Ram Kakaiya

The effect of previous pregnancy and transfusion on HLA alloimmunization in blood donors: implications for a transfusion-related acute lung injury risk reduction strategy

BACKGROUND: Antibodies to human leukocyte antigens (HLA) in donated blood have been implicated as a cause of transfusion‐related acute lung injury (TRALI). A potential measure to reduce the risk of TRALI includes screening plateletpheresis donors for HLA antibodies. The prevalence of HLA antibodies and their relationship to previous transfusion or pregnancy in blood donors was determined.

Prevalence of HLA antibodies in remotely transfused or alloexposed volunteer blood donors

BACKGROUND: HLA antibody testing of previously transfused or pregnant donors may help reduce the risk of transfusion‐related acute lung injury (TRALI). However, the prevalence of HLA antibodies in transfused donors has not been well characterized.

Effect of Mode of Agitation on Storage of Platelet Concentrates in PL-732 Containers for 5 Days

Abstract. To determine the degree of damage induced by different modes of agitation during storage of platelets for 5 days in polyolefin (PL‐732), we studied pH, platelet count, release of lactic dehydrogenase (LDH) and β‐thromboglobulin (β‐TG), morphology and osmotic recovery. Platelets were maintained at 20–24°C on elliptical, 6 rpm circular, 2 rpm circular and flat bed agitators. Results showed that the most and least effective modes of agitation were the 2 rpm circular and the elliptical rotators, respectively. Elliptical rotators exhibited excessive release of LDH (46%) and β‐TG (51%) while the 2 rpm circular model produced significantly less discharge of these proteins (LDH 13%; β‐TG 30%; p<0.05). With elliptical units, by 120 h of storage, pH was often very alkaline (pH >7.5) when platelet counts were under 1×109/ml. Flat bed shakers and 6 rpm circular agitators were acceptable but flat bed units were unable to resuspend the platelet ‘button’ which forms after the final preparative centrifugation. The 2 rpm circular rotator showed significantly less LDH and β‐TG release than did the 6 rpm version (p < 0.05) and permitted smooth resuspension of the platelet ‘button’. Based on our in vitro studies, we conclude that elliptical rotators may not be suitable for storing PL‐732 platelet concentrates and that some other form of agitation should be used.

Tissue transplant-transmitted infections

Tissue bankers, as well as those transplanting tissues, have been sensitized to the possibility of transmission of fatal infection via tissue transplants, particularly following recent reports of a few cases of AIDS or HIV infection from bone, semen, and skin grafts. It is beyond the scope of this review to describe the steps taken by tissue banks to enhance the safety of tissue transplants. Of note is the fact that a number of new donor screening tests, such as those for antibody to HIV, HBcAg, hepatitis C virus, and human T cell lymphotropic virus type I, have recently been implemented. In addition, rapid advances in the medical history screening of tissue donors and tissue procurement, processing, and preservation continue. Viral inactivation studies are also being undertaken. All these measures are being introduced to increase the safety of tissue transplants.

Labile Coagulation Factors in Thawed Fresh Frozen Plasma Prepared by Two Methods

Two preparations of fresh frozen plasma were studied. The plasma from CPDA‐1 whole blood units was either frozen within 6 h (FFP‐I) or 18–20 h (FFP‐II) of phlebotomy. Average activity for factor VIII for FFP‐I (n = 6) and FFP‐II (n = 19) was 102% and 55%, respectively (p<0.01). Average activity for factor V and VII in both products was approximately 100%. Factor XI activity (n = 13) in FFP‐II averaged 84%. We conclude that FFP‐I and FFP‐II are equivalent in terms of coagulation factor activity except for factor VIII.

Adverse reactions and other factors that impact subsequent blood donation visits

BACKGROUND: The importance of adverse reactions in terms of donor safety recently has received significant attention, but their role in subsequent donation behavior has not been thoroughly investigated.

Identification of specificities of antibodies against human leukocyte antigens in blood donors.

BACKGROUND: Transfusion‐related acute lung injury (TRALI) is the leading cause of transfusion‐related mortality. Blood centers are implementing TRALI risk reduction strategies based on screening apheresis donors for antibodies to human leukocyte antigens (HLA).

The Leukocyte Antibody Prevalence Study-II (LAPS-II): A retrospective cohort study of transfusion-related acute lung injury in recipients of high-plasma-volume human leukocyte antigen antibody-positive or -negative components

BACKGROUND: We used a multicenter retrospective cohort study design to evaluate whether human leukocyte antigen (HLA) antibody donor screening would reduce the risk of transfusion‐related acute lung injury (TRALI) or possible TRALI.

The frequency and specificity of human neutrophil antigen antibodies in a blood donor population.

BACKGROUND: Transfusion‐related acute lung injury (TRALI) has been associated with both human leukocyte antigen (HLA) and human neutrophil antigen (HNA) antibodies. HNA antibody frequency, specificity, and demographic associations have not been well defined in the blood donor population.

5-Day Storage of Platelet Concentrates in CLX Containers: Effect of Type of Agitation

Abstract. To determine the degree of platelet damage produced by different modes of agitation during storage of concentrates for 5 days in CLX blood bags, we studied pH, platelet counts, release of LDH and beta thromboglobulin, morphology and osmotic recovery. Platelets were maintained at 20–24°C on elliptical, 6‐rpm circular, 2‐rpm circular and flat bed agitators. At 72–120 h platelet concentrates stored on the flat bed shaker had significantly lower pH values than units stored on the elliptical or on either of the circular rotators (p<0.05). The percent LDH discharged was highest for the units stored on the elliptical rotator (p<0.05). Remaining tests of platelet function were not significantly different for concentrates stored on any of the four agitators. Flat bed shakers were unable to resuspend the platelet ‘button’ which formed after the final preparative centrifugation. Based on our in vitro studies, we conclude that due to problems with low pH values, flat bed shakers may not be optimal for storing platelet concentrates in CLX blood bags and that some other form of agitation should be used.