Jose Mauro Kutner

Brazilian experience with two conditioning regimens in patients with multiple sclerosis: BEAM/horse ATG and CY/rabbit ATG

Studies have shown that autologous hematopoietic SCT (HSCT) can be used as an intensive immunosuppressive therapy to treat refractory patients and to prevent the progression of multiple sclerosis (MS). This is a prospective multicentric Brazilian MS trial comparing two conditioning regimens: BEAM/horse ATG and CY/rabbit ATG. Most (80.4%) of the 41 subjects in the study had the secondary progressive MS subtype and the mean age was 42 years. The baseline EDSS score in 58.5% of the subjects was 6.5 and 78% had a score of 6.0 or higher, respectively. The complication rate during the intra-transplantation period was 56% for all patients: 71.4% of the patients in the BEAM/hATG group and 40% in the CY/rATG group (P=0.04). Three subjects (7.5%) died of cardiac toxicity, sepsis and alveolar hemorrhage, all of them in the BEAM/ATG group. EFS was 58.54% for all patients: 47% in the BEAM/hATG group and 70% in the CY/rATG group (P=0.288). In conclusion, the CY/rATG regimen seems to be associated with similar outcome results, but presented less toxicity when compared with the BEAM/hATG regimen. Long-term follow-up would be required to fully assess the differences in therapeutic effectiveness between the two regimens.

Evaluation of three methods for hemoglobin measurement in a blood donor setting

CONTEXT The hemoglobin (Hb) level is the most-used parameter for screening blood donors for the presence of anemia, one of the most-used methods for measuring Hb levels is based on photometric detection of cyanmetahemoglobin, as an alternative to this technology, HemoCue has developed a photometric method based on the determination of azide metahemoglobin. OBJECTIVE To evaluate the performance of three methods for hemoglobin (Hb) determination in a blood bank setting. DESIGN Prospective study utilizing blood samples to compare methods for Hb determination. SETTING Hemotherapy Service of the Hospital Israelita Albert Einstein, a private institution in the tertiary health care system. SAMPLE Serial blood samples were collected from 259 individuals during the period from March to June 1996. MAIN MEASUREMENTS Test performances and their comparisons were assessed by the analysis of coefficients of variation (CV), linear regression and mean differences. RESULTS The CV for the three methods were: Coulter 0.68%, Cobas 0.82% and HemoCue 0.69%. There was no difference between the mean Hb determination for the three methods (p>0.05). The Coulter and Cobas methods showed the best agreement and the HemoCue method gave a lower Hb determination when compared to both the Coulter and Cobas methods. However, pairs of methods involving the HemoCue seem to have narrower limits of agreement (+/- 0.78 and +/- 1.02) than the Coulter and Cobas combination (+/- 1.13). CONCLUSION The three methods provide good agreement for hemoglobin determination.

Peripheral blood stem cell yield calculated using preapheresis absolute CD34+ cell count, peripheral blood volume processed, and donor body weight accurately predicts actual yield at multiple centers.

Accurate prediction of stem cell yield is important for planning leukapheresis procedures. A formula has been published (Pierelli et al., Vox Sang 2006;91:126‐34) to estimate the CD34+ dose collected on the first day of leukapheresis that was based on the preapheresis peripheral blood (PB) CD34+ counts, the blood volume processed, and the donors weight. The aim of this study was to assess the predictive value of this formula.

RHD Allelic Identification Among D−Brazilian Blood Donors as a Routine Test Using Pools of DNA

RHD alleles leading to a reduced expression of D antigen of the red blood cell (RBC) surface may be erroneously typed as D− by serology and may cause anti‐D immunizations when transfused to recipients.

Molecular HPA genotyping by microarray in Brazilian blood donors.

Human platelet antigens (HPA) polymorphisms may cause HPA alloimmunization, platelet (PLT) refractoriness, fetomaternal alloimmune thrombocytopenia, and posttransfusion purpura. Characterized by significant racial admixture, the Brazilian population might benefit from the knowledge about HPA frequency to guide decision‐making concerning PLT transfusion.

Predictors of high-quality cord blood units

Analysis of umbilical cord blood (UCB) transplants shows a correlation between engraftment and total number of infused cells. Thus, it is worth evaluating what maternal and neonatal characteristics and collection techniques may affect the quality of UCB units.

An international investigation into O red blood cell unit administration in hospitals: the GRoup O Utilization Patterns (GROUP) study

Transfusion of group O blood to non‐O recipients, or transfusion of D– blood to D+ recipients, can result in shortages of group O or D– blood, respectively. This study investigated RBC utilization patterns at hospitals around the world and explored the context and policies that guide ABO blood group and D type selection practices.

Vox Sanguinis International Forum on platelet cryopreservation

The Australian Red Cross Blood Service has recently started manufacturing cryopreserved platelets for the Australian Defence Force. We are also manufacturing cryopreserved platelets for a randomized clinical trial, known as the CLIP trial, which is comparing cryopreserved and conventional platelets in the management of postsurgical bleeding [1, 2]. Platelets for the CLIP trial are being manufactured as an investigational product. In both instances, apheresis platelets are used as the starting product for cryopreservation. We do not have an annual supply target for cryopreserved platelets. However, approximately 100 platelets have been frozen in our centre to date. The majority of these have been prepared for the CLIP trial, and to date, no platelets have been issued to the Australian Defence Force. As the CLIP trial is a double-blinded controlled trial and still recruiting patients, we do not know yet how many cryopreserved platelets have been transfused. We will continue to manufacture platelets for the Australian Defence Force as required. However, implementation of cryopreserved platelets for routine use in civilian hospitals in Australia is more complex. Cryopreserved platelets are not included in the Blood Service Technical Master File, which lists components that have been approved by the Therapeutic Goods Administration (TGA), the regulatory authority in Australia. Further, thawing platelets is considered to be a manufacturing step, and the facility where they are thawed should be licensed by the TGA and adhere to Good Manufacturing Practices in order to do so. Cost is also an important consideration. The additional manufacturing steps and the requirement for clinical grade DMSO add significant costs. As the platelets must be kept at -80°C, large amounts of dry ice are required during transport, which also increases the potential cost as well as potential work health and safety risks. One of the outcomes of the CLIP trial will be feasibility of thawing platelets in hospital blood banks, and issues such as staff training and availability of suitable equipment (-80°C freezer, sterile welding devices) will be considered.

Vox Sanguinis International Forum on application of fetal blood grouping: summary

Fetal RHD genotyping is provided for alloimmunised women [3, 4]. With regard to the situation for all RhD negative pregnant women: The R & D division of the Blood Service is currently carrying out an economic analysis of RHD genotyping to target pregnant women for antenatal and post-partum anti-D prophylaxis. This follows a feasibility study into the uptake and acceptance of the maternal blood test in two obstetric populations. Any decision to introduce fetal blood grouping to a broader population group than alloimmunised women will be dependent on the outcomes of R&D projects currently underway and further business analysis. The Blood Service will then consult with external and government stakeholders whether to introduce the service to alloimmunisedwomen or all RhD-negative pregnant women. A separate R & D study is reviewing the application of a droplet digital PCR (ddPCR) assay for non-invasive detection of fetal KEL*01.01 in isoimmunised pregnancies.

An international survey on the role of the hospital transfusion committee

Hospital transfusion committees (HTCs) can oversee all aspects of transfusion practice at a hospital. This survey sought to identify which quality variables were being reported at HTCs around the world.