Noga Manny

Blood banking–induced alteration of red blood cell flow properties

BACKGROUND: Blood banking procedures are associated with damage to red blood cell (RBC) membranes, which can impair their flow properties, namely, their deformability, aggregability, and adherence to endothelial cells (ECs) and thus possibly introducing a circulatory risk to recipients. This study was undertaken to comprehensively explore the effect of cold storage and gamma irradiation on RBC flow properties.

Alteration of red cell aggregability and shape during blood storage.

BACKGROUND: Storage of blood units (for 35–42 days, depending on the preservative solution) has been reported to induce changes (e.g., reduction of sialic acid level) in red cells that are expected to alter their aggregability.

Rejuvenation treatment of stored red blood cells reverses storage-induced adhesion to vascular endothelial cells.

BACKGROUND: Blood banking procedures are associated with elevated adherence of red blood cells (RBCs) to blood vessel wall endothelial cells (ECs), which can introduce a circulatory risk to recipients. This study was undertaken to examine the possibility of repairing this damage by a poststorage “rejuvenation” procedure before transfusion.

Posttransfusional hemolysis in recipients of glucose-6-phosphate dehydrogenase-deficient erythrocytes.

To test the hypothesis that transfusion of blood donated by individuals with glucose‐6‐phosphate dehydrogenease (G6PD) deficiency may result in a hemolytic reaction, we conducted a prospective longitudinal study in which 10 patients transfused with 1 unit of G6PD‐deficient and 1 unit of normal red blood cells (RBC) were compared with 10 patients transfused with 2 units of age‐matched normal RBC. We found that 24 h after transfusion serum bilirubin (μmol/1) in the recipients of G6PD‐deficient RBC was significantly higher than in the recipients of normal RBC (36±14 vs. 18±5, respectively, p>0.004). A parallel increase was found in the serum lactate dehydrogenase (LDH; IU/1) between the two groups (378±151 vs. 264±56, p<0.001). The difference in serum bilirubin(26±10 vs. 15±5, p<0.03) was still noted 48 h after transfusion, with only a marginal difference (p<0.08) in LDH. We conclude that an immediate posttransfusional hemolytic reaction can occur in recipients of G6PD‐deficient RBC and therefore suggest that the differential diagnosis of posttransfusional hemolysis, particularly in populations where G6PD deficiency is prevalent, includes transfusion of erythrocytes from G6PD‐deficient donors.

Hepatitis c virus infection in employees of a large university hospital in Israel.

OBJECTIVE To assess whether hospital work constitutes a risk factor for hepatitis C virus (HCV) infection among employees of a large hospital in Israel. DESIGN Seroprevalence survey. SETTING A 1,006-bed, tertiary-care university hospital in Jerusalem. PARTICIPANTS All 5,444 employees (18-65 years old) were eligible; 4,287 (79%) participated in the survey. METHODS Sera were tested for antibodies to HCV (anti-HCV) using a third-generation enzyme immunoassay. A third-generation strip immunoblot assay was used for confirmation. Participants were interviewed regarding their occupational history, and they completed a self-administered questionnaire covering history of non-occupational exposure to blood and country of birth. Other demographic information was obtained from the personnel department. Rates and odds ratios (ORs) were calculated, and multivariate logistic-regression analyses were performed to adjust for potential confounding variables. RESULTS Anti-HCV was found in 0.9% of employees (37/4,287; 95% confidence interval, 0.6-1.1), ranging from 0.1% among those born in Israel to 5.7% among those born in Central Asia. After age, gender, social status, country of birth, and history of blood transfusion were controlled for in a logistic regression, occupational exposure to blood > or = 10 years was significantly associated with the presence of antibodies (OR, 2.6; P=.01). Presence of anti-HCV also was associated with country of birth (range: Israel OR, 1; West OR, 3.8 [P=.1]; Central Asia OR, 48.6 [P<.0001]) and history of blood transfusion (OR, 2.7; P=.01). No significant associations were found between anti-HCV and age, gender, social status, history of tattoo, acupuncture, current occupation, department, exposure to blood in current occupation, adherence to safety precautions, or history of percutaneous injury. The association with length of exposure was stronger (OR, 3.6; P=.01) when the same logistic regression was run excluding the outlier ethnic group of Central Asia. CONCLUSIONS Hospital work does not seem to constitute a major risk factor for HCV infection in Israel today. A higher prevalence of anti-HCV among employees with longer versus shorter lengths of occupational exposure may be due to a cumulative effect of exposure over the years. Infection control efforts in recent years may have contributed to this association.

Storage-Induced Damage to Red Blood Cell Mechanical Properties Can Be Only Partially Reversed by Rejuvenation

Background: The storage of red blood cells (RBC) is associated with impairment of their properties that can induce a circulatory risk to recipients. In a preceding study (2009), we reported that post-storage rejuvenation (RJ) of stored RBC (St-RBC) efficiently reduced the storage-induced RBC/endothelial cell interaction, while only partially reversing the level of intracellular Ca2+, reactive oxygen species, and surface phosphatidylserine. In the present study, we examined the RJ effectiveness in repairing St-RBC mechanical properties. Methods: RBC, stored in CPDA-1 without pre-storage leukoreduction, were subjected to post-storage RJ, and the deformability, osmotic fragility (OF), and mechanical fragility (MF) of the rejuvenated St-RBC (St-RBCRj) were compared to those of untreated St-RBC and of freshly-collected RBC (F-RBC). Results: 5-week storage considerably increased OF and MF, and reduced the deformability of St-RBC. All alterations were only partially (40-70%) reversed by RJ, depending on the extent of the damage: the greater the damage, the lesser the relative effect of RJ. Conclusion: The findings of the present and preceding studies suggest that different St-RBC properties are differentially reversed by RJ, implying that some of the changes occur during storage and are irreversible.

Intracellular hemolysis and renal failure in a patient with T polyagglutination

A patient with postoperative intravascular hemolysis aggravated by transfusion with fresh whole blood and fresh plasma products had acute renal failure. Screening with Arachis hypogaea and Glycine soja lectins showed that his red cells were T‐transformed. Only washed red cells were transfused subsequently, and no further fresh plasma products were given. All hemolysis ceased, the renal function returned to normal, and the T‐polyagglutination as measured by lectin tests disappeared 4 months after surgery. Early diagnosis of polyagglutination using lectin screening tests is simple to perform, and will facilitate the immediate choice of the correct transfusion therapy, which in this case may have been life‐saving.

Characterization of a neuraminidase from Corynebacterium aquaticum responsible for Th polyagglutination

Abstract. Th polyagglutinability is characterized by the agglutination of the red blood cells (RBC) by Arachis hypogaea, Medicago disciformis, Vicia cretica but, in contrast to the T phenomenon, not by Glycine max (Glycine soja). Because Th transformation of RBC has been obtained in vitro, the mechanism of Th polyagglutinability expression has been studied and reproduced experimentally. An enzyme with neuraminidase specificity has been isolated from the culture supernatant of Corynebacterium aquaticum, and further characterized (MW = 55,600 kDa, pH = 5.5, Km = 0.138 μM, Kcat = 0.22 μg). Reversely, Th transformation of RBC could be obtained by using other neuraminidases but in very mild conditions of hydrolysis. From our results, it can be concluded that by the release of less than 20 μg of sialic acid per 1010 RBC, Th reactivity can be induced whereas hydrolysis of greater amounts of sialic acid (>20 μg/1010 RBC) give the classical T polyagglutinability.

Posttransfusion Non‐A, Non‐B Hepatitis after Cardiac Surgery: A Prospective Study

Abstract. In a prospective study of 50 recipients of HBsAg‐negative blood who had undergone cardiac surgery, 4 (8%) developed acute non‐A, non‐B hepatitis. The patients who developed hepatitis had received significantly more units of blood or blood products than the patients who had no hepatitis. The incubation period of the disease was 4–13 weeks, 3 patients were asymptomatic with peak alaminotransferase (ALT) levels of 320–497 U/l and 1 patient was jaundiced with a peak ALT of 3,400 U/l. 1 of the patients had high ALT levels after 21 weeks of observation, while 3 patients recovered after 7–10 weeks. It is concluded that non‐A, non‐B posttransfusion hepatitis in Israel is a medical problem similar to that in the USA and that the clinical picture of the disease varies from a mild asymptomatic to a symtomatic and protracted course.

The Yt blood groups in Israeli Jews, Arabs, and Druse

The Yta and Ytb allelic frequencies were determined by examining the red cells of 1683 blood samples from Israeli Jews, Arabs, and Druse with anti‐Yta and ‐Ytb. The Ytb allelic frequencies ranged between 0.1005 and 0.1522 in the Jewish communities and were 0.1294 and 0.1429 in the Arab and Druse communities, respectively. These are the highest Ytb allelic frequencies observed so far in any population tested, so the Yt blood group system can be used as a genetic marker in these populations. No factors were recognized that may have influenced the selection for the Ytb allele.