Leonard I. Friedman

Transfusion-associated bacterial sepsis.

The incidence of sepsis caused by transfusion of bacterially contaminated blood components is similar to or less than that of transfusion-transmitted hepatitis C virus infection, yet significantly exceeds those currently estimated for transfusion-associated human immunodeficiency and hepatitis B viruses. Outcomes are serious and may be fatal. In addition, transfusion of sterile allogenic blood can have generalized immunosuppressive effects on recipients, resulting in increased susceptibility to postoperative infection. This review examines the frequency of occurrence of transfusion-associated sepsis, the organisms implicated, and potential sources of bacteria. Approaches to minimize the frequency of sepsis are discussed, including the benefits and disadvantages of altering the storage conditions for blood. In addition, the impact of high levels of bacteria on the gross characteristics of erythrocyte and platelet concentrates is described. The potentials and limitations of current tests for detecting bacteria in blood are also discussed.

Viability and in vitro properties of AS-1 red cells after gamma irradiation

BACKGROUND: Irradiation has been shown to adversely affect both in vivo 24‐hour recovery (recovery [%]) and in vitro properties of stored red cells (RBCs). There is uncertainty as to how these changes are related to the day of irradiation and the length of storage after irradiation.

Comparison of bacteria growth in single and pooled platelet concentrates after deliberate inoculation and storage.

BACKGROUND: The ability to store pools of platelet concentrates (PCs) for extended periods would provide logistical flexibility. However, reports of severe adverse reactions due to the transfusion of contaminated PCs led to an examination of whether the total bacteria levels after storage of pools containing a deliberately inoculated platelet unit would be significantly different than the levels in paired unpooled concentrates. STUDY DESIGN AND METHODS: A single PC was deliberately inoculated on Day 0 with one of three bacterial species (0.1–8.0 colony‐forming units/mL). On Day 1, the deliberately inoculated PC was divided into three equal parts and either 1) pooled with 5 half‐volume, ABO‐ and Rh‐identical PCs; 2) similarly pooled and white cell reduced; or 3) kept as a control. Sterile connections were used during pooling; modified storage containers were used to ensure the correct surface‐to‐volume ratio of the single unit. RESULTS: Between Day 2 and Day 5 of storage, in 26 of 36 paired samples, nonfiltered pools containing Escherichia coli had greater total numbers of bacteria than did the paired single PCs. Day 2 pools had total bacteria levels approximately five times higher (colony‐forming units/mL × container volume) than those in single units (p < 0.05). There was rapid growth of Staphylococcus aureus by Day 2 in pooled and unpooled PCs; by Day 3, total bacteria levels were approximately five times higher in pools than in single units (p < 0.05). Between Days 3 and 5 of storage, in 23 of 27 paired samples, nonfiltered pools containing S. aureus had greater total bacteria levels than the single PCs. By Day 5, 15 of 16 non‐white‐cell reduced pools had total levels of Staphylococcus epidermidis bacteria approximately five times those in the paired single PCs. Greater total bacteria levels in pooled units than in single units generally occurred when bacteria in pools reached the stationary phase of growth (when bacteria concentration became constant), and they were well correlated with the sixfold volume of pooled units. White cell reduction did not substantially affect the time required to attain stationary phase. CONCLUSION: The potential during storage for greater total bacteria levels in pools than in single PCs is a consequence of the greater volume of the pool.

Reducing the incidence of non-A, non-B post-transfusion hepatitis by testing donor blood for alanine aminotransferase. Economic considerations.

Recent studies have established a relation between elevated alanine aminotransferase levels in donor blood and the incidence of non-A, non-B hepatitis in recipients of such blood. Routine testing of donor blood for alanine aminotransferase activity in order to reduce hepatitis is not currently supported, largely because the results of such testing are unknown. We assessed the potential economic benefits of screening donor blood for alanine aminotransferase as a means to reduce post-transfusion hepatitis. Benefits, defined as the expected costs of hepatitis potentially avoided, ranged from

Effects of oral donor questioning about high-risk behaviors for human immunodeficiency virus infection

898 to

Automated determination of ABO/Rh in microplates.

31,629 per 1000 blood units collected. This wide range reflected lack of information about the natural history of non-A, non-B hepatitis. Costs were defined as the direct costs of testing and the indirect costs associated with loss of blood product, additional donor recruitment, and informing donors of their abnormal aminotransferase levels; costs ranged from

Reducing the Infectivity of Blood Components What we Have Learned

3,151 to

Effects of new brochures on blood donor recruitment and retention

4,003 per 1000 units. Our results suggest that if prospective studies demonstrate that exclusion of blood with elevated aminotransferase levels decreases non-A, non-B hepatitis in recipients, the net economic impact may be positive. However, because of major uncertainties about the medical consequences of non-A, non-B hepatitis, the benefit estimates are so broad that they preclude a definitive policy decision.

Experimental 6 log10 white cell-reduction filters for red cells

The purposes of this study were 1) to compare blood donor deferrals resulting from additional, oral questions about human immunodeficiency virus risk behaviors with deferrals resulting from currently used, written screening questions; 2) to examine differences in donor deferral resulting from use of an indirect (IQ) versus direct (DQ) additional oral question format; and 3) to evaluate written survey responses of donors and staff members to the additional questions. The IQ group (n=3050) were asked if they understood the seven ineligible‐donor risk behaviors, and the DQ group (n=4753) were asked if they had engaged in any of these behaviors. Owing to positive answers or refusal to answer the additional questions, there was an increase in donor deferrals, over the level seen with customary screening. Only 1 percent of donors indicated they would not return if the questions were asked in the future. Embarrassment was indicated by 3 percent of the IQ group and 7 percent of the DQ group; 14 to 15 percent preferred to write their answers rather than give them orally. The staff members generally felt training was adequate (IQ=92%, DQ = 83%) and were comfortable asking the questions (IQ=82%, DQ=78%). Mean screening times were 5.7 minutes before the addition of the oral questions, 7.5 minutes with IQ, and 7.6 minutes with DQ. This study confirms the value of IQ and DQ formats in identifying potentially infectious donors and suggests that the DQ format may be slightly more effective.

The Filtration of Plasma from Whole Blood: A Novel Approach to Clinical Detoxification

Abstract. A semi‐automated system for determining the ABO group and Rh type of blood samples has been developed using a commercially available automated microplate (ELISA) reader and a microcomputer. Optimization of serologic, measurement and interpretation parameters was accomplished without significantly changing an existing manual procedure. The first pass noninterpretation rate of this system in the laboratory prior to field trials is 7.1%. A commercial system of this type should be cost‐effective as a primary instrument for small to medium sized blood centers and transfusion services.