Donor Blood Units Research Articles

A New Score to Determine the Probability of Finding An HLA Identical Unrelated Donor: A Promising Efficient Time and Cost Saving Method,

Abstract 4188 Introduction:We recently demonstrated that a delayed time to find a compatible donor and also to proceed to allogeneic-HSCT can worsen the disease outcome (Michallet et al. ASH 2010). When a patient is presenting at our hospital for unrelated allogeneic-HSCT a donor search on the Bone Marrow Donor Worldwide (BMDW) registry is done, this query is limited to only 2-digits HLA typing of -A, -B, -DRB1 or -DQB1 loci. The identification of a compatible unrelated donor can be very long and expensive because of the limited HLA typing information in the registries. Tiercy et al. developed a computerized software that predicts the chance to find a suitable donor (BMT 2007, 40; 515–522) and the French transplant registry has recently developed a software called “Easy Match” that predicts the number of compatible donors for a given patient. Aims:To refine and accelerate the process of donor search by combining the results of Tiercy score and EasyMatch applied on patients already received allogeneic-HSCT and define a new score for donor finding probability, in order to be time- and cost-efficient. Material and methods:We retrospectively analyzed 104 adult and 34 pediatric patients who underwent allogeneic-HSCT between 2009 and 2011 after finding an unrelated donor (identical or not) or cord blood units. Firstly, we analyzed the HLA characteristics of each patient as previously described by Tiercy et al. to provide a HLA score with low, intermediate or high probability to identify a suitable identical donor.Then, we used the EasyMatch software which realize a “qualitative” analysis that consist on checking that each HLA recipient phenotype was found among all possible pair wise combinations of 2 haplotypes of the different sets of haplotypes. Various “quantitative” analyses calculated the likelihood associated to each recipient phenotype for a given set of HLA genes, in a given population, at low versus high resolution typing. The EasyMatch software gives for each patient a number of potential donors sharing the same phenotype as the patient. Results:Our 138 patients were classified in 5 different categories (A to E) according to the combined results of the HLA score (Tiercy) and the EasyMatch software (Table). [Display omitted] The results of the combination of the two methods associated to the characteristics of our population, allowed the definition of a new scoring system applicable to each patient. Score 0(group A): 0% of chances to identify a 10/10 identical donor for the recipient. The choice of the source will be defined considering the HLA characteristics of the recipient; in case of class I rare allele or rare HLA-BC linkage disequilibrium; a cord blood unit will be easier and more rapidly available. A complementary help should be given by an associated analysis with 4-digit haplotypes as defined by Maiers (Human Immunology 2007, 68; 779–788). Score 1(groups B and C): about 50% of chances to identify a suitable 10/10 identical donor. Score 2(groups D and E): from 75 to 100% of chances to identify a suitable 10/10 identical donor.In conclusion, the use of this new scoring system allows time and cost spare. In case of low chance to find a donor, physicians can have a fast redirection to find another treatment alternative in order to maintain optimal results. Disclosures:No relevant conflicts of interest to declare.

149-P Historical be the match registry HLA match rates for adult donor and cord blood units (CBU) from the inception of the registry

149-P Historical be the match registry HLA match rates for adult donor and cord blood units (CBU) from the inception of the registry

Adoptively Transferred Expanded Natural Killer Cells Inhibit Myeloma Tumor Growth In Vivo.

Abstract 953Recently developed culture conditions for expanding and activating natural killer (NK) cells may improve immunotherapeutic options for patients with multiple myeloma. We have previously shown that co-incubation of NK cells from multiple myeloma patients and healthy donors with K562 cells genetically modified to express membrane-bound interleukin 15 and the co-stimulatory molecule 41BBL (K562-mb15-41BBL) leads to a dramatic increase in both NK cell number and anti-myeloma activity in vitro. In this study, we tested the anti-myeloma activity of these expanded NK cells in vivo using a murine model, which supports the growth of myeloma cells in a microenvironment that reproduces that of the human bone marrow. We first implanted human fetal bones subcutaneously into NOD/SCID/IL2Rγ null mice and allowed them to engraft. Luciferase transfected OPM2 myeloma cells were then injected into the human bone fragment. Tumor burden was followed by bio-imaging and ELISA for human Ig. NK cells were expanded from healthy donor PBMC by co-culture with irradiated K562-mb15-41BBL cells in the presence of 300U/ml IL2 for 10-12 days. Myeloma tumor bearing mice were dosed 6-7 days after OPM2 injection (bio-imaging confirmed myeloma engraftment) with expanded NK cells via tail vein injection followed by subcutaneous IL2 to prolong NK cell survival. Flow cytometry was used to track the human NK cells in blood. Histology was performed by H&E staining of formalin-fixed, paraffin embedded tissues harvested at the end of the study. Sufficient NK cells (3×109) for dosing mice were obtained from one unit of healthy donor blood and their ability to kill OPM2 myeloma was confirmed in vitro by chromium release assays. In experiment 1, OPM2-bearing mice received two tail vein injections, 48h apart, comprising PBS, 4 ×107, or 16 ×107 (total dose) expanded NK cells with 100U IL2 given twice per week. We observed significant myeloma growth inhibition in the cohort given 16 ×107 NK cells (p<0.04) and circulating human NK cells could be detected up to day 21 post-administration. Measurement of tumor burden by bio-imaging and ELISA were highly concordant (correlation coefficient = 0.995). Histologic analyses confirmed a dramatic reduction in tumor burden in the mice treated with expanded NK cells and revealed that bone loss was more pronounced in the implanted fetal bones of the control cohort not receiving NK cells. We observed in a subsequent experiment that increasing the IL2 dose to 1000U daily led to in vivo expansion of CSFE-labeled NK cells of up to 10 generations by day 6 post-infusion, which was associated with an enhanced anti-tumor effect in the 16 ×107 dose cohort. Furthermore, we found that multiple injections of NK cells (four injections of 4 ×107 NK cells versus two injections of 8 ×107) were better tolerated in the highest dose cohort (3/3 surviving versus 6/12 surviving). In conclusion, we observed a significant anti-myeloma effect against the aggressive plasma cell leukemia cell line OPM2 with expanded NK cells and low dose IL2. Adjusting the IL2 dose to 1000U daily led to in vivo expansion of NK cells, longer term NK cell persistence, and an increased anti-myeloma effect. Importantly, this IL2 dose is comparable to the 3×106 U daily dose well tolerated in a previous trial with non-expanded NK cells in humans. Single doses of NK cells >8×107 led to high morbidity in this model while multiple doses of 4×107 were well tolerated. Experiments are in progress testing the in vivo effect of expanded NK cells on primary myeloma cell tumors in this model. Our findings support the planned clinical application of ex vivo expanded NK cells. Disclosures:No relevant conflicts of interest to declare.

High Impact of Human Leukocyte Antigen Matching On Overall Survival and Transplant Related Mortality in Allogeneic Hematopoietic Stem Cell Transplantation for CLL: Long-Term Study From the EBMT Registry.

Abstract 2286Poster Board II-263 Background:The outcomes of related and unrelated donor hematopoietic stem cell transplantations (HSCT) are strongly affected by the degree of human leukocyte antigen (HLA) matching between the transplant recipient and the donor or cord blood unit. HLA matching plays an important role in engraftment, incidence and severity of graft-versus-host disease (GVHD) and also in overall survival; although this factor is still not validated yet in many hematological malignancies. Objective:To evaluate the impact of HLA matching and difference in matching degree among transplants from unrelated donors (UD) on different outcomes in chronic lymphocytic leukemia (CLL). Materials & methods:We have analyzed 370 CLL patients who underwent an allogeneic HSCT reported to the EBMT registry. There were 280 males (75%) and 90 females with a median age of 53 years (24-69). Forty-five patients (12%) have received a previous HSCT. At transplant, 294 among 317 evaluated patients had a good performance status (PS) (93%), 43 patients were in CR (12%), 160 in PR (46%), 44 in SD (13%) and 103 in PD (29%) among 349 evaluated patients. Two hundred and sixty six patients received a reduced intensity conditioning regimen (RIC) and 103 a standard (Std) conditioning; 313 patients received PBSC, 56 BM and 2 cord blood cells from 198 HLA siblings, and 172 unrelated donors (UD). There were 136 (36%) sex-mismatched (91 F/M and 45 M/F), 150 pairs (40%) had an ABO incompatibility (61 minor, 89 major) and for CMV: 78 pairs were +, 146 - and 111 mixed. The median interval between diagnosis and transplantation was 53 months (3-308). According to the registry, there were 198 HLA siblings, 135 matched UD (MUD) and 37 mismatched UD (MMUD). We focused on UD and re-analyzed all HLA typings for patients and donors, after classification we found: 24 well matched (10/10 in high resolution), 28 partially matched (7/7, 8/8 or 9/9 in high resolution), 30 matched in low resolution and 90 mismatched in high resolution, which was different from the registry classification. Results:After transplantation, 359 patients engrafted, 199 developed an AGVHD (gr I: 74, gr II: 79, gr III: 29 and gr IV: 17) and 171 presented a cGVHD (83 limited and 88 extensive). The cumulative incidence of AGVHD for the total population was 22% for gr II and 13% for gr > II. [Siblings: 19% and 12%; well & patially matched: 37% and 10%; low resolution & MMUD: 19.6% and 15.3% for grII & gr > II respectively]. At 1 year after transplant for the total population, the cumulative incidence of limited and extensive cGVHD was 17 % (15-19) and 18.4% (16.4-20.4)[ Siblings: 16.2% (13.6-19) and 17.2% (14.5-20); well & patially matched: 23% (17.2-29) and 23.1% (17.2-29); low resolution & MMUD: 15.8% (12.3-19.1) and 18.3% (14.8-21.8)] respectively. With a median follow up of 48 months, the probability of 3 and 5-years overall survival (OS) for the total population were 62% (56-67) and 52% (45-57) respectively. We found a high significant difference in term of OS between the siblings, well & partially matched groups versus low & MMUD groups (p=0.002) (figure 2). [OS at 3 & 5 years; Siblings: 68.3% (61.8-75.5) and 57.2% (49.8-65.6); well & patially matched: 60.8% (47.6-77.7) and 53.3% (39.2-72.4), low resolution & MMUD: 49% (40.3-59.5) and 38.5% (29.5-50.2) respectively]. We observed also a high significant difference in term of transplant related mortality (TRM) between the same groups (p=0.0022) (figure 4). The multivariate analysis using Cox model studying age, pre-transplant status; gender, PS, cells source, ABO compatibility, conditioning and different HLA groups, showed a significant impact of 4 factors on OS: age: HR=1.04 (1.01-1.6) p=0.001, disease status (PD): HR=3.08 (1.2-7.1) p=0.02, PS: HR=2.37 (1.1-5.1) p=0.02 and HLA MMUD group: HR= 1.62 (1.02-2.59) p=0.03. The same factors were also highly significant in multivariate analysis in term of TRM (age: HR=1.04 (1.001-1.07) p=0.009, disease status (PD): HR=5.49 (1.29-23.4) p=0.02, PS: HR=3.8 (1.7-8.4) p=0.01 and HLA MMUD group: HR= 1.9 (1.07-3.37) p=0.02. Conclusion:This large retrospective analysis pointed out the high impact of HLA matching in terms of OS and TRM (in addition of age, disease status and PS), without any difference between HLA siblings, MUD and partially matched groups. Moreover, we demonstrated the importance of HLA classification when registering patients in the EBMT registry and its impact on different outcomes. [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Erythroid cells in vitro: from developmental biology to blood transfusion products

Red blood cells (RBCs) transfusion plays a critical role in numerous therapies. Disruption of blood collection by political unrest, natural disasters and emerging infections and implementation of restrictions on the use of erythropoiesis-stimulating agents in cancer may impact blood availability in the near future. These considerations highlight the importance of developing alternative blood products. Knowledge about the processes that control RBC production has been applied to the establishment of culture conditions allowing ex-vivo generation of RBCs in numbers close to those (2.5 x 10 cells/ml) present in a transfusion, from cord blood, donated blood units or embryonic stem cells. In addition, experimental studies demonstrate that such cells protect mice from lethal bleeding. Therefore, erythroid cells generated ex vivo may be suitable for transfusion provided they can be produced safely in adequate numbers. However, much remains to be done to translate a theoretical production of approximately 2.5 x 10 RBCs in the laboratory into a 'clinical grade production process'. This review summarizes the state-of-the-art in establishing ex-vivo culture conditions for erythroid cells and discusses the most compelling issues to be addressed to translate this progress into a clinical grade transfusion product.

A Case in Point

Together with my wife, we read this article on the cost that might be saved by not performing group and save prior to elective breast cancer surgery. She had just had elective breast cancer surgery. She was having completion left mastectomy and right mastectomy following previous lumpectomy with sentinel node biopsy (November 2007) and subsequent level 2 left axillary clearance surgery (December 2007) for a grade 3 left breast cancer 1.5 cm with one micrometastasis and one metastasis confirmed in the axilla. ER and PR were both strongly positive, Herceptin negative. She completed 4 cycles of Epirubicin and 2.5 cycles of 4 scheduled of CMF complicated by Mycobacterium chelonae infection of her Hickmann line causing a severe atypical pneumonia. She was on a 3-month course of clarithromycin following on initial clarithromycin/ciprofloxacin/meripenem/ linezolid by infusion which brought rapid improvement in condition, as species were resistant to all except clarithromycin. Her tumour had arisen in an area of previous irradiation fields for Hodgkin' lymphoma treated in her early 20s (she had 4 relapses). She had been under follow-up in the local MR breast scanning screening programme started for long-term Hodgkin' survivors but sadly her lesion was not identified and she found the lump herself. At 6 h postoperatively, she had severe sudden haemorrhage with blood pressure dropping to 60/? and tachycardia of 120 requiring return to theatre. She was transfused with two units of irradiated blood of her own blood group (as previously grouped and saved) and had a further unit of irradiated universal donor blood. She had only recently found out re TA-GvHD from Lymphoma Matters (quarterly newsletter from the Lymphoma Association, Issue 74, Summer 2008) and also having come across the NHS leaflet Information for patients needing irradiated blood. (Blood for Hodgkin' disease patients is irradiated to prevent the life-long risk of graft versus host disease.) We were grateful for the rapidity of response of her surgical team and the availability of blood, otherwise her outcome may not have been so good. We would disagree with the assertion that money can be saved by not doing group and save for patients for elective breast cancer surgery as potentially losing the life (or having a significant hypotensive complication) of a comparatively young patient for lack of transfused blood would easily involve the clinicians/hospital involved in expensive litigation!

Pilot study of oxygen transport rate of banked red blood cells

Dynamic oximetry provides a new way to assess the effect of blood storage on the oxygen transport rate (OTR). In dynamic oximetry, the rate at which oxyhemoglobin becomes deoxyhemoglobin is measured optically, thereby, indirectly measuring the rate at which oxygen leaves the red blood cell (RBC) making it available for transfer to tissues. Extending the physiologic diffusion time in an in vitro apparatus, consisting of a diffusion system and gas exchanger capable of controlling the surface area and the time of exposure for oxygenation and deoxygenation, makes OTR measurement feasible. Eight normal blood donor units, collected in adenine, dextrose, sorbitol, sodium chloride and mannitol , were stored for 8 weeks under standard conditions and serially sampled for OTR. We report that the OTR at the time of blood bank donation appears to be singular for each donor, that the interdonor differences are maintained over time, and that the individual OTR increased 1.72-fold (95% CI 1.51, 1.95) over 8 weeks, adjusting for sex, age and plasma cholesterol level. Oxygen transport rate increases during storage; blood units with similar haemoglobin content may have significant differences in OTR. Studies examining blood parameters at the time of donation and blood storage on patient outcomes should consider measuring OTR, as it may contribute to differences in observed efficacy of tissue oxygenation.

Prospective study of the meaning of indeterminate results of the recombinant immunoblot assay for hepatitis C virus in blood donors.

The interpretation of "indeterminate" results of the recombinant immunoblot assay (RIBA) is a particularly sensitive issue for Transfusion Services, and donors with such a serological condition require long-term follow-up. In the Immunohaematology and Transfusion Medicine Division of Umberto I University Hospital (Rome, Italy), 102,979 donor blood units were screened for hepatitis C virus (HCV) antibodies by enzyme-linked immunosorbent assay (ELISA) over a 5-year period (01.01.2000 - 31.12.2004). Since 24.10.2001, HCV-RNA testing was added. All samples repeatedly reactive by ELISA were then submitted to a HCV confirmatory assay (RIBA). Among the 102,979 donors we found 271 positive to HCV ELISA testing. The results of the RIBA assay for these donors were negative in 178 (65.7%) cases, positive in 28 (10.3%) and indeterminate in 65 (24.0%). Of the 65 subjects with an indeterminate pattern, 24 completed a sufficient follow-up (median 25 months; range, 6 - 52), during which some (n = 8; 33%) converted to a negative status, some (n = 16; 67%) maintained their reactivity pattern, but none became seropositive for HCV. The HCV-RIBA indeterminate status may indicate either a non-specific reaction (false positive) or a real pre-existing or initial infection and does not, therefore, enable a prediction of outcome. The use of HCV genomic assays (nucleic acid amplification testing), which are more specific than antibody-based assays (ELISA, RIBA), therefore improves HCV blood donor testing by allowing an accurate interpretation of such primary assays.

Survey of Hepatitis Markers Among Donors in the State of Qatar

A total of 78,428 blood units collected by the Blood Donor Unit, Hamad Medical Corporation, Doha, from the multinational donors of Qatar (28,622 Qatari nationals donors and 49,806 Non-Qatari donors) in the period January 1994 to Dececember 2001 were screened for hepatitis markers. About 10,382 units (13.2%) were discarded because of positivity for one or more hepatitis markers; 769 units (0.9%) were positive for hepatitis-B surface antigen (HBsAg), 8516 units (10.9%) were positive for hepatitis-B core antibodies (HBcAb) and 1097 units (1.39%) were positive for hepatitis C (HCV) antibodies. There was no significant difference between the rate of positivity for HBcAb and HBsAg in indigenous Qataris and Non-Qataris despite a slightly higher rate ofpositivity for HCV antibodies in the Non-Qatari group. An outstanding finding was the significantly high rate of positivity for HCV antibodies in Egyptian donations (11.2%), which accounted for 31.2% of all discards for the Non-Qatari group. As the Blood Donor Unit at HMC is the only blood collection center in Qatar it is assumed that the results could be representative of the country as a whole.

Improved detection of acute parvovirus B19 infection by immunoglobulin M EIA in combination with a novel antigen EIA

Although parvovirus B19 is a significant blood product contaminant, few methods other than polymerase chain reaction (PCR) have been developed to detect the presence of the virus. A B19 antigen enzyme immunoassay (EIA) has been developed and the sensitivity of detection is ascertained using dilutions of the B19 capsid protein VP2 and 10-fold dilutions of B19 viraemic serum. Once the assay cut-off was established, a panel of viraemic donations (n = 70) was screened by the antigen EIA. The B19 immunoglobulin M (IgM) and IgG status of these specimens was also determined. During screening of blood donor units by quantitative PCR, 70 individuals were identified with levels of B19 DNA greater than 10(6) IU/ml at the time of blood donation. The sensitivity of the B19 antigen EIA was estimated to be equivalent to between 10(8) and 10(9) IU/ml B19 DNA or 1-10 pg/ml of recombinant capsid protein. B19 detection was significantly enhanced when viraemic specimens were pretreated with a low pH proprietary reagent. Unlike other virus-detection assays, detection of the B19 antigen was not affected by the presence of B19 IgM or IgG antibodies. In addition, the assay was capable of detecting all three genotypes of human erythrovirus. Combined specimen analysis by the B19 antigen assay and a B19 IgM assay facilitated the detection of 91% of acute B19 infections in the test population. In combination with B19 IgM detection, application of the B19 antigen EIA is a flexible and efficient method of detecting recent B19 infection and can be used as an alternative to PCR.

Cochrane review: Late erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants

Cochrane review: Late erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants

Risk of transfusion-transmitted hepatitis C virus in a tertiary hospital in Nigeria

To evaluate the risk of probable iatrogenic hepatitis C virus (HCV) infection following transfusion of donor blood that has not been screened for HCV. Prospective study. Screening for human immunodeficiency virus and hepatitis B virus is routine in the University of Benin Teaching Hospital. HCV screening was performed on transfused bags of donor blood selected at random. The detection of anti-HCV was based on the principle of double antigen sandwich immunoassay, in which purified recombinant antigens are employed sufficiently to identify anti-HCV. The outcomes of interest included the proportion of HCV-positive units of transfused donor blood, the source of blood and the total number of units of blood processed in the hospital blood bank. A total of 4532 units of donor blood were procured in the blood bank. Of these, 4132 units were certified as fit for transfusion following the hospital protocols. The sources of the transfused blood samples were commercial blood donors [89.2% (n = 3687)] and targeted donation [10.8% (n = 445)]. One hundred and ninety-two transfused blood samples were randomly screened for HCV, and 3% (n = 6) were found to be positive (95% confidence intervals 0.007-0.06). The likely risk of iatrogenic transfusion-related HCV infection was estimated to be 129 cases/year at the present rate of utilization of donor blood at the University of Benin Teaching Hospital. There is a risk of iatrogenic transfusion-transmitted HCV in the study hospital. Hospitals in Nigeria should screen for HCV prior to allogeneic transfusion, which may help in avoiding transfusion-related HCV and its probable long-term effects.

Preoperative autologous blood donation for bone marrow harvests: Are we wasting donors' time and blood?

Predeposit autologous blood donation (PAD) is frequently offered to bone marrow donors, but its cost-effectiveness is dubious. We assessed the impact of PAD and bone marrow donation on transfusion requirements; and the use of donated blood units in a retrospective study of 61 bone marrow donors. The mean haemoglobin (Hb) concentration fell from 12.9 to 11.8 g dL(-1) in women who predonated one unit and from 13.2 to 10.9 g dL(-1) in those who predonated two units. In men who donated two units of blood, the Hb concentration decreased to 12.9 g dL(-1). Bone marrow harvest led to a further decline in Hb concentration by 2.3 g dL(-1) in women and by 2.4 g dL(-1) in men. The postharvest Hb fell to <or=9.0 g dL(-1) in 39% of female and in 6% of the male donors; all but one of them had predonated blood. The utilization rate of autologous units was 45.6%, with 55% of women and 24% of men receiving autologous blood. In females, 59% of transfused autologous units were given with the donor's Hb of >or= 9.0 g dL(-1); overtransfusion was even more apparent in men: 71% units were given with a Hb >or= 10.0 g dL(-1). PAD in bone marrow donors is associated with high wastage and increases the likelihood of requiring a transfusion. We recommend that PAD should not be routinely offered to bone marrow donors.

A semi-automated technique for the isolation of live lymphocyte suspensions from peripheral blood.

Abstract A semi-automated method has been devised for the separation of viable human peripheral blood lymphocytes from standard units of donor blood. The tech- nique is based on the carbonyl iron method (Levine, 1956; Cassen, Hitt, and Hays, 1958), but using a continuous-flow system. Lymphocytes harvested by this technique have been used in the production of heterologous antilymphocytic serum (ALS).

The risk of transfusion-transmissible viral infections in the Niger-Delta area of Nigeria

Background and objectives: Million\'s of lives are saved each year through blood transfusion. Nevertheless people have increased risk of becoming infected with transfusion - transmissible viral infections through transfusion of blood and blood products that have not been tested correctly. This study was undertaken to determine the risk of transfusion- transmissible viral infections through transfusion of unscreened blood and blood products. Methodology: Human Immunodeficiency Virus (HIV), Hepatitis B surface antigen (HBsAg) and antibodies to Hepatitis C virus (anti-HCV) screening was performed on 1500 consecutive blood donors in the University of Port-Harcourt Teaching Hospital, Rivers State, Nigeria. Results: Of the one thousand five hundred blood donors screened, 15 (1%), 17 (1.1%) and 7 (0.5%) of donors had HIV, HBsAg and anti-HCV respectively. 12 (0.8%) had HIV-1 infection, 2 (0.1%) had HIV-2 while 1(0.07%) had dual HIV 1 and 2 infection. Two (0.1%) had co-infection of HIV and HBV. The highest HBsAg and anti-HCV burden occurred in the 18-27 years age group, 12/1026 (1.2%) and 7/1026 (0.7%) respectively, while the 28-37 years age group accounted for the highest infection burden for HIV 7/362 (1.9%). Males accounted for the highest infection burden for HBV 17/1481 (1.1%) and anti-HCV 7/1481 (0.1%) while female donors had the highest HIV prevalence 1/19 (5.3%). Commercial remunerated donors showed the highest HIV, HBsAg and anti-HCV infection rates (1.4%), (1 .7%) and (0.8%) respectively. Conclusion: This study confirms a high prevalence of transfusion-transmissible viral infections among blood donors and describes the groups that are at risk. This calls for the immediate implementation of a mandatory universal donor screening policy for screening all blood donor units intended for transfusion, the setting up of a national blood transfusion service, run on the basis of voluntary non remunerated, low risk blood donors, and health eduction of the entire Niger Delta area aimed at behavioural change from high risk behaviour that makes people vulnerable. Keywords : blood donors, transfusion, viral infection, Niger-Delta, Nigeria Sahel Medical Journal Vol. 8(1) 2005: 16-19

PMEA Polymer-Coated PVC Tubing Maintains Anti-Thrombogenic Properties during in vitro Whole Blood Circulation

Poly(2-methoxyethylacrylate) (PMEA) is a new coating material that appears to reduce protein and platelet adsorption. However, the exact performance of PMEA coated circuit remains to be revealed in well-controlled experiments. Therefore, we compared its hemocompatibility with covalent-bound heparin-, and non-coated circuits during 6 hours of in vitro circulation, using donor blood from six volunteers. In our model, simple tubing circuits containing one-way ball valve were placed on the rotary table, which moved alternatively to generate pulsatile recirculation of heparinized human blood inside the tubing. Using this model, we expected fine assessment of the material surface, because we could reduce blood damage by avoiding air and a blood pump. Moreover, the small capacity of circuit allowed us to compare three kinds of circuits using a single unit of donor blood, eliminating effects by possible variations between blood donors. The anti-thrombin capacity of the PMEA-coated circuits was maintained even after six hours blood circulation, whereas surface thrombin generation increased markedly after use in non-coated circuits (P<0.05). Deposition of fibrin onto PMEA circuits was reduced more than 30% compared with heparin and non-coated circuits (P<0.05). However, the increase of plasma Factor XIIa was similar in all circuits. Increase of CD11b expression on circulating leukocytes and of plasma C3a was ameliorated in the heparin- and PMEA-coated circuits (P<0.05). PMEA-coated circuits appear to maintain their anti-thrombogenicity during use, otherwise PMEA-coated and heparin-coated circuits showed a similar character in hemocompatibility. This long-standing anti-thrombogenicity might be attributable to less adsorption of activated blood components onto the surface.

Schistosoma infection inhibits cellular immune responses to core HCV peptides

Patients coinfected with hepatitis C virus (HCV) and the trematode, Schistosoma mansoni, have an increased incidence of viral persistence and accelerated fibrosis. To investigate immunological mechanisms responsible for this more aggressive natural history of HCV, the core HCV-specific T-cell responses were analysed in 44 donated blood units rejected because they had antibodies to HCV (anti-HCV). Half also had anti-S. mansoni antibodies, evidence of past or active infection. HCV-specific ELISPOT responses were examined using pools of 180 overlapping 9-mer peptides with offsets of one covering the core of HCV genotype 4a. Comparison of T-cell responses in blood units positive for both anti-HCV and anti-Schistosoma antibodies with blood units positive only for anti-HCV antibodies showed a significant decrease in core-specific T-cell IFN-gamma (505+/- 46 vs. 803 +/- 66 ISC/10(6) cells, P < 0.001), IL-4 (2 +/- 108 vs. 641 +/- 131 ISC/10(6) cells, P < 0.001), and IL-10 (159 +/- 105 vs. 466 +/- 407 ISC/10(6) cells, P < 0.002) responses. In contrast, there was no significant difference in cell-mediated immune response (CMI) to PHA mitogen between these two groups. Therefore, we concluded T cells from persons with anti-Schistosoma have reduced IFN-gamma, IL-4, and IL-10 secreting HCV-specific T-cell responses. This may explain why Schistosoma coinfection increases persistence and severity of HCV infection.

Donor Blood Procurement and Utilisation at the University of Benin Teaching Hospital, Benin City

Banked blood is a limited resource in Nigeria. We sought to evaluate factors that may further limit the effective utilisation of donor blood in a tertiary hospital in Benin City. The records of the blood transfusion unit of the hospital were studied to identify the methods of blood procurement and utilisation from January 1, 2000 to December 31, 2002. A total of 11,021 units of blood were received in the blood transfusion unit within this period out of which 1491 (13.5%) donor blood samples were found unfit for transfusion and, hence, discarded. Commercial blood donation accounted for 95.3%, compared to 4.7% from replacement and volunteer donors. Commercial blood donation was a major risk factor for likely disposal of donor blood (chi2 = 74.3, p < 0.0001, OR = 21.1. 95% CI = 7.8-56.7). Expired units of blood with low PCV were discarded for lack of infrastructure to fractionate and store them. Over 0.8million naira (US$6000.00) is wasted annually on discarded units of donor blood mainly from commercial donors. A policy on blood procurement to include subgroup selection of donors and improved funding of blood banking services may enhance efficient and effective utilisation of donor blood.

A randomized trial of aprotinin (Trasylol) on blood loss, blood product requirement, and myocardial injury in total arterial grafting

Background Total arterial grafting is increasingly preferred in coronary artery bypass grafting, but it increases blood loss. Aprotinin (Trasylol; Bayer Corp, Leverkusen, Germany) reduces blood loss in cardiac surgery but has not been subjected to a randomized trial in total arterial grafting. Methods A single-center, randomized, double blind, placebo-controlled trial of aprotinin administration in total arterial grafting was performed. The primary outcome variable was postoperative blood loss, and the secondary outcome variable was the number of units of donor blood or coagulant products transfused. The incidence of myocardial injury was determined from serial measurements of cardiac troponin T and creatine kinase-MB and renal injury from serum creatinine. Results The placebo group (n = 34) and aprotinin group (n = 36) were similar with respect to all preoperative and intraoperative comparisons. One patient in each group underwent reexploration for bleeding. Open-label aprotinin was administered to 9 patients in the placebo group (26%) and to 2 patients in the aprotinin group (6%). There was a highly significant reduction in the median (interquartile range) blood loss in the aprotinin group compared with the placebo group (785 mL [590-1025 mL] vs 1525 mL [1175-1920 mL], respectively). Similarly, the aprotinin group demonstrated a marked reduction in the need for blood transfusion (77% vs 39%; P = .0001), the mean number of transfused blood units (2.6 vs 0.8, P < .001), and the number of patients requiring coagulant products (24% vs 3%; P < .001). There was no difference in myocardial injury in the 2 groups. Four patients in the aprotinin group had persistently elevated creatinine levels in the postoperative period (3 of whom had elevated preoperative creatinine levels and perioperative complications). Conclusions Aprotinin significantly reduces blood loss and the need for blood component transfusion in patients undergoing total arterial grafting without increasing the risk of myocardial injury. Aprotinin should be considered routinely in patients undergoing total arterial grafting but cautiously in patients with an elevated preoperative creatinine level.

Alanine aminotransferase cut-off values for blood donor screening using the new International Federation of Clinical Chemistry reference method at 37 degrees C.

Serum alanine aminotransferase (ALT) determination is recommended, or even required by law, in the screening of blood donors in many countries, and donors with an increased catalytic activity of ALT are excluded from blood donation. In most countries, the ALT cut-off value for blood donor screening for men and women is twice the upper limit of the normal range. The introduction, in 2002, of the new International Federation of Clinical Chemistry (IFCC) reference method, performed at 37 degrees C, required new ALT reference values to be established for healthy individuals and a new cut-off point to be determined for blood donor screening. We compared ALT values of donor blood units using the previous German standard method, which measures ALT values at 25 degrees C, and the new IFCC reference procedure, where ALT levels are measured at 37 degrees C. We found a linear correlation between the ALT values obtained by the method at 25 degrees C and the new IFCC reference method (37 degrees C) (r = 0.983), and a gender- and age-independent ratio of 0.523. Using this ratio we calculated the new ALT cut-off for blood donations and now propose a new upper limit of 132 U/l (2.20 microkat/l) for men and 86 U/l (1.43 microkat/l) for women. Only 220 of 151 678 blood donations collected over a period of 5 years showed an ALT value higher than the cut-off. None were hepatitis C virus (HCV) positive in serological or nucleic acid amplification technology (NAT) assays. Only 0.006% of all blood donations were positive for antibody to HCV and thus excluded. With the implementation of the new IFCC reference method for ALT determination at 37 degrees C, we propose a new ALT cut-off for blood donor screening, which, for men, is about three times the upper limit of the normal range and for women about 2.5 times. Our results show that a lower cut-off would probably not yield a higher safety of blood products in terms of detecting viral infections, but would result in a loss of approximately 0.75% of suitable blood donors.