Christoph Buchta

Anti‐D immunization by DEL red blood cells

BACKGROUND: No data are available on the immunogenicity of extremely weak D variants called DEL. Evaluation of alloanti‐D formation in a D– female patient after transfusion of apparently D– blood from an Austrian donor led to discovery of a so far unknown DEL type.

Stability of coagulation factors in thawed, solvent/detergent-treated plasma during storage at 4 °C for 6 days

Background and Objectives  Transfusion of fresh‐frozen plasma is still a pillar in emergency medicine for using to prevent dilutional coagulopathy or disseminated intravascular coagulation after severe blood loss, but thawing procedures can delay its availability. On the other hand, the wastage of plasma, once thawed and not transfused within a defined time‐period, represents an inefficient handling of economic resources and is contradictory to blood donor intentions. In this study we investigated the stability of coagulation factor activities and plasma protein levels during 6 days of storage of thawed solvent/detergent (S/D)‐treated plasma at +4 °C. Our results may form the basis for reconsideration of expiry times of thawed S/D‐treated plasma.

Reduction of adverse citrate reactions during autologous large‐volume PBPC apheresis by continuous infusion of calcium‐gluconate

BACKGROUND:  Citrate‐related side effects are common adverse reactions during PBPC apheresis. To reduce the incidence of citrate‐related reactions, the effect of a continuous calcium‐gluconate infusion on the appearance of hypocalcemic symptoms and on the subjective tolerance toward large‐volume leukapheresis (LVL) was tested.

Application of platelet-rich plasma for enhanced bone regeneration in grafted sinus.

PURPOSE The present study was conducted to evaluate the effect of platelet-rich plasma (PRP) on new bone formation and remodeling after grafting of the maxillary sinus with an algae-derived hydroxyapatite AlgOss/C Graft/Algipore. MATERIALS AND METHODS Fourteen consecutive patients with severely atrophic maxillae underwent uni- or bilateral grafting of the maxillary sinus with a mixture of collected bone, algae-derived hydroxyapatite AlgOss/C Graft/Algipore (ratio 1:10), and a combined addition of PRP and thrombin (Tissucol Kit; Baxter, Vienna, Austria) to allow for fast clotting. After an average healing period of 7.1 months bone samples were retrieved. Patients from a former consecutive series treated without PRP served as control group. Statistical analysis was done by Welch 2-sample t test and mixed linear model testing. RESULTS In the coronal specimen portions, mean values for newly formed bone area, biomaterial area and marrow space of 32.2% ± 10.4%, 20.1% ± 13.0%, and 47.7% ± 8.5% were found with PRP, respectively. In the control group the corresponding values were 27.6% ± 13.4%, 20.3% ± 12.9%, and 52.1% ± 9.3%. In the apical specimen portions in the PRP group, the newly formed bone area, biomaterial area, and marrow space was 25.7% ± 15.0%, 23.4% ± 14.9%, and 50.9% ± 12.5%, respectively. The corresponding values in the control group were 17.0% ± 8.6%, 34.5% ± 11.2%, and 48.5% ± 8.5%. CONCLUSIONS Statistical evaluation of the samples proved significantly better overall resorption of algae-derived hydroxyapatite AlgOss/C Graft/Algipore and increased new bone formation when PRP was used, especially in the apical region.

Transfusion‐related exposure to the plasticizer di(2‐ethylhexyl)phthalate in patients receiving plateletpheresis concentrates

BACKGROUND: Di(2‐ethylhexyl)phthalate (DEHP) is a plasticizer that can leach from medical devices including storage bags for plateletpheresis concentrates (PCs). In this study, the DEHP exposure to patients receiving PCs was determined and several variables were evaluated to reduce DEHP load to PC recipients.

Skin plugs in phlebotomy puncture for blood donation

SummaryContamination at the site of the donor’s skin may occur despite proper disinfection, because pathogens in deeper regions (such as pores) may not be eliminated by skin disinfection. It is suspected that the cannula detaches fragments of tissue when it penetrates the skin; the tissue fragments may reach blood products and release pathogens there. In the present study we punctured piglet skin with cannulas commonly used for blood donation and performed histological as well as cytological investigations of the lavage fluid in the cannula to identify superficial skin cells and skin plugs. Histological specimens of the pierced skin showed frayed puncture sites with loosely attached tissue fragments. In the lavage fluid of the cannula, a collection of epidermal cells was found in one of 150 punctures. Our results confirm that the phlebotomy cannula may cause superficial tissue fragments to be punched out of the donor’s skin during blood donation. This fact should be taken into account when devising methods to reduce bacterial contamination in blood products.ZusammenfassungEine der Quellen für bakterielle Kontamination von Blutprodukten ist die Haut des Spenders an der Punktionsstelle; auch nach deren sachgerechter Desinfektion, da in tieferliegenden Bereichen (z.B. Poren) Keime für die Hautdesinfektion unzugänglich sein können. Bisher ist nicht geklärt, ob die Kanüle beim Durchtritt durch die Haut Gewebeteile losreissen kann, die in das Blutprodukt gelangen und dort Keime freisetzen können. In dieser Studie haben wir Ferkelhaut mit bei der Blutspende üblichen Kanülen punktiert und Stichkanäle sowie die Spülflüssigkeit der Kanüle auf das Vorkommen von oberflächlichen Hautzellen oder Hautstanzen histologisch und zytologisch untersucht. Histologische Präparate der durchstochenen Haut zeigten ausgefranste Einstichstellen mit nur lose anhängenden Gewebeteilen. In der Spülflüssigkeit der Kanüle konnte nach einer von 150 Punktionen ein Verband epidermaler Zellen gefunden werden. Unsere Ergebnisse bestätigen die Vermutung, dass die Phlebotomiekanüle bei der Blutspende oberflächliche Gewebeteile aus der Haut des Spenders stanzen kann. Diese Ergebnisse sollten bei der Suche nach Möglichkeiten zur Reduktion der Häufigkeit bakterieller Kontamination von Blutprodukten berücksichtigt werden.

Anticoagulation in large-volume leukapheresis: comparison between citrate- versus heparin-based anticoagulation on safety and CD34 + cell collection efficiency

BACKGROUND AIMS Little is known of the effect of anticoagulation on peripheral blood progenitor cell (PBPC) harvest during large-volume leukapheresis (LVL). Because of the interaction of heparin with stromal cell-derived factor (SDF)-1α, it has been proposed that a heparin-based anticoagulation may result in an increased PBPC collection efficiency compared with standard citrate-based anticoagulation. METHODS We conducted a prospective randomized trial to address the effect of both anticoagulation regimes on safety, subjective comfort and CD34 (+) collection efficiency in 90 adult patients undergoing standardized LVL. Anticoagulation consisted of either citrate (group C) or a combination of heparin and low-dose citrate (group H). RESULTS The overall incidence of adverse reactions (AR) during LVL was 17%. AR consisted only of citrate-related AR; no bleeding complications were observed. Determination of parameters of the acid-base balance revealed a higher frequency of metabolic alkalosis in group C. Analysis of serum SDF-1α revealed no differences in SDF-1α plasma levels. There were no differences in the CD34 (+) cell collection efficiency, resulting in the harvest of equal CD34 (+) cell yields independent of the anticoagulation used. CONCLUSIONS Our data show no clinical relevant effect of a heparin containing anticoagulation in terms of an increased overall CD34 (+) cell collection during LVL, although this regime shows some benefits in terms of the incidence and subjective tolerance towards AR. Based on our results the decision between a citrate- and heparin-substituted anticoagulation for LVL should be driven by patient-related factors, and should concern potential contraindications of both methods.

Lack of impact of ABO blood group or corresponding isoantibodies on the immune response after rabies vaccination

SummaryDemand for rabies hyperimmunoglobulin has increased recently, requiring optimization of vaccination schemes for immunized plasma donors. Possible resemblance of rabies vaccine to blood group antigens and consequential association of the immune response to rabies vaccine and blood group or corresponding isoantibodies has not yet been investigated. We analyzed anti-rabies antibodies after rabies vaccination and ABO blood group in 142 individuals, and isoantibody titers in 92 of those individuals. We did not find any correlation of the immune response with blood group or isoantibody levels. There was also no correlation with the sex of individuals, but there was a weak correlation between age and rabies-specific antibody level. Rabies vaccination schemes for immunized donors cannot be optimized on the basis of blood groups or isoantibody titers.ZusammenfassungIn letzter Zeit ist die Nachfrage nach Rabies-Hyperimmunglobulin stark gestiegen. Daher sollten optimale Rabies-Impfschemata für immunisierte Plasmaspender gefunden werden. Eine eventuelle Ähnlichkeit von Rabies- und Blutgruppen-Antigenen und ein daraus resultierender Zusammenhang zwischen dem Impferfolg nach Rabies-Impfung und der Blutgruppe bzw. der Titerhöhe der korrespondierenden Isoantikörper wurde bisher noch nicht untersucht. Wir bestimmten Rabies-Antikörper nach Impfung und Blutgruppen von 142 Personen sowie Isoantikörper in 92 dieser Personen. Die Ergebnisse zeigen keinen Zusammenhang zwischen Impferfolg nach Rabies-Impfung und Blutgruppe oder Titer der Isoantikörper. Ebenso konnten wir keinen Zusammenhang zwischen Geschlecht und Impferfolg sehen, wohl aber eine schwache Korrelation zwischen Alter und Höhe der Rabies-spezifischen Antikörper nach Impfung. Rabies-Impfschemata für Plasmaspender können also nicht durch Abstimmung auf Blutgruppe oder Titer der Isoantikörper optimiert werden.

Apheresis products of the Amicus™ and the AS.TEC 204® cell separators are comparable with regard to dendritic cells derived from the mononuclear cell collection

Background  In this study, we investigated the quality of autologous mononuclear cells (MNC) collected with two different cell separators using standard MNC‐apheresis procedure modalities. MNCs were purified by density gradient centrifugation and cultured according to standard protocols to generate dendritic cells (DC) and 1 × 107/ml immature DCs were pulsed with tumour lysate for 3 days and subsequently characterized by fluorescent‐activated cell sorter analysis.

Evidence for the positive impact of ISO 9001 and ISO 15189 quality systems on laboratory performance – evaluation of immunohaematology external quality assessment results during 19 years in Austria

Abstract Background ISO 9001 and ISO 15189 have been established as continuative models for quality systems beyond national laws, mandatory standards and guidelines of expert associations regarding analytical and organisational performance of medical laboratories and transfusion services. Although widely used, their impact on laboratory performance has not been investigated. Methods We retrospectively analysed the results of 167 laboratories in 59 distributions of the Austrian red cell immunohaematology external quality assessment (EQA) scheme in the years 1999–2017. The performance for each parameter and trends of individual participants were compared with respect to certification or accreditation status of participants’ quality systems and to laboratory type. Results Considering more than 52,000 EQA results, the absence or presence of a laboratory quality management system showed different error rates. Laboratories with ISO 9001 or ISO 15189 certification/accreditation had 0.7% incorrect results, while this rate was doubled without such quality systems (1.4%, p=0.0002). Statistically significant error reductions were seen upon ISO 9001/ISO 15189 implementation (1.3% before vs. 0.7% after; p=0.0468). Transfusion services had fewer errors (0.9%) compared to hospital and independent laboratories (both 1.2%). Conclusions Implementation and maintenance of quality systems according to ISO 9001 or ISO 15189 as well as laboratory specialisation result in better analytical performance as can be seen in immunohaematology EQA results. The conclusion is that these results apply to other laboratory tests and perhaps to other areas of health care.