Transfusion
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Transfusion of ABO‐nonidentical platelets is not associated with adverse clinical outcomes in cardiovascular surgery patients BACKGROUND: Current blood transfusion standards in Canada and the United States permit transfusion of ABO‐nonidentical platelets when ABO‐identical platelets are not available. This practice increases the availability of platelets, a component in chronic shortage in Ontario, Canada because of the 5‐day shelf‐life. The impact of transfusing ABO‐nonidentical platelets on patient outcomes is unknown. STUDY DESIGN AND METHODS: A retrospective review of 1721 patients who had cardiovascular surgery between November 1989 and December 1999 and who had also received a platelet transfusion perioperatively was conducted. The impact of platelet and plasma incompatibility on clinical outcomes was analyzed. RESULTS: The analysis included 1691 patients who were divided into two groups according to the compatibility of the first platelet transfusion received: ABO‐identical platelet transfusion (n = 1008) and ABO‐nonidentical platelet transfusion (n = 683). The only difference in baseline characteristics between the two groups was that there were more urgent cases in the ABO‐identical platelet transfusion group (p = 0.04). There were no significant differences in mortality at 30 days (10% for both groups, p = NS) or in postoperative length of stay (median, 7.0 days for both groups, p = NS). No significant differences were found with respect to the use of blood components, indices of bleeding, incidence of infection, or platelet CCIs. CONCLUSION: Transfusion of ABO‐nonidentical platelets in patients undergoing cardiovascular surgery is not associated with an adverse impact on patient outcome.
Transfusion - Tập 42 Số 2 - Trang 166-172 - 2002
Transplantation of adipose‐derived mesenchymal stem cells into a murine model of passive chronic immune thrombocytopenia BACKGROUND: Immune thrombocytopenia (ITP) is a bleeding disorder characterized by antibody‐opsonized platelets (PLTs) being prematurely destroyed by macrophages in the reticuloendothelial system. T helper (Th) cells and different Th cytokines play an important role in the pathophysiology of ITP. As immunomodulators, adipose‐derived mesenchymal stem cells (ADSCs) regulate Th cells and show therapeutic effects in autoimmune diseases. However, it is not clear how ADSCs affect ITP. In this study, we explored the specific effects of ADSCs on ITP in mice.STUDY DESIGN AND METHODS: BALB/c mice were randomly divided into three groups: normal controls, ITP controls, and ITP with ADSC transplantation. PLT levels were monitored by an automatic blood cell counter, and the cytokines interferon‐γ (IFN‐γ); interleukin (IL)‐2, ‐4, ‐10, and ‐17; and transforming growth factor‐β1 (TGF‐β1) were analyzed by enzyme‐linked immunosorbent assays.RESULTS: Compared to the untreated ITP mice, the PLT level of the ITP mice significantly increased after ADSC treatment. In the ADSC group, IFN‐γ, IL‐2, and IL‐17 significantly decreased, while IL‐4, IL‐10, and TGF‐β1 increased.CONCLUSION: These findings constitute the first experimental evidence that ADSCs are efficacious in improving PLT levels and reducing the related Th cytokines mediating proinflammatory response in ITP mice, which may provide a scientific basis for using ADSCs as a new therapy for ITP.
Transfusion - Tập 52 Số 12 - Trang 2551-2558 - 2012
Laboratory diagnosis of heparin‐associated thrombocytopenia and comparison of platelet aggregation test, heparin‐induced platelet activation test, and platelet factor 4/heparin enzyme‐linked immunosorbent assay BACKGROUND : As clinical diagnosis of heparin‐associated thrombocytopenia (HAT) is often difficult, confirmation by sensitive laboratory assays is desirable.STUDY DESIGN AND METHODS : The sensitivity of the heparin‐induced platelet activation (HIPA) test and the platelet aggregation test (PAT) was prospectively compared by using the sera of 209 patients with the putative diagnosis of HAT. Both assays were performed concomitantly with platelets of the same four donors using a different combination of donors from day to day. Further, all sera were assessed with a platelet factor 4 (PF4)/heparin enzyme‐linked immunosorbent assay (ELISA).RESULTS : Positive results were obtained with 33 percent of sera in the PF4/heparin ELISA, with 33.5 percent of sera in the HIPA test, and with 11.5 percent of sera in the PAT. The PF4/heparin ELISA and the HIPA test showed no difference in sensitivity (p = 0.27 by McNemar's test) and were more sensitive than PAT (p < 10(‐8) by McNemar's test). However, they recognized different patient cohorts. Nine HIPA‐indeterminate and 12 HIPA‐negative sera were positive in the PF4/heparin ELISA. Eight of the nine indeterminate sera caused platelet activation with high heparin concentrations in the HIPA test. Eleven of the 12 negative sera contained no IgG, but 9 contained IgM and 2 contained IgA HAT antibodies. Four sera that were indeterminate in the PF4/heparin ELISA and 18 sera that were negative were positive in the HIPA test. None of the sera that were positive in the PAT was missed in the HIPA test, but two of those were negative in the PF4/heparin ELISA. All sera were assessed with four low‐molecular‐weight heparins and a low‐molecular‐ weight heparinoid in the HIPA test with platelets from the same four donors. Low‐molecular‐weight heparin caused platelet activation with positive sera in 98 percent of tests, and the heparinoid did so in 10 percent; in a further 12.8 percent, crossreactivity to the low‐ molecular‐weight heparinoid could not be excluded.CONCLUSION : The majority of HAT antibodies react with a PF4/heparin complex, but there is strong evidence that other antigens are involved in some patients. The HIPA test and the PF4/heparin ELISA are sensitive for diagnosing HAT, and they complement one another.
Transfusion - Tập 34 Số 5 - Trang 381-385 - 1994
Complications of apheresis in children BACKGROUND: Although the frequency of complications in adults undergoing therapeutic apheresis is low, there are little data in children.STUDY DESIGN AND METHODS: A retrospective study of 186 children who had undergone a total of 1632 apheresis procedures between 1994 and 2002 was conducted. Adverse reactions were prospectively documented. The procedures were plasma exchange (67%), hematopoietic progenitor cell collection (18%), red blood cell exchange (6.9%), leukodepletion (0.7%), and plasma exchange with immunoadsorption (6.7%).RESULTS: Adverse reactions, most minor, were reported in 55 percent of procedures in 82 percent of patients. The most frequent complications, per procedure and per patient during an entire course of therapy, were hypotension (14 and 48.4%), hypotension requiring fluid bolus (4.8 and 26.9%), symptomatic hypocalcemia (9.7 and 28.5%), allergic reactions (4.4 and 5.9%), catheter‐related thrombosis (1.7 and 12.4%), catheter‐related infection (2.1 and 16.1%), and severe anemia (hemoglobin [Hb] level, <7 g/dL; 2.5 and 17.2%). There were two deaths (1% of patients). Risk factors for complications by multivariate analysis were lower body weight, lower preapheresis Hb level, apheresis in a critical care unit, and number of procedures per patient. The 55 percent incidence of complications per procedure in our pediatric cohort is much higher than the 4.3 to 28 percent incidence reported in adults. The excess of adverse reactions in children are mostly related to citrate toxicity, higher relative vascular volume shifts, and the need for vascular access.CONCLUSION: Pediatric apheresis presents unique challenges and is associated with higher complication rate compared to adults. It is recommended that this procedure be performed in specialized centers.
Transfusion - Tập 47 Số 10 - Trang 1837-1842 - 2007
Fibroblast Colony Formation from Monolayer Cultures of Blood Cells The quantitative method of measuring fibroblast precursors in populations of hematopoietic cells demonstrates that their concentration in blood does not depend on the number of heart punctures during blood collection. This means that fibroblast colonies, originating in monolayer cultures of blood cells, develop from circulating blood cells. From the indices of 3 H‐thymidine labeling it is calculated that the mean generation time for fibroblasts in seven and 11‐day cultures is 34 to 43 hours and that the proliferative pool in fibroblast colonies is not less than 84 and 79 per cent respectively. The concentration of fibroblast precursors among nucleated cells of peripheral blood of guinea pigs ranges between 0.2 and 2 × 10‐5 .
Transfusion - Tập 11 Số 6 - Trang 345-349 - 1971
Bioactive lipids accumulate in stored red blood cells despite leukoreduction: a targeted metabolomics study BACKGROUND Accumulation of bioactive lipids during red blood cell (RBC) storage has been identified as a potential source of posttransfusion sequelae in vulnerable populations. Typically, white blood cells (WBCs) have been implicated in the generation of bioactive lipids, and leukoreduction has been seen as a solution to this issue. STUDY DESIGN AND METHODS We developed a targeted metabolomics approach with isotope dilution to quantify a panel of bioactive lipids in both leukoreduced (LR) and nonleukoreduced (NLR) RBC units over the course of storage. RESULTS Leukoreduction greatly attenuated the production of 12‐hydroxyeicosatetraenoic acid (HETE), 12‐hydroxyeicosapentaenoic acid, and 14‐hydroxydocosahexaenoic acid (HDoHE), all three of which are mediated by 12‐lipoxygenase present in WBCs and platelets. However, despite leukoreduction, micromolar levels of linoleic acid (LA), arachidonic acid (AA), and docosahexaenoic acid (DHA) were observed in the RBC units stored for 42 days. These major polyunsaturated fatty acids (PUFAs) and their oxidation products (oxylipins) also significantly increased with storage time, including 5‐, 8‐, 9‐, 11‐, 12‐, and 15‐ HETEs from AA; 9‐ and 13‐hydroxyoctadecadienoic acid (HODE); 9‐, 10‐, and 12,13‐dihydroxyoctadecenoic acids from LA; and 14‐, 16‐, and 17‐HDoHEs from DHA. The majority of PUFAs and oxylipins accumulated in the supernatant fraction. Large donor‐to‐donor variations were observed in both LR‐RBC and NLR‐RBC units. CONCLUSION While the exact role the accumulation of PUFAs and oxylipins plays in RBC unit quality and transfusion medical outcomes remains undetermined, the analytes of interest in this study may serve as biomarkers for lipid degradation and oxidation during storage and may induce changes in human physiology upon transfusion.
Transfusion - Tập 56 Số 10 - Trang 2560-2570 - 2016
Testosterone‐dependent sex differences in red blood cell hemolysis in storage, stress, and disease BACKGROUND Red blood cell (RBC) hemolysis represents an intrinsic mechanism for human vascular disease. Intravascular hemolysis releases hemoglobin and other metabolites that inhibit nitric oxide signaling and drive oxidative and inflammatory stress. Although these pathways are important in disease pathogenesis, genetic and population modifiers of hemolysis, including sex, have not been established. STUDY DESIGN AND METHODS We studied sex differences in storage or stress‐induced hemolysis in RBC units from the United States and Canada in 22 inbred mouse strains and in patients with sickle cell disease (SCD) using measures of hemolysis in 315 patients who had homozygous SS hemoglobin from the Walk‐PHASST cohort. A mouse model also was used to evaluate posttransfusion recovery of stored RBCs, and gonadectomy was used to determine the mechanisms related to sex hormones. RESULTS An analysis of predisposition to hemolysis based on sex revealed that male RBCs consistently exhibit increased susceptibility to hemolysis compared with females in response to routine cold storage, under osmotic or oxidative stress, after transfusion in mice, and in patients with SCD. The sex difference is intrinsic to the RBC and is not mediated by plasmatic factors or female sex hormones. Importantly, orchiectomy in mice improves RBC storage stability and posttransfusion recovery, whereas testosterone repletion therapy exacerbates hemolytic response to osmotic or oxidative stress. CONCLUSION Our findings suggest that testosterone increases susceptibility to hemolysis across human diseases, suggesting that male sex may modulate clinical outcomes in blood storage and SCD and establishing a role for donor genetic variables in the viability of stored RBCs and in human hemolytic diseases.
Transfusion - Tập 56 Số 10 - Trang 2571-2583 - 2016
Proteomic analyses of human plasma: Venus versus Mars BACKGROUND: Plasma is vital for the resuscitation of injured patients and to restore necessary procoagulants, especially Factors (F)II, FV, FVII, FX, and FXIII; however, female plasma has been implicated in the majority of transfusion‐related acute lung injury (TRALI) cases and male‐only plasma transfusion regimens have significantly decreased the incidence of TRALI. Little is known about the human plasma proteome, and no comparisons have been made between male and female plasma; therefore, we hypothesize that there are significant differences between plasma from male and female donors.STUDY DESIGN AND METHODS: Five units of fresh‐frozen plasma each were collected from nulliparous female donors and male donors, and the proteome was analyzed by depleting the 14 most common proteins by immunoaffinity columns followed by protein separation by one dimension gel electrophoresis, tryptic digestion of the proteins, analysis of the peptides by liquid chromatography–tandem mass spectrometry, and identification employing human protein sequence databases.RESULTS: Female plasma versus male plasma contained pregnancy zone protein (419‐ to 580‐fold), FV (twofold), α1 ‐antitrypsin (twofold), β2 ‐microglobulin (twofold), and Complement Factors H and C4B (1.5‐ to 2‐fold) at significantly higher concentrations than males and males contained significant increases in Fc‐binding protein (twofold), protein Z–dependent protease inhibitor (twofold), phosphatidylinositol glycan–specific phospholipase (fourfold), protein S‐100 (threefold), and transgelin‐2 (14‐fold) versus females (p < 0.005). The increases in FV, α1 ‐antitrypsin, and β2 ‐microglobulin were confirmed by an activity assay or immunoblots.CONCLUSION: We conclude that there are proteomic differences between male and female plasma, which could be exploited to improve clinical outcomes in transfused patients.
Transfusion - Tập 52 Số 2 - Trang 417-424 - 2012
An update on red blood cell storage lesions, as gleaned through biochemistry and omics technologies Red blood cell (RBC ) aging in the blood bank is characterized by the accumulation of a significant number of biochemical and morphologic alterations. Recent mass spectrometry and electron microscopy studies have provided novel insights into the molecular changes underpinning the accumulation of storage lesions toRBCs in the blood bank. Biochemical lesions include altered cation homeostasis, reprogrammed energy, and redox metabolism, which result in the impairment of enzymatic activity and progressive depletion of high‐energy phosphate compounds. These factors contribute to the progressive accumulation of oxidative stress, which in turn promotes oxidative lesions to proteins (carbonylation, fragmentation, hemoglobin glycation) and lipids (peroxidation). Biochemical lesions negatively affectRBC morphology, which is marked by progressive membrane blebbing and vesiculation. These storage lesions contribute to the altered physiology of long‐storedRBCs and promote the rapid clearance of up to one‐fourth of long‐storedRBCs from the recipient's bloodstream after 24 hours from administration. While prospective clinical evidence is accumulating, from the present review it emerges that biochemical, morphologic, and omics profiles of storedRBCs have observable changes after approximately 14 days of storage. Future studies will assess whether these in vitro observations might have clinically meaningful effects.
Transfusion - Tập 55 Số 1 - Trang 205-219 - 2015
The effects of red blood cell preparation method on in vitro markers of red blood cell aging and inflammatory response Background Studies are currently under way examining whether the age of stored red blood cells (RBCs ) affects clinical outcome in transfusion recipients. The effects of storage duration on the RBC storage lesion are well documented, while fewer studies are available regarding the effect of RBC production method. In this study, we compared in vitro RBC quality variables and markers of inflammatory response in apheresis and whole blood (WB )‐derived RBCs , specifically those prepared after an overnight room temperature hold (RTH ) of WB . Study Design and Methods SAGM RBCs , prepared from WB after overnight RTH (n = 10), were compared to SAGM RBCs prepared using an apheresis device (A lyx, n = 10). As a control, SAGM RBCs were also prepared within 2 hours of WB collection (2‐hr WB , n = 10). All RBCs were stored at 4°C for 42 days with weekly assay of in vitro variables, cytokines and/or chemokines, and neutrophil activation after incubation with RBC supernatant.Results RTH WB RBCs exhibited decreased levels of 2,3‐diphosphoglycerate acid (2.3 μmol/g hemoglobin [Hb ] ± 2.1 vs. 13.7 ± 1.3 μmol/g Hb ) and morphology (160 ± 10 vs. 192 ± 5) on Day 1 and increased hemolysis (0.45 ± 0.21% vs. 0.31 ± 0.09%) and microparticles (6.1 ± 2.8/103 RBCs vs. 3.9 ± 1.1/103 RBCs ) on Day 42 compared to apheresis RBCs . Gro‐α and ENA ‐78 cytokine levels were significantly higher in RTH WB than A lyx RBCs during storage. CD 11b expression was highest in neutrophils exposed to supernatant from RTH WB RBCs (p < 0.05).Conclusion RBC preparation method has a meaningful effect on the RBC storage lesion, which should be taken into account in addition to length of storage.
Transfusion - Tập 53 Số 12 - Trang 3128-3138 - 2013
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