Jürgen Zingsem

Cytokine Generation in Whole Blood, Leukocyte‐Depleted and Temporarily Warmed Red Blood Cell Concentrates

Background and Objectives: It has been suggested that inflammatory cytokines such as Interleukin (IL)–1β, IL–6, tumor necrosis factor–α (TNF–α) and IL–8 might be responsible for a large number of non–antibody–mediated adverse reactions to the transfusion of blood components, especially of platelet concentrates (PCs). The aim of this study was to compare the levels of proinflammatory cytokines in different blood components containing red cells such as buffy–coat–free packed red cells (RBCs), filtered RBCs and whole blood (WB) during storage under several conditions. Materials and Methods: WB (CPD–A1, n = 16) was stored for 35 days at 2–6°C; samples were taken on days 0, 21 and 35. Buffy–coat–poor RBCs in additive solution PAGGS–M (n = 16) were divided into halves, one half was leukocyte (WBC)–depleted by filtration on day 0, both halves were stored for 49 days at 2–6°C (samples: days 0, 21, 49). Furthermore, buffy–coat–poor, unfiltered SAG–M RBCs (n = 16) were halved immediately after production and stored at 2–6°C until day 42 (samples: days 0, 21, 42). One half remained at room temperature for 24 h on day 3. Cytokine levels were determined with commercial enzyme–linked immunosorbent assays. Results: Levels of IL–1β and TNF–α rose during storage of WB and RBCs. IL–6 could be detected markedly above the detection threshold in WB only. At the end of storage, we detected IL–8 in 1 of 16 units of WB tested, in 10 of 16 standard PAGGS–M RBCs and in 15 of 16 temporarily warmed SAG–M RBCs. Prestorage filtration of RBCs prevented the accumulation of IL–1β and TNF–α. Temporarily warming of RBCs for 24 h did not cause any substantial increase in cytokine levels other than IL–8. RBCs stored in different additive solutions (PAGGS–M versus SAG–M) showed similar cytokine concentrations during storage. The cytokine content of WB was very similar to that of buffy–coat–poor RBCs. Conclusion: Cytokine levels measured in WB and buffy–coat–poor RBCs result in levels which are unlikely to cause febrile reactions even in the case of massive transfusion. We conclude that, according to present knowledge, there is no reason for prestorage filtration of buffy–coat–poor RBCs or WB to avoid febrile transfusion reactions due to cytokine accumulation during storage.

A survey of blood component use in a German university hospital

BACKGROUND: There are no recent studies on transfusion practice and blood use with regard to diagnoses of European recipients. We conducted a survey of blood component use, including packed red cells, fresh‐ frozen plasma, and platelets, in an acute‐care university hospital in the Greater Nurnberg area. STUDY DESIGN AND METHODS: A survey was carried out of blood component transfusion at a university hospital (Erlangen, Germany) between June 1994 and May 1996. Transfused units were listed by broad diagnostic categories formed from principal diagnoses of the recipients according to the International Classification of Diseases, Ninth Revision. RESULTS: Among 100,497 discharged patients, 6,590 patients who received transfusion (6.6%) are represented in this survey. Of 28,440 red cell units and 8,592 fresh‐ frozen plasma units, 72.4 percent and 66.9 percent, respectively, were used in patients with neoplastic diseases, circulatory system diseases, or disorders of the digestive system. Of 2704 platelet units, 78.1 percent were transfused to patients with neoplastic or gastrointestinal diseases or diseases of blood‐forming organs. These four diagnostic categories accounted for 77.7 percent of all costs of transfusion therapy. Males received 60.1 percent of all blood components transfused, and patients less than 65 years old received 68.0 percent. CONCLUSION: This survey provides information on blood component usage in a German university hospital. It demonstrates the concentration of todays blood utilization among a few diagnostic categories. The study shows that detailed information on local blood use may be obtained quickly by using data available from transfusion services and medical record departments. This information is relevant for quality management of transfusion practice, cost analyses and for planning local and regional blood donation programs.

A multicenter evaluation of the routine use of a new white cell‐ reduction apheresis system for collection of platelets

BACKGROUND: Residual white cells (WBCs) cause serious side effects in platelet transfusion. An in‐line WBC‐reduction system based on fluidized particle bed technology was recently developed as a modification of an existing plateletpheresis system.

Comparison of COBE white cell-reduction and standard plateletpheresis protocols in the same donors

BACKGROUND: It is necessary to protect patients from white cell (WBC)‐ caused side effects of platelet transfusion by reducing the WBC contamination in single‐donor platelets. STUDY DESIGN AND METHODS: A new COBE Spectra WBC (leuko)‐reduction system (LRS) was compared to the COBE standard plateletpheresis (standard) procedure. Each of 62 donors underwent plateletpheresis under the two protocols (LRS and standard). The collection efficiency and WBC contamination in the components collected using the techniques were compared. Platelets were counted in a cell counter and WBCs were counted using two full grids of a Nageotte chamber. RESULTS: The preseparation and postseparation numbers for red cells, WBCs, and platelets as well as the number of collected platelets were not different in the two techniques. Collection efficiency in the LRS procedures was 96.2 +/− 13.0 percent of that in the standard procedures. Median WBC contamination in the platelet components was 10,160 per LRS procedure and 56,500 per standard procedure. The purity of the LRS components was significantly improved (p = 0.001), as seen in a comparison of the WBC numbers in components per procedure after log10 transformation (LRS: 0.096 +/− 0.195 × 10(6); standard: 0.390 +/− 1.075 × 10(6)). CONCLUSION: These data suggest that the LRS procedure produces platelet concentrates with a collection efficiency that is comparable to that obtained with the standard technique and with a residual WBC content that satisfies even the most stringent criteria for filtered platelets. As this purity can be achieved without platelet loss or alteration, conventional fiber filtration no longer seems necessary or useful in this type of single‐donor platelet component.

Microbiologic Contamination of Peripheral Blood Stem Cell Autografts

We have determined the incidence and clinical significance of positive microbiologic cultures in a series of 290 peripheral blood stem cell concentrates in 95 patients undergoing multiple apheresis procedures for autologous stem cell rescue. Specimens for bacterial cultures were obtained after processing of the autografts just prior to freezing. The incidence of microbial contamination was 4.5% (n = 13). The predominant pathogenic microorganism cultured was coagulasenegative Staphylococcus (n = 11). From 8 patients with contaminated leukapheresis products 6 underwent autologous stem cell transplantation. Five patients received 1–5 culture‐positive stem cell concentrates without serious sequelae, whereas the sixth patient was autografted with noncontaminated leukapheresis products, 1 concentrate contaminated with Aspergillus fumigatus being not reinfused. No microorganism present in the stem cell autograft was recovered in vivo in the posttransplantation period, although fever as a sign of infection occurred in all but 1 patient. Peripheral blood stem cell collection and ex vivo processing for cryopreservation may result in microbiologic contamination. However, our data show that infusion of contaminated stem cell autografts does not play a significant role as a source for infections in the clinical setting of autologous stem cell rescue.

Oral or intravenous iron as an adjuvant to autologous blood donation in elective surgery: a randomized, controlled study

BACKGROUND: This study was performed to evaluate the capacity of oral and intravenous (IV) iron administration during autologous blood donation (ABD) to improve the efficacy of ABD and to prevent the need for allogeneic blood transfusion in patients without iron deficiency who are undergoing major elective surgery for which a minimum of 3 autologous units have been ordered.

Hyperconcentrated platelets stored in additive solution: aspects on productivity and in vitro quality

Background and Objectives  New platelet (PLT) additive solutions (PASs) allow a plasma carryover of < 30% in PLT concentrates. This implicates the need to collect apheresis PLT concentrates at very high PLT concentrations: so‐called dry PLTs (DPs). We used the TRIMA, with software version 4 (TRIMA V4), to collect such DPs and investigated the in vitro quality of these PLTs when stored in the new modified PAS‐III (PAS‐IIIM).

Comparison of the performance of four microtube column agglutination systems in the detection of red cell alloantibodies.

BACKGROUND: The purpose of this study was to compare the performance of four currently available microtube column agglutination systems in the detection of red cell alloantibodies to that of the standard tube low‐ionic‐strength solution (LISS) indirect antiglobulin test (IAT) (tube LISS‐IAT).

Bacterial contamination of autologous bone marrow. Reinfusion of culture-positive grafts does not result in clinical sequelae during the posttransplantation course

Objectives: Microbiological cultures and posttransplantation course were analyzed in order to investigate the incidence and clinical significance of bacterial contamination of autologous bone marrow (BM) grafts. Methods: Cultures were obtained from BM after collection, BM concentrate after processing, contaminated/cryopreserved BM at thawing, and from peripheral blood (PB) following autologous BM transplantation (ABMT). The posttransplantation course of patients grafted with culture-positive BM was recorded and compared with patients who underwent ABMT with noncontaminated BM grafts. Results: In 239 BM grafts processed, the incidence of microbiological contamination was 26.4% (n = 63). Fifty marrow grafts were contaminated by bacteria from the skin flora: coagulase-negative Staphylococcus (CNSC), Propionibacterium, and Corynebacterium species (79%). Thirty-eight patients underwent ABMT (day 0) with cryopreserved culture-positive BM, and 32 patients were evaluable for microbiological cultures at thawing: in 10 of 32 BM grafts CNSC was found prior to reinfusion. Following ABMT, PB cultures revealed CNSC in 5 of 38 patients between days +4 and +12. However, the late occurrence of positive PB cultures after BM reinfusion made a relationship between BM CNSC and PB CNSC unlikely. In 33 of 38 patients, no graft-contaminating bacteria were detected in PB. Comparison of the posttransplantation course of patients who received contaminated BM with that of patients grafted with noncontaminated BM showed no significant differences concerning time to engraftment, febrile days, and days on antibiotics. Conclusion: (1) Collection and/or ex vivo processing can result in microbiological contamination of BM grafts predominantly with bacteria from the skin flora, and (2) only CNSC can be cultured at thawing from previously contaminated/cryopreserved BM. Since patients undergoing ABMT usually receive oral antibiotics from beginning of the conditioning regimen which are active against CNSC, no further administration of antibiotics is recommended for the reinfusion of bacterially contaminated BM grafts.

Cord blood processing with an automated and functionally closed system

BACKGROUND: Umbilical cord blood processing with standard centrifugation techniques is performed in open systems and results in varying cell and volume recoveries.