Fresh Whole Blood Transfusion Research Articles

Irradiation of Fresh Whole Blood for Prevention of Transfusion-Associated Graft-versus-Host Disease Does Not Impair Platelet Function and Clinical Hemostasis after Open Heart Surgery

Since our previous studies suggested that the transfusion of 1 unit fresh whole blood (FWB) after cardiopulmonary bypass (CPB) using a bubble oxygenator may provide hemostatic benefit equivalent to 8-10 units of platelet concentrates, we have routinely used FWB at the termination of CPB. Two patients who received FWB and developed transfusion-associated graft-versus-host disease (TA-GVFID) prompted us to investigate the effect of irradiation of FWB on platelet and clinical hemostasis. Twenty-four patients were randomized to receive either 1 unit FWB (12 patients), or 1 unit irradiated FWB (IrFWB, 1,500 cGy, 12 patients) after CPB. Platelet aggregation on extracellular matrix, studied by a scanning electron microscope and graded from 1 to 4 (from poor to excellent aggregation), was similar in both groups preoperatively [3.3±0.9 (FWB) and 3.5 ±0.5 (Ir FWB)], and at the end of CPB [1.8±1.2 (FWB) and 1.9±0.9 (IrFWB)]. Platelet aggregation was similar after transfusion of FWB (3.0±1.0) and after IrFWB (3.2±0.8), as was the increase in platelet count. Twenty-four hours total postoperative bleeding was similar (560±420 and 523±236ml for FWB and IrFWB, respectively). We conclude that irradiation of FWB for prevention of TA-GVHD does not impair platelet aggregating capacity, and can be used when blood is donated by the patient’s next of kin.

Con: Whole blood transfusions are not useful in patients undergoing cardiac surgery

Data supporting fresh whole blood transfusion or fresh component therapy are nonblinded, and although both are conceptually attractive, neither can be considered proven. Recent blinded studies reflect fresh blood ineffectiveness. Larger, blinded, randomized trials will need to be performed. Proven methods of blood conservation' 19, 20 as well as standardized criteria for transfusion of blood components 21 will more effectively decrease homologous blood transfusion. Transfusion of fresh or banked whole blood, or its components, has yet to be shown to decrease the usage of homologous blood products.

The potential use of monoclonal antibodies as therapeutic modalities in neonatal infection.

Group B streptococcal (GBS) and Escherichia coli infections are serious problems in human neonates. It is estimated that 11,000 cases of neonatal GBS disease occur per year in the US, resulting in 2600 deaths (1). In most series, GBS and E. coli account for approximately equal numbers of cases of neonatal sepsis and meningitis. Thus, over 20,000 cases of neonatal disease and 4000–5000 deaths occur per year owing to these two major bacterial pathogens. Approximately one-half of the survivors suffer significant sequelae. Thus, neonatal sepsis and meningitis are major health problems in this as well as in other countries throughout the world. Attempts have been made to improve methods for detecting and treating or preventing these infections, but to date these have not gained wide enough use to affect the problem significantly. The lack of opsonic antibody in human neonates is one major risk factor for the development of bacterial infection (2,3). In 1978, we (4) showed that the administration of fresh whole-blood transfusions, containing opsonic antibody, could be effective in decreasing mortality from GBS infection in human neonates. It was impossible to predict, however, whether blood donors would possess antibody to the bacterial strains causing infection. Furthermore, blood transfusion has significant risks, including transmission of infectious agents, such as hepatitis, cytomega- lovirus, and, more recently, the human immunodeficiency virus. Because of these problems, our group as well as others began to explore the possibility of using intravenous immunoglobulin (IVIG) in the therapy of experimental neonatal infection (5,6). These preparations had reasonable activity against less virulent GBS and E. coli strains, but almost no activity against more virulent strains, which produce or contain an excess of sialic acid in type-specific GBS or E. coli Kl antigens (7,8). Furthermore, significant lot-to-lot variation in antibody concentrations among the available IVIG preparations was detected (9). For these reasons, our group turned to the developing technology of making hybridoma antibodies as a way of producing more efficacious preparations for use in neonatal bacterial infection.KeywordsSialic AcidNeonatal SepsisNeonatal InfectionAntibody PreparationHuman NeonateThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Transfusion of fresh whole blood stored (4° C) for short period fails to improve platelet aggregation on extracellular matrix and clinical hemostasis after cardiopulmonary bypass

It has recently been shown that the hemostatic effect of 1 unit of fresh whole blood is equivalent to the effect of 8 to 10 platelet units. This study was designed to evaluate the effect of short periods of cold (4 degrees C) storage on the hemostatic effect of fresh whole blood transfusion in 36 patients immediately after cardiopulmonary bypass. Twelve patients (group A) received unrefrigerated fresh whole blood, 12 (group B) received fresh whole blood after 5 hours' storage at 4 degrees C, and 12 (group C) after 24 hours' storage at 4 degrees C. For evaluation of platelet function, a method with an extracellular matrix and an electron microscope was used. The platelet function was graded from 1 to 4, with grade 4 being normal aggregation. Postoperatively, group A patients bled less than groups B and C (267 +/- 42 versus 397 +/- 72 and 601 +/- 172 ml/24 hr, respectively, p less than 0.001) and therefore received fewer blood units (1.4 +/- 0.5 versus 2 +/- 0.9 and 3 +/- 1.4, respectively, p less than 0.01). Five patients of group A (42%) reached grade A aggregation after transfusion of unstored fresh whole blood, compared with two (17%) of group B and none (0%) of group C (p less than 0.01). Posttransfusion platelet count and mean platelet volume were not significantly different in the three groups. We conclude that storage at 4 degrees C, even for a short period of 5 hours, diminishes the hemostatic effect of fresh whole blood by decreasing platelet aggregability.

The effect of transfusion of fresh whole blood versus platelet concentrates after cardiac operations: A scanning electron microscope study of platelet aggregation on extracellular matrix

To evaluate the effect of fresh whole blood transfusion versus platelet concentrates transfusion on platelet aggregation after cardiac operations, 24 patients were randomized to receive either one unit of fresh whole blood (12 patients) or 10 platelet units (12 patients) after cardiopulmonary bypass. Platelet aggregation on extracellular matrix, platelet count, and mean platelet volume were studied preoperatively, at termination of cardiopulmonary bypass, after protamine administration, and after the transfusion of fresh whole blood or after transfusion of each two platelet units. Extracellular matrix produced by cultured bovine corneal cells closely resembles the vascular subendothelial basal lamina, and is an ideal in vitro model in the study of platelet interaction with the subendothelium. Platelet aggregation on extracellular matrix, studied by a scanning electron microscope, was graded from 1 to 4, wherein grade 1 represents nonactivated platelets and grade 4 a mature platelet aggregate. With this grading system, the two groups were similar in preoperative values (3.3 +/- 0.9 versus 3.7 +/- 0.4) and values after cardiopulmonary bypass (1.5 +/- 1.0 in both groups). One unit of fresh whole blood restored platelet aggregation on extracellular matrix to preoperative status (3.0 +/- 1.0), whereas eight platelet units were needed for the same result (3.2 +/- 0.8). One unit of fresh whole blood increased platelet count in a manner similar to that achieved by six platelet units and increased mean platelet volume to a level higher than that achieved by 10 platelet units. These results suggest that the effect of one unit of fresh whole blood on platelet aggregation after cardiopulmonary bypass is at least equal, if not superior, to the effect of 8 to 10 platelet units.

Serum opsonic activity and peripheral neutrophil counts before and after exchange transfusion in infants with early onset group B streptococcal septicemia.

Serum opsonic antibody activity and peripheral neutrophil counts were measured in 41 infants who received an exchange transfusion of fresh whole blood for early onset group B streptococcal septicemia. Immature and mature neutrophils increased significantly in the peripheral blood post-exchange transfusion among survivors. Increases in opsonic antibody levels did not reach statistical significance following exchange transfusion. It is possible that exchange transfusion with fresh whole blood may enhance mobilization of neutrophils in infants with adequate bone marrow storage pools. A prospective controlled study is required to evaluate properly the role of exchange transfusion in infants with group B streptococcal sepsis.

1022 EFFECT OF BLOOD TRANSFUSIONS ON GROUP B STREPTOCOCCAL ANTIBODY LEVELS

The morbidity and mortality rate from group B streptococcal infection continues to be exceedingly high even with the use of potent antibiotics and optimal support measures. In previous studies we suggested that transfusion of fresh, whole blood containing opsonic antibody might alter mortality in this fulminant neonatal disease (Lancet I: 636, 1978). In the present studies we have examined type specific streptococcal antibody levels and opsonic activity in 38 infants who received transfusions of fresh, whole blood. Thirty-three infants received donor blood containing higher levels of opsonic activity than in their own pre-transfusion specimen. Twenty of these infants had increased opsonic activity in their post-transfusion specimen. Among the 20 with increased levels, 18 received partial or complete exchanges amounting to 50% or more of their blood volume (mean 65 ± 7.2 SE%). The mean transfusion volume in the patients whose opsonic level did not increase was only 33 ± 7.5 SE%. Five patients received blood with lower opsonic activity than their own and all had decreased levels in post-transfusion specimens. The mortality rate in the 21 patients studied who had group B disease and received transfusion of fresh whole blood (14%) was exceedingly low. Thus, transfusion may significantly affect the outcome of group B disease.

BLOOD-TRANSFUSION IN GROUP-B STREPTOCOCCAL SEPSIS

Transfusion of fresh whole blood was evaluated as a means of supplying opsonins and lessening the high mortality of group-B streptococcal sepsis in neonates. Pre-transfusion and post-transfusion sera from 22 infants were examined for the presence of opsonins against group-B organisms. Opsonic activity rose only when donor blood containing heat-stable antibody was administered in high volume (>40% of blood-volume). 9 of 9 infants transfused with blood containing antibody to their infecting strain survived septic episodes. 3 of 6 who received blood lacking antibody to their infecting strain died.

Idiopathic thrombocytopenic purpura: report of case

A patient with classic symptoms of blood dyscrasia, specifically idiopathic thrombocytopenic purpura, failed to receive laboratory tests because the condition had gone undetected by a dentist and a physician. However, after the patient was given a provisional diagnosis supported by laboratory test results, one of the general treatment procedures for idiopathic thrombocytopenic purpura that consisted of a regimen of corticosteroids was instituted and was proved successful. More radical procedures, such as transfusions of fresh whole blood or of fresh platelets, or a splenectomy, were unnecessary. The responsibility of a dentist to detect oral changes that are not of dental origin is emphasized.

Presence of leukocytic antibodies in major thermal burns

Cytotoxic leukocytic antibodies were found in the serum of thirty-nine of forty-four persons with thermal burns. Antibody formation was rapid and unrelated to the thermal agent, patients' age and sex, or resuscitation fluid. It is postulated that these antibodies developed in response to leukocytes which were thermally damaged. Leukocytic antibodies may be an essential part of the inflammatory response to injury, but can cause edematous and febrile reactions when a transfusion of fresh whole blood is given. These laboratory findings may be of value to other investigators studying persons with thermal injuries.

Congenital Combined Deficiency of Factor V and Factor VIII

SummaryA case of congenital combined deficiency of factor V and factor VIII was reported. The patient, a 9 year old boy, gave a history of epistaxis, hematomas, and of hemorrhages following dental extraction since the age of 2 ; plasma levels of factor V and factor VIII were found to be 16% and 8% of normal, respectively. No one in his family had a deficiency of either factor. The effects of transfusion of normal fresh plasma and whole blood from a patient with hemophilia A were studied. While the former were similar to the pattern as seen in classical hemophilia, the latter consisted of an immediate increase of factor V activity and a delayed increase of factor VIII activity, despite the fact that factor VIII activity was almost absent from the donor’s blood.

Treatment by Transfusion of Severe General Radiation Injury in Dogs

The effects of transfusion of fresh whole blood were observed in 55 dogs exposed to 1,250 ± 100 r of continuous total body gamma radiation. Seven controls received the same basic care, fluids and antibiotics, but no transfusions. The amount of blood administered ranged from 100–150 ml in daily infusions through exchanges of seven liters or more repeated once or twice. Transfusion increased survival time but hazards were apparent. The anesthesia and surgical procedures required for the larger exchanges of blood led to complicating infections. Large amounts of fresh unirradiated blood induced early return of hematopoiesis apparently by implantation of cells present in the blood administered, but jaundice and serious liver injury also occurred, perhaps as a reaction of foreiga cells against their host. Best results were obtained by frequent non‐traumatic administration of small amounts of blood, roughly equivalent to one‐tenth the dog's blood volume daily. There were two long term survivors. One received irradiated blood and the other received blood from a litter‐mate.When histocompatibility is adequate, fresh blood can be used without irradiation and will hasten marrow recovery. When the histocompatibility of donor and recipient is unknown, frequent nontraumatic administration of irradiated fresh blood is helpful and free from injurious effects.

SURVIVAL OF TRANSFUSED DONOR MONONUCLEAR LEUKOCYTES DURING OPEN-HEART SURGERY.

IN 1962 Petrakis and Politis,1 utilizing tissue-culture methods, demonstrated that certain mononuclear leukocytes remained viable in stored human blood for as long as twenty-two days, with no significant change in viability for as long as twenty-four hours. It follows that donor mononuclear leukocytes are viable at the time of transfusion of short-term stored blood to the recipients. Recently, Seaman and Starr2 described a new entity, designated as "febrile post cardiotomy lymphocytic splenomegaly," occurring after open-heart surgery with the pump oxygenator, in which massive transfusions of fresh whole blood are employed. In 9 of 250 patients a typical syndrome of fever, . . .

An Effective Therapeutic Regimen for the Hemopoietic Phase of the Acute Radiation Syndrome in Dogs

A therapeutic regimen consisting in administration of large amounts of fresh whole blood when indicated to control bleeding, the judicious use of antibiotics to control infection, and parenteral fluids to combat dehydration was successful in reducing the mortatity from nine of ten untreated controls to two of ten in the treated group. The dogs were exposed to 400 r of h irradiation measured free in air at the position corresponding to the proximal skin surfface. It was found easier to control hemorrhage by fresh whole-blood transfusion than to control infection with antibiotice. Regeneration of the bone marrow as reflected by peripheral counts commenced on approximately the twenty-third to the thirtieth day postirradiation. The leukocytes appeared several days earlier than the platetets in all dogs. The rate of regeneration was different in the treated dogs and was slower in the four smaller dogs. The preirradiation-platelet, leukocyte, and red-blood-cell levels were not reached at the end of 100 days in these four dogs. The greater degree of effect seen in smaller dogs is discussed in terms of the greater tissue, or absorbed dose received by these animats with a given air-exposure dose. (auth)

Congenital absence of fibrinogen: A rare cause of oral bleeding

A case of congenital absence of fibrinogen (afibrinogenemia), which we believe is the twenty-fourth to appear in the literature, has been reported. The importance of accurately diagnosing this disease is obvious. Treatment consists of replacing that constituent of the blood which is deficient. For the control of bleeding, transfusions of fresh whole blood, fresh plasma, or thawed plasma that was frozen while fresh are recommended. The use of commercially prepared fibrinogen is not recommended.

Oral manifestations in a case of myelogenous leukemia and leukopenia: Report of a case

A case is reported in which we were in a position to observe a patient with a chronic myelogenous leukemia convert to an aleukemic phase, with severe leukopenia becoming progressively more acute. It was in the stage of leukopenia that the oral lesions and persistent hemorrhage appeared and necessitated emergency treatment. Following frequent transfusions of fresh whole blood from a patient with a polycythemia, the blood picture improved and the white blood count showed a steady increase until it was over 2,000 cells per cubic millimeter, at which point the hemorrhage ceased and healing of the lesions took place.