Julian Strobel

Influence of prestorage leukoreduction and subsequent irradiation on in vitro red blood cell (RBC) storage variables of RBCs in additive solution saline-adenine-glucose-mannitol.

BACKGROUND: There exists only very few data on in vitro and in vivo effects of gamma irradiation of red blood cells (RBCs) that have been leukoreduced by filtration before a subsequent irradiation. Reported studies reflect neither the current Food and Drug Administration (FDA) nor the European recommendations on timing of irradiation and subsequent storage.

Why do some apheresis donors donate blood just once

Background and Objectives  More knowledge about the reasons for non‐return of blood donors (BD) would enable blood donation services (BDS) to improve the efficacy of recruitment and retention programmes. We interviewed returning (RBD) and non‐returning apheresis BDs (NRBD) of our university hospital‐based BDS.

Influence of late irradiation on the in vitro RBC storage variables of leucoreduced RBCs in SAGM additive solution

Background  There exists only few data on in vitro and in vivo effects of gamma irradiation of leucoreduced red blood cells (RBCs). Reported studies reflect the effects of early irradiation and subsequent storage. The effects of irradiation on RBCs shortly before the end of their shelf‐life have not been examined.

Ex Vivo Expansion of Hematopoietic Stem- and Progenitor Cells from Cord Blood in Coculture with Mesenchymal Stroma Cells from Amnion, Chorion, Wharton's Jelly, Amniotic Fluid, Cord Blood, and Bone Marrow

In most cases, the amount of hematopoietic stem and progenitor cells (HSPCs) in a single cord blood (CB) unit is not sufficient for allogenic transplantation of adults. Therefore, two CB units are usually required. The ex vivo expansion of HSPCs from CB in coculture with mesenchymal stroma cells (MSCs) might be an alternative. It was investigated, whether bone marrow-derived MSCs, which have to be obtained in an invasive procedure, introduce a further donor and increases the risk of transmissible infectious diseases for the patient can be replaced by MSCs from amnion, chorion, Whartons jelly, amniotic fluid, and CB, which can be isolated from placental tissue which is readily available when CB is sampled. In a two-step ex vivo coculture mononuclear cells from cryopreserved CB were cultured with different MSC-feederlayers in a medium supplemented with cytokines (stem cell factor, thrombopoietin [TPO], and granulocyte colony-stimulating factor). Expansion rates were analyzed as well, by long-term culture-initiating cell (LTC-IC) and colony-forming unit (CFU) assays, as by measuring CD34(+)- and CD45(+)-cells. Due to the comparably low number of 5×10(2) to 1×10(4) CD34(+)-cells per cm(2) MSC-monolayer, we observed comparably high expansion rates from 80 to 391,000 for CFU, 70 to 313,000 for CD34(+)-, and 200 to 352,000 for CD45(+)-cells. Expansion of LTC-IC was partly observed. Compared to the literature, we found a better expansion rate of CD34(+)-cells with MSCs from all different sources. This is probably due to the comparably low number of 5×10(2) to 1×10 CD34(+)-cells per cm(2) MSC-monolayer we used. Comparably, high expansion rates were observed from 80 to 391,000 for CFUs, 70 to 313,000 for CD34(+)-, and 200 to 352,000 for CD45(+)-cells. However, the expansion of CD34(+)-cells was significantly more effective with MSCs from bone marrow compared to MSCs from amnion, chorion, and Whartons jelly. The comparison of MSCs from bone marrow with MSCs from CB and amniotic fluid showed no significant difference. We conclude that MSCs from placental tissues might be useful in the expansion of HSPCs, at least if low numbers of CD34(+)-cells per cm(2) MSC-monolayer and a high TPO concentration are implemented in the expansion culture.

Travel and Oral Anticoagulation

Millions of individuals worldwide are on permanent or temporary oral anticoagulation treatment with vitamin K antagonists (VKAs). The effectiveness of VKAs has been established by clinical trials for several indications. Among these, the primary or secondary prevention of venous thromboembolism, the prevention of systemic embolism in patients with prosthetic heart valves, or atrial fibrillation are of highest relevance.1 Such travelers are at higher risk for bleeding episodes due to the anticoagulation and for thromboembolic events due to the underlying disease. This article reviews the most important issues to be considered to give adequate advice to travelers on oral anticoagulants. Vitamin K is an essential cofactor for the production of functional clotting factors II, VII, IX, and X, as well as inhibitors such as protein C, S, and Z.2 If vitamin K is deficient or the effect of vitamin K is pharmaceutically blocked, the above‐mentioned clotting factors cannot be activated, and the dependant clotting time is prolonged. The three available VKAs phenprocoumon, warfarin, and acenocoumarol exert their anticoagulant effect by reducing the regeneration of vitamin K from vitamin K epoxide in the vitamin K cycle.3 The main difference between the different VKAs is the different half‐life with the 105 to 114 hours for phenprocoumon, 35 to 45 hours for warfarin, and 9 hours for acenocoumarol. Several exogenous and endogenous factors influencing the metabolism of vitamin K and its antagonists (eg, nutrition, comedication, antibiotics) result in individual response to the treatment. ### The International Normalized Ratio and Patient Self‐Management The small therapeutic range of the oral anticoagulant drugs and the potentially life‐threatening effects of both underdosing and overdosing necessitate a close control of the actual intensity of anticoagulation using the international normalized ratio (INR).4 A major improvement toward an increased mobility of patients permanently treated with VKAs was the introduction of self‐testing and self‐dosing of the … Corresponding Author: Jurgen Ringwald, MD, Department of Transfusion Medicine and Hemostaseology, University Hospital of Erlangen, Krankenhausstrase 12, D‐91054 Erlangen, Germany. E‐mail: juergen.ringwald{at}ukerlangen.de

Influence of irradiation on in vitro red-blood-cell (RBC) storage variables of leucoreduced RBCs in additive solution PAGGS-M

The only accepted way to avoid transfusion‐associated graft‐versus‐host disease is irradiation of blood components. With respect to irradiation and associated storage time, different recommendations exist. We examined early irradiated (day +3) leucoreduced red blood cell units for irradiation‐associated damages during storage.

Effect of gamma irradiation with 30 Gy on the coagulation system in leukoreduced fresh‐frozen plasma

BACKGROUND: The aim of this study was to investigate the effect of gamma irradiation with 30 Gy on the coagulation system in leukoreduced fresh‐frozen plasma (FFP).

Intrauterine use of hyperconcentrated platelet concentrates collected with Trima Accel in a case of neonatal alloimmune thrombocytopenia

BACKGROUND: Due to the threat of serious or fatal bleedings, fetuses with neonatal alloimmune thrombocytopenia (NAIT) may need intrauterine platelet (PLT) transfusions. To prevent a volume overload or an ABO minor mismatch, standard PLT concentrates need to be washed to increase the PLT concentration and to reduce the plasma content. Hyperconcentrated single‐donor PLT concentrates (HCPs) are a therapeutic alternative. The first case of NAIT successfully treated with HCPs collected with the Trima Accel (TA; Gambro BCT) is reported.

Comparison of a new microscopic system for the measurement of residual leucocytes in apheresis platelets with flow cytometry and manual counting.

Since 2001, all blood components in Germany must be leucocyte depleted. Recently, a new method for quality control of depletion was introduced. Our study aimed at the validation of the method for routine use in apheresis platelet concentrates.

Travel behaviour of patients with haemophilia

BACKGROUND We aimed to identify socio-demographic, or illness-specific variables, influencing travel behaviour of haemophilic patients. METHODS A standardised questionnaire was sent to more than 2000 members of two German Haemophilia associations. Multivariable logistic regression with the outcomes frequent (at least two journeys per year) and long-haul travel (outside of Europe) was applied separately on adult patients and patients younger than 18 years. RESULTS Among 345 adults, high education level, living in a partnership or travelling alone was significantly associated with frequent travel with odds ratios (ORs)/95%-confidence intervals (95%-CI) of 3.10/1.72-5.80, 1.99/1.10-3.62 and 1.73/1.01-3.62, respectively. High education level and self-application of clotting factors were significant variables for long-haul travel (OR/95%-CI: 2.45/1.43-4.26 and 3.25/1.33-8.52, respectively). Among 144 non-adults, a younger age or performing permanent prophylactic treatment was significantly associated with a lower likelihood for long-haul travel (OR/95%-CI: 0.51/0.22-0.95 and 0.10/0.01-0.65, respectively). Longer awareness of the disease increased the likelihood for long-haul travel (OR/95%-CI: 1.06/1.01-1.14). CONCLUSIONS High education level and self-application of clotting factors influence travel intensity of adult patients most strikingly. Parents of very young patients on permanent prophylactic treatment might need special education to facilitate holiday travel for these families.