large amount of data from laboratory and small clinical studies is available to inform this choice of colloid in a variety of situations. Significant patient outcome data from large studies has until recently been lacking, and clinicians have continued to prescribe a variety of crystalloids and colloids for the maintenance of effective hemodynamic stability in critically ill patients. The recently published Saline vs Albumin Fluid Evaluation Study demonstrates that albumin has an equivalent effectiveness and safety profile to 0.9% saline as a resuscitation fluid. The choice of clinical endpoints to guide dosage (infused volume) of colloids is probably therefore more important than the choice between individual products.

    更新日期:2019-11-01
  • Putting the pieces together: Roger I. Lee and modern transfusion medicine.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2005-04-15
    Lynn G Stansbury,John R Hess

    Roger Irving Lee (1881-1964) played significant scientific and leadership roles in overcoming the clinical impediments to blood transfusion in the 1910s. He developed the first successful anticoagulant system, paraffinized glass, and the first sterile system for indirect transfusion without defibrination, the Lee-Vincent flask. He used citrate as an anticoagulant before those generally credited with its discovery did. He introduced surgical antisepsis of the donor site and a practical system for maintaining typed blood for a large hospital donor and transfusion service. He was Oswald Robertson's mentor at Harvard as well as his commanding officer in the Harvard Medical Unit on the Western Front during World War I. Lee sent Robertson to perform "his preserved blood cells transfusion" in the casualty clearing stations of the British Third Army and provided Robertson's group with O donors, enabling the most important medical development of the war. Lee put the pieces of modern blood banking and transfusion together.

    更新日期:2019-11-01
  • The cost of blood: multidisciplinary consensus conference for a standard methodology.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2005-04-15

    Prior attempts to account for the cost of blood have varied in economic perspective, methodology, and scope and may have underestimated both direct and indirect costs associated with transfusions. To devise a comprehensive and standardized methodology for the United States that will improve upon existing estimates, a panel of experts in blood banking and transfusion medicine was assembled and participated in consensus deliberations using modified Delphi methods. As a first step, a process-flow model that describes all the major steps involved in collecting, processing, and transfusing blood such as donor recruitment and follow-up of transfusion sequelae was constructed. Next, interdependencies were outlined and detailed cost elements within each step were itemized. The relative importance of each element was rated. Personnel, screening for infectious agents, information systems, laboratory evaluations, management of transfusion reactions, and equipment were ranked as the most important factors to capture but, in an effort to be all-inclusive, even minor elements were included. This consensus model is broad-based and should serve societal, provider, and payer perspectives for future cost studies. Recognizing the limitations of process-flow models, the next iteration will use an activity-based approach to more fully account for the cost of blood than present estimates.

    更新日期:2019-11-01
  • Can we improve the management of blood donors with nonspecific reactivity in viral screening and confirmatory assays?
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2005-04-15
    Philip Kiely,Erica Wood

    Donors with nonspecific reactivity in viral screening or confirmatory assays are problematic for blood services because of donor management issues and product loss. Considerable experience has now accumulated in the use of screening and confirmatory assays; therefore, it is timely to examine the ways in which donors with nonspecific reactivity are managed. In this review, we summarize the causes and characteristics of nonspecific reactivity in blood donors and approaches for reducing the number of nonspecific reactive results and we offer some suggestions for improving the management of these donors.

    更新日期:2019-11-01
  • Human blood group genes 2004: chromosomal locations and cloning strategies.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2005-04-15
    Lennart Lögdberg,Marion E Reid,Ryan E Lamont,Teresa Zelinski

    Of the 29 human blood group system genes, 27 have been localized to 14 autosomes and 2 have been assigned to the X chromosome. It is remarkable that 28 of the 29 system genes have now been localized to a single cytogenetic band on a specific chromosome. In this review, we summarize the chromosomal locations and cloning strategies used for those genes encoding blood group systems. We highlight such information about the 3 most recently defined blood group systems (I, GLOB, and GIL). In addition, we provide new information about 2 older blood group systems (SC and RAPH) whose polymorphisms have been defined in cloned genes.

    更新日期:2019-11-01
  • Erythrocyte adhesion receptors: blood group antigens and related molecules.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2005-04-15
    Marilyn J Telen

    During the second half of the 20th century, blood bankers quickly expanded our knowledge of human erythrocyte blood group antigens. By the dawn of the 21st century, several hundred blood group antigen polymorphisms had been identified. Hot on the heels of the serologists, membrane biochemists and molecular geneticists defined both the biochemical and genetic bases of most of these antigens. Perhaps to their surprise, this work has led to the discovery of functionally diverse and important membrane proteins expressed on the surface of red cells, including numerous adhesion molecules. Red cells express an unexpected number of such adhesion receptors, some of which contribute to human disease, as well as to normal red cell development. And perhaps most interestingly, study of these molecules has elucidated ways in which even mature red cells respond to external stimuli, such as adrenergic hormones.

    更新日期:2019-11-01
  • Proceedings of a consensus conference: towards an understanding of TRALI.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2005-04-15
    Mindy Goldman,Kathryn E Webert,Donald M Arnold,John Freedman,Judith Hannon,Morris A Blajchman,

    Transfusion-related acute lung injury is a relatively uncommon transfusion-associated adverse effect occurring during or soon after an allogeneic blood transfusion. Transfusion-related acute lung injury is a complex syndrome that has many manifestations and has only recently been identified to be an important cause of transfusion-associated morbidity and mortality. But despite its increasing recognition, much about the pathogenesis, treatment, and prevention is poorly understood and often controversial. The purpose of this consensus conference was to bring together international experts in an effort to try to standardize a case definition, which could be used to enhance future understanding of transfusion-related acute lung injury including its epidemiology, pathogenesis, management, prevention, and research. These proceedings are being provided with a view to making available to the transfusion medicine community the considerable amount of important information presented at this consensus conference by the invited international panel of experts.

    更新日期:2019-11-01
  • Transfusion-transmitted tick-borne infections: a cornucopia of threats.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2004-10-22
    David A Leiby,Jennifer E Gill

    Over the past several decades, the frequency of contact between humans and ticks has increased dramatically. Concomitantly, several newly recognized tick-borne pathogens have emerged joining those already known to be transmitted by ticks. Together these factors have led to an enhanced public health awareness of ticks, tick-borne agents, and their associated diseases. Reports that several of these agents are transmitted by blood transfusion have raised concerns about blood safety. The primary agents of interest are members of the genus Babesia, but Anaplasma phagocytophilum, Rickettsia rickettsii, Colorado tick fever virus, and tick-borne encephalitis virus also have been transmitted by transfusion. In many cases, these agents and their diseases share common features including vectors, symptoms, and diagnosis. Unfortunately, they also share the common problem of insufficient epidemiologic and transmissibility data necessary for making informed decisions regarding potential blood safety interventions. Although further surveillance and epidemiologic studies of tick-borne agents are clearly needed, at present only the Babesia warrant consideration for active intervention; because donor management strategies based on risk-factor questions are inadequate, leukoreduction not effective for agents found in red cells and pathogen inactivation remains problematic for red cell products. Despite the present unavailability of screening assays, some form of serologic and nucleic acid testing may be justified for the Babesia. Given that interactions between humans and ticks are likely to increase in the future, vigilance is required as new and extant tick-borne agents pose potential threats to transfusion safety.

    更新日期:2019-11-01
  • Fresh blood product manufacture, issue, and use: a chain of diminishing returns?
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2004-10-22
    Trevor J Cobain

    The available pool of potential blood donors continues to decrease. There are blood component losses all along the chain of production from the recruitment of the donor, attendance and bleeding of the donor, production process, storage of the inventory in the blood center, storage in the hospital or laboratory, selection, and transfusion of the recipient. There is a requirement and potential to improve product availability by better recruitment strategies, production methods, inventory management, and recipient selection. All of these areas of transfusion medicine have been investigated, and some data and options for improving donor/donation utilization are available in the literature. There are also some developing strategies that have the potential to have a positive influence on the availability of blood components. They include the use of blood components that have often been regarded as expensive. Further studies are required to determine if products such as leukoreduced red cells and platelets, unrefrigerated or fresh whole blood, and some recombinant products can conserve large numbers of other components or reduce hospital costs.

    更新日期:2019-11-01
  • Evidence-based practice of transfusion medicine: is it possible and what do the words mean?
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2004-10-22
    Eleftherios C Vamvakas

    Evidence-based medicine (EBM) optimizes clinical decision making by dictating that clinical decisions be based on the best available research evidence and by integrating best research evidence with clinical expertise and patient values. Several rankings of the strength of the evidence generated from different types of clinical research designs have been presented, and, in addressing a particular problem, clinicians can base their decision making on the types of clinical reports that have been published, along with an assessment of the strengths and weaknesses of each study. At a policy level, the concept of EBM would dictate that policy decisions also be made based on the best available research evidence. In transfusion medicine, however, decisions are based on a broader range of inputs, and the criteria for evaluating the efficacy and/or cost-effectiveness of proposed interventions differ from those used in other areas. Reasons why policy decisions are often based on considerations other than the best research evidence include public expectations about transfusion safety and proposals for applying the precautionary principle to transfusion medicine. Using the debate over the appropriateness of introducing universal white-cell reduction as an example, this review describes 2 perspectives for assessing evidence and/or making clinical or policy decisions: the evidence-based approach and the precautionary-principle approach; and also considers whether decisions in transfusion medicine can be truly evidence based.

    更新日期:2019-11-01
  • Improving technology for collecting platelets by apheresis: five-year experience in one blood center.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2004-10-22
    Ralph R Vassallo,Fawzi Wahab,Karen Giordano,Scott Murphy

    Over the past decade, newly introduced methods for apheresis platelet collection have led to increased collection yields. This has resulted in "splitting," which allows transfusion of 2 patients from 1 high-yield collection. Although many small studies exist, no large studies have described the impact of methodological changes on routine blood center collections. We constructed a database containing selected parameters from 45,224 apheresis collections spanning July 1997 to April 2002, using Gambro BCT Spectra (Lakewood, CO), Fenwal CS-3000+ (Baxter Healthcare Corp, Fenwal Division, Deerfield, IL), and Baxter Amicus instruments. A Baker 9110+ hematology analyzer (Bio Chem Immunosystems, Inc., Allentown, PA) was used for platelet counting. Monthly average collection yields, distribution yields (product platelet contents after splitting), and split rates (the fraction of donations which may be split) were determined. The monthly mean collection yield and split rate correlated very closely. Both rose throughout the study period. The split rate climbed from 25% to 70% by study end. However, mean monthly distribution yields decreased by 7% because split and unsplit platelet yields both rose as split rates rose. Overcollections with the Amicus correlated with underestimation of donors' true preprocedure platelet counts during machine programming. Undercollections occurred in donors with low counts and, with-single needle Amicus, microcytic platelet collection. These results may assist in the optimization of an apheresis program. Increased collection yields correlated with cell separator type, dual-needle access, donor platelet count >250 x 10(9)/L, programming with true preprocedure platelet counts and capacity for triple product preparation from collection yields exceeding 2-bag storage capacity.

    更新日期:2019-11-01
  • Progress in modulating the RBC membrane to produce transfusable universal/stealth donor RBCs.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2004-10-22
    George Garratty

    Two approaches have been used to produce red blood cells (RBCs) that could be transfused, regardless of the ABO group of the donor and recipient, the so-called "universal donor" RBCs. The first approach has involved converting group A and B RBCs to group O by cleaving off the terminal immunodominant sugars; the second approach involves masking the A and B antigens with polyethylene glycol (PEG). The latter approach has also been used to mask all other blood group antigens on the RBC membrane, yielding so-called "stealth RBCs"; the hope is that such PEGylated RBCs (PEG-RBCs) will not react with any blood group antibodies and may not be recognized as foreign, thus not initiating an immune response. The former approach is well advanced. Clinical trials have shown that units of group B blood converted to group O, using a galactosidase, survived normally without any ill effects to recipients. Work is progressing on the efficient conversion of group A RBCs to group O. PEG-RBCs can be prepared that will not react with any blood group antibodies in vitro, but RBC survival in animals has not been good. Recent data show that PEG is immunogenic and can induce antibodies that shorten survival of transfused PEG-RBCs in rabbits.

    更新日期:2019-11-01
  • Improving the bacteriological safety of platelet transfusions.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2004-07-13
    Joan Cid,Miquel Lozano

    更新日期:2019-11-01
  • The structure and function of the molecules that carry human red blood cell and platelet antigens.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2004-07-13
    Gregory A Denomme

    A number of molecules on the surface of red blood cells (RBCs) and platelets express antigenic activity. Various biochemical and molecular approaches have been used to determine the structure and possible function that these molecules have for their respective cell types. The existence of variant molecules and null phenotypes and the immunological response to these antigens have aided in the analysis of the structure and function relationships of these molecules. A comparison of the sequence to moieties of known function and the presence of functional domains for many of the molecules allows for a prediction of their function. The proposed function of the molecules that express RBC and platelet antigens includes membrane structure, transporter or channel formation, receptor/ligand signaling or adhesion, enzyme activity, and glycocalyx formation. However, the function of some of these molecules is not known, and many of the variant antigens do not show an obvious functional difference. For unknown reasons, some of these molecules are exceptionally polymorphic and the elucidation of the precise role that these polymorphisms play in structure and function is hindered by limitations in the in vitro and ex vivo analyses and access to precursor cell types. The objective of this review is to define the structure and function of those molecules that express RBC and platelet antigens and the significance, if any, that polymorphisms have for these molecules.

    更新日期:2019-11-01
  • Dendritic cell-based immunotherapy for cancer and relevant challenges for transfusion medicine.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2004-07-13
    Ching Y Voss,Mark R Albertini,James S Malter

    The encouraging results from dendritic cell-related cancer immunotherapy have created tremendous interest for its broad clinical application. Dendritic cells are the most potent antigen-presenting cells. In cancer patients, dendritic cell production and function along with other antitumor immune defenses are compromised. Autologous dendritic cells enriched and sensitized in vitro with tumor-associated antigens can effectively elicit host cellular immunity against cancer and result in clinical antitumor responses through either direct injection or ex vivo generation of antitumor T lymphocytes. In small group studies, clinical response rates have reached 50% in patients with advanced stage of cancer. These cellular products caused minimal side effects and were well tolerated. The isolation and preparation of clinical grade dendritic cells have been driven by transfusion medicine specialists who are well versed in similar processes for hematopoietic stem-cell preparation. The purpose of this article is to review the mechanisms of tumor immune surveillance and the biology of dendritic cells relevant to tumor antigen presentation, sensitization, and T-lymphocyte stimulation. Information on tumor-associated antigens and clinical trial results with dendritic cell-based cancer immunotherapy are summarized. The potential challenges for blood banking/transfusion medicine involving both technical and regulatory issues are discussed.

    更新日期:2019-11-01
  • Fatalities caused by TRALI.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2004-07-13
    Leslie Holness,Maureen A Knippen,Lois Simmons,Peter A Lachenbruch

    This article includes a retrospective review of fatalities caused by transfusion-related acute lung injury (TRALI) over a 5-year period (from 1997 to 2002) that were reported to the Center for Biologics Evaluation and Research involving 58 recipient deaths and the corresponding 63 blood component donors. Descriptive statistics are presented. Recipient characteristics include age, sex, and admitting diagnosis. Cardiovascular disease, pulmonary disorders, and cancer were the most frequent diagnoses of transfusion recipients. Reported deaths did not appear to be associated with age, sex, reason for transfusion, or transfusion component. Implicated blood component(s) and clinical symptoms at the time of reaction were recorded. Fresh frozen plasma was implicated in one half of the cases, whereas red blood cells played a role in approximately one third. The clinical characteristics described most often in TRALI reports included shortness of breath, frothy sputum, pulmonary infiltrates, and hypoxia. Donor variables included age, sex, parity, and laboratory tests for antibodies to HLA and/or antigranulocyte antibodies. Laboratory tests showed HLA antibodies and/or antigranulocyte antibodies were positive in the majority of donors tested. More data are needed to better describe the role of antibodies in these reactions. Greater awareness is crucial for the practitioner to be alert for signs and symptoms of TRALI and to be aware of the necessary steps in treatment.

    更新日期:2019-11-01
  • Informed consent for blood transfusion: should the possibility of prion risk be included?
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2004-07-13
    Jason Hart,Brendan Leier,Susan Nahirniak

    The emergence of bovine spongiform encephalopathy (BSE) in British cattle has received significant media attention since its discovery in 1986. Transmission of this prion from cattle to humans has been documented, and the BSE prion is believed to be the causative agent for variant Creutzfeldt-Jakob disease (vCJD). Evidence of this spread is a significant threat to public health, and, although there has never been a proven case, there is a theoretical risk of transmission between humans by blood transfusions. In addition, recent animal studies have documented spread in this fashion, raising the question of whether vCJD should be included as part of informed consent for blood transfusions. The process of informed consent requires disclosure of material risks, defined as the risks that a reasonable person, under such circumstances, would want to know. Consent should, therefore, include the risks of a transfusion reaction, as well as the known infectious risks of blood. It should also include the unknown or theoretical risks of blood transfusions because full disclosure of even remote risks preserves the patient/physician trust relationship, which if breached, is very difficult to mend. Given the high level of public awareness, the potential lethality of the infection, and the theoretical risk of transmission by blood, vCJD can be considered a material risk, and consequently, it is reasonable to include it in the informed consent process.

    更新日期:2019-11-01
  • Leukoreduction filtration of blood with sickle cell trait.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2004-07-13
    Audrey N Schuetz,Krista L Hillyer,John D Roback,Christopher D Hillyer

    Leukoreduction of cellular blood products by filtration has been shown to decrease the incidence of febrile nonhemolytic transfusion reactions, transmission of leukocyte-associated viruses, and HLA alloimmunization. However, the increasing popularity of leukofiltering blood products over the past few years has highlighted specific filtration failures associated with sickle trait (hemoglobin AS) blood. Sickle trait blood does not filter adequately, which leads to prolonged or incomplete filtration, often with a higher number of postfiltration leukocytes in the unit than the mandated minimal residual volume of <1 to 5 x 10(6). This review of the literature highlights various parameters that affect the adequacy of filtration of blood products, including effects of temperature, pH, osmolarity, type of anticoagulant, time of storage, and oxygen saturation of the blood unit. A combination of these factors likely contributes to the frequent filtration failure of sickle trait products. Although blood units are not routinely screened for sickle cell hemoglobin, administration of units with sickle trait red blood cells can be disadvantageous to certain patient populations. This review concludes with a discussion of different approaches to screening blood units for sickle cell trait.

    更新日期:2019-11-01
  • Relationship between platelet count and bleeding risk in thrombocytopenic patients.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2004-07-13
    Sherrill J Slichter

    Platelets are lost from circulation by 2 mechanisms: senescence and random loss. Approximately 7.1 x 10(3) platelets/microL/d are postulated to be randomly used in maintaining vascular integrity. Thus, in clinically stable patients, major bleeding is unusual unless the platelet count is

    更新日期:2019-11-01
  • Economic analyses of blood safety and transfusion medicine interventions: a systematic review.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2004-04-07
    Brian Custer

    Economic evaluations are increasingly common in blood safety and transfusion medicine. We sought to summarize and review economic evaluations of donated blood interventions conducted in the United States. By using computer database searches, we identified 19 studies that reported both cost and health benefit results, and relative to each other, we rated the quality of their design and reporting. We classified 6 of the studies as having high quality, 10 as having fair quality, and 3 as having poor quality. Several strengths and limitations in economic evaluations of blood safety and transfusion medicine interventions were identified. Four key improvements can increase the quality of literature in this discipline. We believe researchers should (1) provide more explicit detail on cost parameters in each study and the methods used to obtain them; (2) adopt a clear analysis perspective relevant to decision makers that captures all key costs and consequences, such as the societal perspective; (3) use a consistent approach to reporting sensitivity analyses; and (4) place greater reliance on graphical presentation of results including sensitivity analyses because a large amount of information can be conveyed in relatively simple figures, leaving space to discuss the impact of important analysis assumptions and applicability of the results to other settings.

    更新日期:2019-11-01
  • Importance of blood groups and blood group antibodies in companion animals.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2004-04-07
    Ann E Hohenhaus

    Dogs, cats, birds, and ferrets are popular companion animals. Because these pets are considered by many to be family members, they are provided high-quality veterinary medical care, including blood transfusions. This article reviews the current status of blood groups in dogs, cats, birds, and ferrets and discusses the impact of blood groups on veterinary transfusion medicine. One blood group with 3 types has been described in the cat, whereas multiple blood groups have been described in the dog. Only rudimentary knowledge exists regarding pet bird blood groups, and, to date, the ferret appears to be unique because no blood groups have been described. Antibodies against blood group antigens also play a role in animal blood transfusions. Cats have naturally occurring alloantibodies; however, dogs do not appear to have clinically significant naturally occurring alloantibodies. Understanding the issues related to blood groups and blood group antibodies in companion animals will also benefit those using these species as research models for human diseases.

    更新日期:2019-11-01
  • Meeting the clinical challenge of care for Jehovah's Witnesses.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2004-04-07
    Zenon M Bodnaruk,Colin J Wong,Mervyn J Thomas

    Quality patient care entails more than simply biomedical interventions. Respect for the wishes, values, and preferences of patients are important elements of quality care. Unique aspects of the beliefs of Jehovah's Witnesses may present physicians with ethical and clinical conflicts. Witnesses believe that allogeneic blood transfusion (ie, whole blood, red blood cells, white cells, platelets, and plasma) and preoperative autologous blood deposit (PAD) are prohibited by several Biblical passages. This article reviews the Witness position on medical care, blood components, and fractions, placing these and related interventions into categories that may help physicians to individualize clinical management plans and meet the challenge of caring for patients who are Jehovah's Witnesses. It includes an overview of cost, safety, efficacy, and medicolegal issues related to patient care using transfusion-alternative strategies.

    更新日期:2019-11-01
  • The role of hospital transfusion committees in blood product conservation.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2004-04-07
    Sarah L Haynes,Francesco Torella

    Transfusion committees have been created in different countries to oversee all aspects of blood product transfusion within individual institutions. A fundamental role of hospital transfusion committees is to ensure appropriate blood product use by developing local policies, educating clinicians, and auditing blood use. Unfortunately, this task is hampered by the lack of universally accepted criteria for blood product transfusion. Several examples of specific interventions directed toward improving blood use have been described in the literature. Despite some limitations of these reports, largely because of shortfalls in study design, such interventions appear to be generally effective, but there is not enough evidence to recommend a specific course of action to ensure appropriate blood use. Notwithstanding such problems, a functional hospital transfusion committee can have a major impact on local rates of inappropriate transfusion.

    更新日期:2019-11-01
  • Proceedings of a consensus conference: the screening of blood donors for variant CJD.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2004-04-07
    Morris A Blajchman,Mindy Goldman,Kathryn E Webert,Eleftherios C Vamvakas,Judith Hannon,Gilles Delage

    Since the identification, in 1996, of the first case of variant Creutzfeldt-Jakob disease (vCJD) in humans various approaches have been implemented and/or proposed to prevent this disease from being transfusion transmitted. In addition, a variety of possible laboratory-based approaches have been developed and will continue to be developed for the vCJD screening of blood donors. Various issues related to the implementation of such vCJD testing is likely to assume greater importance as diagnostic tests for vCJD becomes available for the potential screening of blood donors. The purpose of this Consensus Conference was to bring together international experts in an effort to determine which principles should guide the introduction of such testing. These experts provided the scientific and biological background of bovine spongiform encephalopathy (BSE) and vCJD, an understanding of their current epidemiology, as well as the ethical and legal issues that would impact on the implementation of a screening test for preventing the transfusion transmission of vCJD. This contentious issue is of potential considerable importance to transfusion medicine personnel worldwide, as well as to future recipients of allogeneic blood components.

    更新日期:2019-11-01
  • L-carnitine and its possible role in red cell and platelet storage.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2003-12-23
    Joseph D Sweeney,Arduino Arduini

    The storage of red cells or platelets in the liquid state results in changes in quality over time. These changes are collectively known as the storage lesion and are associated with decreased in vivo viability and functionality. Modification of the components of the liquid milieu could favorably influence these changes. L-carnitine is a naturally occurring compound, which is best known for its role in facilitating the transport of long chain fatty acids across the mitochondrial membrane. An additional role for this compound may also exist as a reservoir of acylcarnitines to replace oxidized fatty acids in membrane phospholipids. In experimental studies, L-carnitine has been shown to reduce hemolysis and to improve in vivo survival in nonleukoreduced red cells. This effect on hemolysis appears to be attenuated by prestorage leukoreduction, but the practical benefit of this effect to transfusion recipients is unclear. L-carnitine has also been shown to reduce glycolysis and maintain a better pH in liquid stored platelets. This effect could result in extended platelet storage to 7 or 10 days. Based on such results, a role for L-carnitine as an additive to improve platelet quality in extended platelet storage is suggested.

    更新日期:2019-11-01
  • HTLV-I/II prevalence in different geographic locations.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2003-12-23
    Hans Vrielink,Henk W Reesink

    Human T-cell lymphotropic virus (HTLV) type I (HTLV-I) is the etiological agent of adult T-cell leukemia and HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). HTLV-II is a closely related virus, and this infection is not clearly associated with clinical disease, although neurologic disorders are observed resembling HAM/TSP. Prevalence rates for HTLV-I infection in the general population are greater than 1% in the Caribbean Basin, Central Africa, and South Japan. In most other areas in the world, as far as we know, HTLV-I/II infections are mainly found in high-risk groups (ie, immigrants from endemic areas, their offspring, their sexual contacts and in patients and intravenous injection users attending sexually transmitted disease clinics). Also, a high rate of infection for both HTLV-I and HTLV-II infection was observed in the native Amerindian population in North America as well as South America. Blood donors are routinely screened for HTLV-I/II in North America, several countries in Europe, Japan, and Taiwan.

    更新日期:2019-11-01
  • Managing recalls and withdrawals of blood components.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2003-12-23
    Glenn Ramsey

    Donor centers are issuing a growing number of recalls and market withdrawals to hospital transfusion services about blood components. More than 1 in 2,000 units were recalled in the late 1990s in the United States. The most common reason for these notices from donor centers is postdonation donor information. Most of these units had been transfused, and many present a "risk of a risk" (ie, a problem might have been present that might have affected the recipient). A few regulations and standards address recalls in general terms, but transfusion services generally have wide discretion in the management of specific common recall problems. The Food and Drug Administration (FDA) is now including posttransfusion evaluations in its guidelines for emerging infectious threats to the blood supply. We suggest that hospital transfusion services should have standard operating procedures for managing recalls and that the hospital transfusion committee and the quality management program should provide local input or oversight. Using the FDA's categories of donor center biological product deviations, we provide recommendations to consider for when to notify the recipient's physician, after postdonation information is received about a previously transfused blood component. More study of this important everyday issue in transfusion medicine is highly desirable.

    更新日期:2019-11-01
  • Review of the quality monitoring methods used by countries using or implementing universal leukoreduction.
    Transfus. Med. Rev. (IF 3.610) Pub Date : 2003-12-23
    Neil Beckman,Graham Sher,Maurice Masse,Ekkehard Richter,Juergen Ringwald,Paolo Rebulla,Pieter van der Meer,Benvindo Justica,Brian Walker,Graham Rowe,

    Several countries are implementing or have implemented universal leukoreduction (ULR). Specifications, leukocyte counting, and monitoring methods were essential elements in achieving process confidence and conformance. A review of these protocols is presented. A questionnaire was prepared, agreed, and circulated, and responses were collated. Different specifications have been adopted as well as disparate approaches to leukocyte counting and residual leukocyte monitoring. Parametric, nonparametric, and pass-rate methods of analysis were used. Despite these differences, users were satisfied that the methodologies were providing assurance of component quality.

    更新日期:2019-11-01
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