Kenneth E. Nollet

Overview on platelet preservation: Better controls over storage lesion

Platelet storage lesion (PSL), correlating with reduced in vivo recovery/survival and hemostatic capacity after transfusion, is characterized essentially by morphological and molecular evidence of platelet activation and energy consumption in the medium. Processes that limit shelf-life are multifactorial, and include both necrosis and apoptosis. PSL is greatly influenced by factors including duration of storage, temperature, ratio of platelet number to media volume, solution composition with respect to energy content and buffering capacity, and gas permeability of the container. Recent progress for slowing PSL has been made with storage media that more effectively fuel ATP production and buffer the inevitable effects of metabolism. Improved oxygen-permeability of containers also helps to maintain aerobic-dominant glycolysis. Patients stand to benefit from platelet products of higher intrinsic quality that store well until the moment of transfusion.

Nuclear disasters and health: lessons learned, challenges, and proposals

Past nuclear disasters, such as the atomic bombings in 1945 and major accidents at nuclear power plants, have highlighted similarities in potential public health effects of radiation in both circumstances, including health issues unrelated to radiation exposure. Although the rarity of nuclear disasters limits opportunities to undertake rigorous research of evidence-based interventions and strategies, identification of lessons learned and development of an effective plan to protect the public, minimise negative effects, and protect emergency workers from exposure to high-dose radiation is important. Additionally, research is needed to help decision makers to avoid premature deaths among patients already in hospitals and other vulnerable groups during evacuation. Since nuclear disasters can affect hundreds of thousands of people, a substantial number of people are at risk of physical and mental harm in each disaster. During the recovery period after a nuclear disaster, physicians might need to screen for psychological burdens and provide general physical and mental health care for many affected residents who might experience long-term displacement. Reliable communication of personalised risks has emerged as a challenge for health-care professionals beyond the need to explain radiation protection. To overcome difficulties of risk communication and provide decision aids to protect workers, vulnerable people, and residents after a nuclear disaster, physicians should receive training in nuclear disaster response. This training should include evidence-based interventions, support decisions to balance potential harms and benefits, and take account of scientific uncertainty in provision of community health care. An open and joint learning process is essential to prepare for, and minimise the effects of, future nuclear disasters.

Preventing platelet-derived microparticle formation--and possible side effects-with prestorage leukofiltration of whole blood.

CONTEXT Platelet-derived microparticles (PDMPs) probably function in hemostasis, thrombosis, inflammation, and transfusion-related immunomodulation. OBJECTIVE To compare PDMP levels of leukocyte-filtered and unfiltered whole blood during storage. DESIGN Ten whole blood donations were collected and processed. Half of each collection was filtered, half remained unfiltered, and both halves were measured for red cell, white cell, and platelet (PLT) content before storage. Samples were drawn on days 0, 1, 2, 3, 5, 7, 14, 21, 28, and 35 and analyzed by flow cytometry. RESULTS Leukocyte filtration lowered prestorage PDMP and PLT counts by an average of 72% and 99%, respectively. Prestorage PDMP counts were 123 +/- 51/microL in unfiltered whole blood supernatant versus 34 +/- 18/microL after filtration. Prestorage PLT counts were 190 +/- 49/microL in unfiltered whole blood supernatant versus 2 +/- 4/microL after filtration. Moreover, PDMP and PLT counts in filtered whole blood remained low throughout storage, typically below 100/microL. In contrast, unfiltered whole blood PDMP- and PLT-gated events increased approximately 2 log during storage, with the peak number of PLT-gated events tending to coincide with the peak number of PDMP-gated events (4 donors) or to come after the peak number of PDMP-gated events (6 donors). CONCLUSIONS Leukocyte filtration of whole blood lowers prestorage PDMP and PLT counts. Platelet-derived microparticle and PLT counts remain low throughout 35 days of storage. In contrast, PDMP- and PLT-gated events increase significantly in unfiltered whole blood. The nature of PLT-gated events in stored blood warrants further investigation.

The great East Japan earthquake of March 11, 2011, from the vantage point of blood banking and transfusion medicine.

BACKGROUND The Great East Japan Earthquake of March 11, 2011, and subsequent tsunami took nearly 20 000 lives in Tohoku, the northeastern part of Japans main island. Most victims were either carried away by the tsunami or drowned. The ability to collect blood was disrupted on the Pacific coast of Tohoku. Inland areas were less affected, but allogeneic blood collected in Tohoku is tested at the Miyagi Red Cross Blood Center (Miyagi Center) in the coastal city of Sendai. Miyagi Center was damaged and could not test for 2 months. OBJECTIVES The aims of this study are as follows: (1) to assess transfusion practice at 8 disaster response hospitals in Tohokus Fukushima Prefecture, for equal intervals before and after March 11, 2011; (2) to report activities related to blood collection and distribution in response to the disaster; and (3) to describe the Great East Japan Earthquake in the context of other disasters. METHODS Data were collected through a survey of transfusion services at 8 major disaster response hospitals, communication at transfusion conferences, and literature review. RESULTS Transfused patients and units transfused were about 70% and 60% of normal in the surveyed hospitals because this was a disaster of mass casualty rather than mass injury, and patients requiring chronic care were evacuated out. A nationally coordinated effort allowed excess blood collected outside Tohoku to be transported in, despite infrastructure damage. CONCLUSION Japans national system of blood collection and distribution responded effectively to local needs after the Great East Japan Earthquake. Disasters such as Japans 3.11 should guide discourse about emergency preparedness and centralization of services.

Non-D Rh antibodies appearing after apheresis platelet transfusion: stimulation by red cells or microparticles?

Background  Apheresis platelets (APs) have gained favour over whole blood‐derived platelets on the presumption that they are less likely to provoke alloimmunization to red‐blood‐cell antigens.

Microparticle formation in apheresis platelets is not affected by three leukoreduction filters

Microparticles in blood components might contribute to transfusion‐related immunomodulation or other side effects. To elucidate the role of leukofiltration, we compared three commercially available filters for their effect on platelet (PLT)‐derived (PDMP), leukocyte‐derived (LDMP), and red blood cell–derived (RDMP) microparticle formation in apheresis PLTs.

Survival and recovery of apheresis platelets stored in a polyolefin container with high oxygen permeability

Background and Objectives  Oxygen permeability is important in platelet storage media. We compared a new polyolefin container with enhanced oxygen permeability (PO‐80; Kawasumi, Tokyo, Japan) to a widely used alternative (PL2410; Baxter Healthcare, Deerfield, IL, USA).

Red blood cell alloimmunization in transfused patients in sub-Saharan Africa: A systematic review and meta-analysis

BACKGROUND AND OBJECTIVES Previous studies of Sub-Saharan Africans show significant alloimmunization to red blood cell (RBC) antigens, but country-specific data are limited. Thus, the aim of this study was to estimate, by meta-analysis, the overall proportion of red blood cell alloantibodies among transfused patients. METHODS We systematically searched Medline, Embase, and the Africa-Wide Information database to identify relevant studies in any language. Case reports, comments, letters, conference abstracts, editorials, and review articles were excluded. Of the 269 potentially relevant articles, 11 studies fulfilled our selection criteria. RESULTS Overall proportions of alloimmunization were 6.7 (95% CI: 5.7, 7.8) per 100 transfused patients. With regard to antibody specificity, among clinically significant antibodies, anti-E ranked as the most common, followed by anti-K, anti-C and anti-D. CONCLUSION Meta-analysis of available literature quantifies and qualifies the clinical challenge of RBC alloimmunization among transfused patients in Sub-Saharan Africa. These results should drive policy decisions in favour of routine testing of RBC antigens and irregular antibodies for transfused patients as a standard of care throughout Sub-Saharan Africa.

Peripheral blood progenitor cell collection by two programs for autologous and allogeneic transplantation

In the Spectra apheresis instrument (Terumo BCT), both manual (Spectra‐MNC) and automated (Spectra‐Auto) programs have been widely used to collect peripheral blood progenitor cells (PBPCs). However, direct comparison of these programs remains extremely limited.

Toward a coalition against transfusion-associated GVHD

ransfusion-associated GVHD (TA-GVHD) is uncommon in the sense of being rare, but common in the sense of being a global problem worthy of our best collaborative efforts. This issue of TRANSFUSION includes two articles addressing TA-GVHD: Aoun and colleagues 1 present 10 cases from a 10-year record review at the American University of Beirut-Medical Center (AUB-MC, Lebanon). Leitman and colleagues 2 describe a single case from a cohort of four patients treated in the US with fludarabine for autoimmune disease. The incidence of TA-GVHD varies among different populations; some studies place Japanese people at greatest risk. Why? A genetic explanation emerges from HLA typing efforts that show the Japanese population to be relatively homogeneous. 3-5 This increases the likelihood of a one-way tissue match, in which an HLA-homozygous donor is haploidentical with an HLA-heterozygous recipient. In such a situation, viable donor lymphocytes escape host immune surveillance, but see recipient tissue as foreign. The unopposed donor lymphocytes can engraft, proliferate, and attack recipient tissue, especially in the cytokine milieu engendered by tissue damage and inflammation. 6 It has been estimated that, in a cohort of Japanese blood donors and recipients, such a one-way match will occur once in every 719 to 7,981 transfusions from unrelated donors and once in every 93 to 623 transfusions between parents and children. By way of contrast, a oneway match will occur among French nationals once in every 6,365 to 68,724 transfusions between nonrelatives and once in every 372 to 2,604 transfusions between parents and children. 3,5