American Association Of Blood Banks Research Articles

American Association of Blood Banks 50th annual meeting. Denver, Colorado, October 18-22, 1997. Abstracts.

American Association of Blood Banks 50th annual meeting. Denver, Colorado, October 18-22, 1997. Abstracts.

The limits of bloodwarming: maximally heating blood with an inline microwave bloodwarmer.

Bloodwarmers, mandatory for use in trauma resuscitation, are currently limited to a maximum temperature of 42 degrees C by the American Association of Blood Banks. Using newly available inline microwave bloodwarming technology, we sought to identify the maximal temperature to which blood may be safely heated. Using an inline microwave bloodwarmer, we warmed refrigerated packed red blood cells to settings ranging from "Off" to 60 degrees C. We evaluated heated blood for changes in red cell structure and function by measuring hemoglobin/hematocrit, potassium, lactate dehydrogenase, plasma hemoglobin, blood smear, osmotic fragility, PO2, giving 50% O2 saturation, and hemoglobin electrophoresis. Measures of hemolysis showed no increase above control until temperatures of 51 to 53 degrees C were achieved (p < 0.05). Red cell size remained unaffected until temperatures of 53 degrees C were achieved (p < 0.05). Osmotic fragility was not elevated until 60 degrees C (p < 0.05). PO2 giving 50% O2 saturation was low for all samples. Hemoglobin electrophoresis remained unchanged at all temperature settings. An inline microwave bloodwarmer may be used to heat blood safely to 49 degrees C. Blood warmed to this temperature may significantly increase the amount of heat returned to the hypothermic trauma patient.

Effect of long-term platelet donation on lymphocyte subsets and plasma protein concentrations

Previous studies of changes in immune function in platelet donors have investigated subjects who were undergoing plateletpheresis using older equipment that is no longer in general use. Therefore, the purpose of this study was to determine the effect of long-term platelet donation on lymphocyte numbers and subsets and plasma protein concentrations in platelet donors using newer cell separators. Three groups included in the study were nondonor controls (n=27), long-term whole blood donors (n=29), and long-term platelet donors (n=20). Using a cross-sectional analysis, lymphocyte numbers and subsets were determined and compared among the three groups. Plasma concentrations of total protein, globulin, albumin, and IgG were also compared. Among the three groups there were no significant differences in total white blood cell counts, percentage or absolute number of lymphocytes, or percentage or absolute number of lymphocyte subsets. Serum total protein, globulin, albumin, and IgG concentrations of platelet donors were within normal ranges. These data support the current Food and Drug Administration (FDA) and American Association of Blood Banks' standards for the frequency of platelet donation allowed and monitoring required for plateletpheresis donors. Furthermore, these data indicate that the FDA could eliminate the requirement for the warning in informed consents about lymphocyte depletion in platelet donors.

Effect of long-term platelet donation on lymphocyte subsets and plasma protein concentrations

Previous studies of changes in immune function in platelet donors have investigated subjects who were undergoing plateletpheresis using older equipment that is no longer in general use. Therefore, the purpose of this study was to determine the effect of long-term platelet donation on lymphocyte numbers and subsets and plasma protein concentrations in platelet donors using newer cell separators. Three groups included in the study were nondonor controls ( n=27), long-term whole blood donors ( n=29), and long-term platelet donors ( n=20). Using a cross-sectional analysis, lymphocyte numbers and subsets were determined and compared among the three groups. Plasma concentrations of total protein, globulin, albumin, and IgG were also compared. Among the three groups there were no significant differences in total white blood cell counts, percentage or absolute number of lymphocytes, or percentage or absolute number of lymphocyte subsets. Serum total protein, globulin, albumin, and IgG concentrations of platelet donors were within normal ranges. These data support the current Food and Drug Administration (FDA) and American Association of Blood Banks' standards for the frequency of platelet donation allowed and monitoring required for plateletpheresis donors. Furthermore, these data indicate that the FDA could eliminate the requirement for the warning in informed consents about lymphocyte depletion in platelet donors.

Should cardiac disease prevent autologous blood donation?

AIDS has created considerable concern among the public regarding being transfused with potentially infectious blood. However, autologous blood donations are still not maximally provided nor utilized. Significant heart disease disqualifies all allogeneic and most autologous blood donors (American Association of Blood Banks (AABB) Standards 1994). Disqualification is based on the widespread belief that donating blood could possibly be detrimental to their health. However, this belief has not been sufficiently documented. Sixty-eight donors (ages 14–84 years), all with histories of significant cardiac diseases, donated 111 units of whole blood (1–3 units). Twenty-eight patients donated 1 unit, 37 donated 2 units, and three patients donated 3 units. Fifty-nine patients had ischemic heart disease, and nine had valvular heart disease (five with mitral stenosis and four with mitral valve prolapse). No patient received erythropoietin, and only one received equal volume replacement with normal saline during donation. All these patients eagerly wished to donate in spite of being informed of the possible complications. No patient wishing to donate has been refused, and none has experienced any adverse consequences from donating. Forty-four patients underwent total hip/ knee replacements. Only 56 units (50%) were transfused to 37 patients (54%). Although our experience is limited, it appears that many patients with histories of well established cardiac diseases can easily tolerate donating blood without compromising their health.

Should cardiac disease prevent autologous blood donation?

AIDS has created considerable concern among the public regarding being transfused with potentially infectious blood. However, autologous blood donations are still not maximally provided nor utilized. Significant heart disease disqualifies all allogeneic and most autologous blood donors (American Association of Blood Banks (AABB) Standards 1994). Disqualification is based on the widespread belief that donating blood could possibly be detrimental to their health. However, this belief has not been sufficiently documented. Sixty-eight donors (ages 14–84 years), all with histories of significant cardiac diseases, donated 111 units of whole blood (1–3 units). Twenty-eight patients donated 1 unit, 37 donated 2 units, and three patients donated 3 units. Fifty-nine patients had ischemic heart disease, and nine had valvular heart disease (five with mitral stenosis and four with mitral valve prolapse). No patient received erythropoietin, and only one received equal volume replacement with normal saline during donation. All these patients eagerly wished to donate in spite of being informed of the possible complications. No patient wishing to donate has been refused, and none has experienced any adverse consequences from donating. Forty-four patients underwent total hip/ knee replacements. Only 56 units (50%) were transfused to 37 patients (54%). Although our experience is limited, it appears that many patients with histories of well established cardiac diseases can easily tolerate donating blood without compromising their health.

A survey of canadian neonatal blood transfusion practices

In 1990, the Pediatric Hemotherapy Committee of the American Association of Blood Banks developed and distributed a questionnaire addressing neonatal blood transfusion practices. The same questionnaire was subsequently sent to Canadian university-affiliated hospitals ( n=92). This report describes the results of the Canadian survey. Seventy-two percent ( n=66) of institutions contacted responded. Of these 42% ( n=28) had sufficient experience with neonatal transfusions and provided sufficient data for analysis. Although the majority of stated practices did follow published guidelines, several areas of variability and/or suboptimal practices were identified. With respect to component selection and preparation, suboptimal practices included excessive pretransfusion testing, unnecessary routine washing of RBC concentrates for small-volume transfusions, routine volume reduction of platelet concentrates and the use of suboptimal granulocyte preparations. With respect to transfusion practices, a disturbingly high percentage of respondents indicated that frozen plasma would be given in situations generally considered inappropriate. There was a great deal of variability in the provision of blood components at low risk for CMV, in the use of gamma irradiation and in the platelet count used for prophylactic platelet transfusions. The data collected in this survey provide information concerning practices that require improvement, identify areas where further research is desirable and provide a basis for comparison with current and future neonatal blood transfusion practices.

The American Association of Blood Banks founded 50 years ago.

TransfusionVolume 37, Issue 1 p. 93-94 The American Association of Blood Banks founded 50 years ago P.J. Schmidt MD, P.J. Schmidt MD Florida Blood Services, Tampa, FLSearch for more papers by this author P.J. Schmidt MD, P.J. Schmidt MD Florida Blood Services, Tampa, FLSearch for more papers by this author First published: 27 February 2003 https://doi.org/10.1046/j.1537-2995.1997.37197176957.xCitations: 4AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume37, Issue1January 1997Pages 93-94 RelatedInformation

Hypotensive reactions: a previously uncharacterized complication of platelet transfusion?

In 1993, the American Association of Blood Banks (AABB) received reports of severe hypotensive reactions associated with platelet transfusions. The question arose as to whether these reports were indicative of a previously uncharacterized platelet transfusion reaction. To further characterize these reactions, the AABB Transfusion Practices Committee developed a series of three questionnaires. The initial questionnaire was sent to all AABB institutional members; the two subsequent questionnaires were sent to those institutions reporting severe and/or unusual platelet transfusion reactions. This report focuses on the 24 responses to the third and most detailed questionnaire, which specifically addressed reactions that were characterized by hypotension and/or unexplained respiratory failure. Of the 24 detailed responses received, 4 were not considered to represent unusual reactions to platelet transfusion, 3 described reactions consistent with a (presumably unrecognized) diagnosis of transfusion-related acute lung injury, and 17 described reactions that were primarily characterized by hypotension. The majority of the hypotensive reactions occurred within 1 hour of the beginning of the transfusion (88%), were associated with respiratory distress (82%), and resolved rapidly after cessation of the transfusion (82%). Eighty-eight percent of implicated components had been white cell reduced by filtration. The hypotensive platelet transfusion reactions that were described appear to represent a previously uncharacterized complication of platelet transfusion. However, the nature of the questionnaires used in this investigation does not allow the drawing of firm conclusions as to the frequency or the cause of these reactions.

Abstracts of Papers to be Presented at American Association of Blood Banks. 49 Annual Meeting October 12–16, 1996

TransfusionVolume 36, Issue S9 p. 1s-65s Abstracts of Papers to be Presented at American Association of Blood Banks. 49 Annual Meeting October 12–16, 1996 First published: September 1996 https://doi.org/10.1111/j.1537-2995.1996.tb02719.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume36, IssueS9September 1996Pages 1s-65s RelatedInformation

American Association of Blood Banks 49th annual meeting. Orlando, Florida, October 12-16, 1996. Abstracts.

American Association of Blood Banks 49th annual meeting. Orlando, Florida, October 12-16, 1996. Abstracts.

Hotline Fluid Warming Fails to Maintain Normothermia

Manager, I.V. Products, SIMS Level 1 Technologies, Inc., 160 Weymouth Street Rockland, Massachusetts 02370.In Reply:--Werlhof has challenged Level 1's guarantee that 90% of HOTLINE(R) patients will wake up warm. Level 1's claim is supported by unpublished clinical data kept on file at the company. We found that, by changing only the infusion equipment during an extensive variety of elective surgical procedures, nine of ten patients ended the procedure warm, with temperatures greater or equal to 36 degrees C, or losing no more than 0.2 degree C.Fluid warmers are an important method of heat conservation. [1]During anesthesia, average heat production decreases from roughly 70 kcal *symbol* h sup -1 to 40–60 kcal *symbol* h sup -1 (1 kcal *symbol* kg sup -1 *symbol* h sup -1). [2]Because 17 kcals are required to increase the temperature of 1 l of room temperature (20 degrees C) crystalloid to 37 degrees C, administering just 3 l of room temperature crystalloid would require the equivalent of nearly 1 h of an anesthetized patient's entire energy expenditure. With the specific heat of the body being 0.83 kcal *symbol* kg sup -1 *symbol* degrees C sup -1, 3 l of room temperature fluid would decrease body temperature by approximately 0.9 degree C.Approximately 30 kcals are required to increase the temperature of 1 l of refrigerated blood (4 degrees C) to 37 degrees C. Therefore, approximately 0.5 h total energy expenditure is required to increase the temperature of 1 l of cold blood to 37 degrees C. One liter of refrigerated blood would decrease body temperature by approximately 0.5 degree C.A study using HOTLINE and no other intraoperative warming devices conducted with 36 adult patients undergoing major orthopaedic and gynecologic surgery confirmed, "The HOTLINE fluid warmer … prevented accidental hypothermia in all patients." [3]Nineteen patients receiving HOTLINE therapy underwent surgery that lasted approximately 4 h and received approximately 4 l of intravenous fluids. No patients receiving HOTLINE therapy finished surgery with a body temperature below 35.5 degrees C.Regarding the studies Werlhof cites that "demonstrate that fluid warming alone will not maintain normothermia," none involve a HOTLINE. All use old, conventional fluid-warming technologies with exposed patient tubing that fail to deliver body temperature fluids at any flow rate. Regarding the comment that "cooling at typical flow rates is trivial and of no consequence," the study referenced by Werlhof does not make, or even imply, this referenced conclusion. [4]Regarding Werlhof's statement that "intravenous fluid temperature cannot much exceed 40 degrees C without harming blood cells," it has been demonstrated that erythrocyte integrity is not heat-compromised until a temperature of 46 degrees C, [5]and the American Association of Blood Banks' standard has allowed blood warming to 42 degrees C since November 1994. [6].Level 1 is committed to changing surgical results for the better, which is why Level 1 unconditionally guarantees HOTLINE. If any clinician is not satisfied with HOTLINE or its results, Level 1 will gladly make good on its money-back guarantee with no questions asked.Barbara J. Lambert, Manager, I.V. Products, SIMS Level 1 Technologies, Inc., 160 Weymouth Street, Rockland, Massachusetts 02370.

Data on apheresis, blood collection, and transfusion-related activities: statistical analyses of the American Association of Blood Banks institutional membership questionnaires.

The American Association of Blood Banks annually surveys institutional members on activities pertinent to blood collections, apheresis, and transfusions. Retrospective descriptive statistics and comparative statistical analyses including trend tests were performed on selected topics from the 1989, 1990, and 1991 Institutional Questionnaires. The data were compiled by institution type, namely, regional and community blood donor collection centers and hospital-based facilities. Evaluated topics included the apheresis and therapeutic procedures performed, transfusion-associated AIDS and hepatitis, and the blood components (red cells, platelets, fresh-frozen plasma, and cryoprecipitate) that were collected, transfused, or outdated or discarded. Significant findings (p<0.05) included upward trends over time in the numbers of donor plateletpheresis units collected and transfused and in the numbers of random-donor platelet concentrates collected by hospitals. There was an upward trend over time in the outdating or discarding of all blood component types that was reported by hospitals. Data from blood centers showed the outdating or discarding of significant numbers of apheresis platelets, fresh-frozen plasma, and cryoprecipitate. No significant trends were identified in the reported cases of transfusion-associated hepatitis or AIDS. Ongoing data analysis of the institutional questionnaires provides information on trends in blood collection and transfusion-related activities.

Bacterial contamination rates following processing of bone marrow and peripheral blood progenitor cell preparations.

The performance of cultures to assess possible bacterial contamination of bone marrow and peripheral blood progenitor cell preparations is required by the standards of the American Association of Blood Banks. Consecutive (n = 893) bone marrow and peripheral blood progenitor cell preparations were cultured for assessment of possible contamination by microorganisms. Consecutive bone marrow and peripheral blood progenitor cell preparations (n = 893) were cultured; the overall positive rate detected was 2.5 percent (22/893). The isolates predominantly were skin contaminants (gram-positive cocci) and so-called water-borne organisms (gram-negative rods). The 6.0-percent rate of positivity in 317 bone marrow preparations was higher than the 0.5-percent rate in 576 peripheral blood progenitor cell preparations (p < 10(-6)). Culture-positive preparations were transfused to 16 patients at this institution; however, none of these transfusions led to documented sepsis with the contaminating organism. The culture method described here complies with the standards of the American Association of Blood Banks. Contamination can be detected in both bone marrow and peripheral blood progenitor cell preparations. When contaminated preparations are transfused, there are few complications that can be attributed to the contamination.

Abstracts of Papers to be Presented at American Association of Blood Banks. 48 Annual Meeting November 11–15, 1995

TransfusionVolume 35, Issue S10 p. 1s-68s Abstracts of Papers to be Presented at American Association of Blood Banks. 48 Annual Meeting November 11–15, 1995 First published: October 1995 https://doi.org/10.1111/j.1537-2995.1995.tb02717.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume35, IssueS10October 1995Pages 1s-68s RelatedInformation

Collection and transfusion of blood and blood components in the United States, 1992.

Studies were conducted to measure the state of the United States' national blood resource in 1992 and changes therein from 1989. With data supplied by the American Red Cross and the American Association of Blood Banks, as well as data from a stratified random-sample survey of 3350 non-American Association of Blood Banks hospitals, statistical methods were applied to estimate national blood activities in 1992. The total US blood supply in 1992 was 13,794,000 units, a decrease of 3.1 percent from 1989. Some 11,307,000 red cell units were transfused to 3,772,000 patients, an average of 3.0 units per transfused patient. Preoperative autologous blood deposits totaled 1,117,000 units, a 70-percent increase over 1989. Of this number, 566,000 units (50.7%) were transfused, 5,000 (4.4%) transferred to the allogeneic supply, and 546,000 (48.9%) discarded. Of 436,000 directed-donation units, 136,000 (31.2%) were transfused, 57,000 (13.1%) transferred to allogeneic supply, and 243,000 (55.7%) discarded. The total allogeneic blood supply, including imports, decreased by 7.4 percent from 1989, and allogeneic blood transfusions, including those to children, decreased by 8.6 percent. Over 8,300,000 platelet units were transfused; of these, some 3,600,000 were apheresis platelets. In addition, 2,255,000 units of plasma and 939,000 units of cryoprecipitate were transfused. While the US blood supply was adequate for transfusion needs in 1992, blood collections and red cell transfusions had decreased substantially since 1989.

American Association of Blood Banks 48th annual meeting. New Orleans, Louisiana, November 11-15, 1995. Abstracts.

American Association of Blood Banks 48th annual meeting. New Orleans, Louisiana, November 11-15, 1995. Abstracts.

Transfusion practices in human immunodeficiency virus-infected patients.

The reported immunomodulatory effects of transfusion raise concern about the potential for virus activation and tumor growth in human immunodeficiency virus (HIV)-infected patients. In the absence of "standards" of transfusion practice for such patients, a survey of transfusion policies among institutions specializing in the care of HIV-infected patients was performed to delineate current practices. A survey developed by the Transfusion Practices Committee of the American Association of Blood Banks was sent to 47 AIDS clinical trial units and 14 regional hemophilia centers in North America. Forty-three percent of centers completed the survey. Most centers observed more than 200 HIV-infected patients each. The key findings were that 1) 81 percent of centers used identical red cell transfusion criteria for HIV-infected and noninfected patients; 2) 52 percent used recombinant human erythropoietin as initial treatment for zidovudine-induced anemia, while 46 percent used recombinant human erythropoietin for anemia not associated with zidovudine; 3) 35 percent of centers used white cell-reduced blood components in lieu of cytomegalovirus (CMV)-seronegative components when administering transfusion(s) to CMV-seronegative patients; 4) 27 percent gamma-radiated cellular components, but no case of graft-versus-host disease had been observed; 5) > 85 percent of centers used monoclonal factor VIII for pediatric and adult hemophiliacs infected with HIV; 6) approximately one-third of centers routinely white cell-reduced cellular components; and 7) the most common reasons for white cell reduction included reduction of febrile reactions and CMV risk, reduction of platelet alloimmunization, and delay of immunomodulatory consequences of transfusion. There is marked heterogeneity in transfusion practice for HIV-infected patients. Modification of cellular components to achieve different objectives is routine in many centers.

Prophylactic versus therapeutic platelet transfusion practices in hematology and/or oncology patients.

Platelet utilization has steadily increased throughout the past three decades. At the same time, there has been very little study of the current transfusion practices. A survey was conducted of institutional members of the American Association of Blood Banks (hospitals) that were actively involved in the care of pediatric and/or adult hematology and/or oncology patients. Inquiries were made relating to the extent of prophylactic versus therapeutic use of platelets, criteria used for prophylactic transfusion of platelets and type, and dose of platelets used. Data were analyzed according to patient age and type of hospital. Of 786 responding hospitals, 630 (80.2%) provided sufficient data for analysis; 126 of that 630 provided care for pediatric patients. The majority (60.9%) of responding hospitals had a minimum of four hematologists and/or oncologists. Eighty-four percent of hospitals reported transfusing some apheresis platelets. The dose of platelet concentrates most frequently used for adults ranged from 6 to 10, with pools of 10 more commonly used in community hospitals. More than 70 percent of hospitals reported transfusing platelets primarily for prophylaxis: 60 percent of hospitals set the threshold platelet count for prophylactic platelet transfusion at 20,000 per microL, with approximately 20 percent each transfusing at higher and lower levels. A platelet count of 50,000 per microL was most frequently required for performance of a minor invasive procedure. The data from this study show that the majority of institutions use prophylactic platelet transfusion in both pediatric and adult hematology and/or oncology patients. However, there is considerable variation in platelet transfusion practice.

Procurement and transfusion of human immunodeficiency virus-positive or untested autologous blood units: issues and concerns: a report prepared by the Autologous Transfusion Committee of the American Association of Blood Banks.

Procurement and transfusion of human immunodeficiency virus-positive or untested autologous blood units: issues and concerns: a report prepared by the Autologous Transfusion Committee of the American Association of Blood Banks.