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Abstract Hematopoietic stem cell transplantation requires a wide-range of expertise and procedural competence, in which nurses play important roles throughout, including stem cell mobilization and collection by apheresis. Little is published about post-licensure nursing education in apheresis, which suggests that it proceeds at the discretion of individual institutions, supplemented with practical training by equipment manufacturers. Information can be obtained on a small number of apheresis training courses for nurses in Australia, Canada, Indonesia, Italy, The Netherlands, Sweden and Turkey, and on nurse certification systems in Turkey and the United States. There seems to be no certification officially linked to institutional accreditation or medical insurance reimbursement related to apheresis, except in Turkey. Because apheresis is associated with various adverse events, including citrate toxicity and vasovagal reactions, the Japan Society of Transfusion Medicine and Cell Therapy, in cooperation with 3 other speciality societies, started a "Qualified Apheresis Nurse" certification in 2010, when the Japan Marrow Donor Program officially added circulating stem cell collection to bone marrow harvest from unrelated donors as a source of hematopoietic stem cells. Questionnaire surveys, collected when nurses must renew or surrender their 5-year certification, show that our system matches nurses' learning desire and can be an objective and motive of their learning, thus leading to safer and more effective apheresis practice. We dare to imagine that an internationally standardized curriculum might emerge, to which we would contribute, and from which we would learn. [ABSTRACT FROM AUTHOR]

The Great East Japan Earthquake of March 11, 2011 provoked tsunami waves with inland penetration up to 5 km and run-up heights to 40 m. More than 400 km 2 were flooded, mainly along the northeast coast of Japan's largest island, Honshu. Nearly 20,000 human lives were abruptly taken by this natural disaster. Four coastal nuclear facilities went into automatic shutdown; at one, Fukushima Daiichi, cooling system failures resulted in the meltdown of three reactor cores, accompanied by explosive release of radioisotopes. Essentials of modern blood banking and transfusion medicine were lost: roads, vehicles, blood collection venues, and facilities for blood testing and processing. Normal channels of communication were interrupted, not only by physical damage but also due to circuit overload as mobile phone users sought information and tried to exchange messages about their own and others' health, welfare, and whereabouts. The Japanese Red Cross, as a monopoly supplier of allogeneic blood, responded with a nationally coordinated effort that met the transfusion demands of a disaster characterized by immediate mass fatality rather than mass injury. Japan's routine transfusion demands are also met by hospital-based autologous blood programs, which could be pressed into service for emergency allogeneic collections. Herein we report institutional and personal experience in anticipation of future disasters, in which transfusion needs might differ from routine demand. [ABSTRACT FROM AUTHOR]

Abstract: Twenty-first century demand for radio spectrum continues to increase with the explosive growth of wireless devices, but authorities reserve slices of the spectrum for licensed Amateur Radio operators, recognizing their value to the public, particularly with respect to providing emergency communications. Blood banking and transfusion medicine are among the specialties that should also recognize the value of Amateur Radio as an emergency communications medium, because blood collection, testing, processing, storage, and transfusion are life-saving activities that in modern times can be separated by considerable distance. [Copyright &y& Elsevier]

Background 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. Study Design and Methods Apheresis PLTs from pairs of ABO-identical male donors were pooled and divided into four volumes. One volume was stored without filtration, whereas the other three were filtered with different devices. PDMPs, LDMPs, and RDMPs were measured by flow cytometry during 2 weeks of controlled-temperature (22°C) agitated storage. Results On average, PDMPs doubled over 5 days of storage, followed by a much steeper increase by which PDMPs on Day 14 were nearly 20 times higher than on Day 0. LDMP and RDMP counts were relatively stable over 14 days. Significant differences among filtered and nonfiltered products did not emerge. Conclusion Although the conditions of this study showed no favorable or unfavorable effects of three different filters on microparticle formation, surveillance and investigation of unanticipated outcomes in other experimental and clinical circumstances should continue. [ABSTRACT FROM AUTHOR]

Abstract: 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. [Copyright &y& Elsevier]

Context.--Platelet-derived microparticles (PDMPs) probably function in hemostasis, thrombosis, inflammation, and transfusion-related immunomodulation. Objectives.--To compare PDMP levels of leukocytefiltered 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 6 51/mL in unfiltered whole blood supernatant versus 34 6 18/mL after filtration. Prestorage PLT counts were 190 6 49/mL in unfiltered whole blood supernatant versus 2 6 4/mL after filtration. Moreover, PDMP and PLT counts in filtered whole blood remained low throughout storage, typically below 100/mL. In contrast, unfiltered whole blood PDMPand 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). Conclusion.--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. [ABSTRACT FROM AUTHOR]

Irradiation of cellular blood components is well established as a countermeasure against transfusion-associated graft-versus-host disease (TA-GVHD). Unintended consequences of ionizing radiation are also well established. The red cell "storage lesion" – a progression of metabolic, functional, and morphological changes – may be exacerbated by irradiation rates and doses typically used for TA-GVHD prophylaxis. With or without irradiation, a storage lesion change of clinical concern is the accelerated egress of intracellular potassium. ATP depletion during storage limits the activity of the red cell membrane's sodium-potassium pump (Na,K-ATPase), which normally maintains intracellular potassium (K+) at levels 30–40 times higher than the extracellular milieu. The natural diffusion of potassium down this concentration gradient proceeds faster if the cell membrane is damaged, and oxidative damage to cellular membranes and membrane proteins – including Na,K-ATPase – is an effect of ionizing radiation. Preventing transfusion-related hyperkalemia is a reason for limiting the shelf life of irradiated red cells. In the absence of specific measurements to assess storage lesion in a particular unit of blood, and in the absence of specific interventions at the time of transfusion to mitigate effects of storage lesion, it is consistent with the precautionary principle to put conservative limits on a blood component's shelf life. On the other hand, both the safety and sufficiency of a nation's blood supply might be improved by interventions that benefit specific recipients when they are transfused, and benefit future patients by extending the allowable shelf life of blood components. Potassium filtration of irradiated red blood cell components is one such intervention. [ABSTRACT FROM AUTHOR]

Examines the transfusion-associated graft versus host disease (TA-GVHD). Description of the single case form a cohort of patients; Variation of TA-GVHD among different populations; Correlation between socioeconomics and historical incidence of TA-GVHD.

Background and Objectives Materials and Methods Results Conclusion Restless legs syndrome (RLS), with adverse health outcomes, has been linked to blood donation, but evidence published thus far has not been rigorously analysed. This systematic review aggregates existing evidence on RLS among blood donors and identifies associated factors worthy of further investigation.MEDLINE and EMBASE were searched for articles published through 16 December 2023. Eleven studies from eight countries were selected from 142 publications. The pooled prevalence of RLS was calculated using a random‐effects model, with heterogeneity assessed by the Cochran Q and I2 statistics. Meta‐regression and sensitivity analyses explored sources of heterogeneity and the robustness of findings.Eleven studies, involving 20,255 blood donors, were included. The pooled prevalence of RLS among blood donors was 10.30% (95% confidence interval [CI]: 5.54%–16.30%), which was significantly higher than in the general adult population (3.0%, 95% CI: 1.4%–3.8%). Meta‐regression identified the year of study and geographical region as significant sources of heterogeneity. From the five studies that used logistic regression analyses, female sex and older age stand out as associated factors. No publication bias was detected, and sensitivity analysis confirmed the robustness of results.Our findings suggest a high burden of RLS among blood donors, underscoring the need for further research with standardized criteria, appropriate design and analytical methodologies to better understand the impact of RLS on individual donors and the global blood supply. [ABSTRACT FROM AUTHOR]

Bronchopulmonary dysplasia (BPD) is the most common morbidity complicating preterm birth. Red blood cell distribution width (RDW), a measure of the variation red blood cell size, could reflect oxidative stress and chronic inflammation in many diseases such as cardiovascular, pulmonary, and other diseases. The objectives of the present study were to evaluate perinatal factors affecting RDW and to validate whether RDW could be a potential biomarker for BPD. A total of 176 preterm infants born at < 30 weeks were included in this study. They were categorized into BPD (n = 85) and non-BPD (n = 91) infants. RDW at birth and 14 days and 28 days of life (DOL 14, DOL 28) were measured. Clinical data were obtained from all subjects at Fukushima Medical University (Fukushima, Japan). The mean RDW at birth, DOL 14 and DOL 28 were 16.1%, 18.6%, 20.1%, respectively. Small for gestational age (SGA), chorioamnionitis (CAM), hypertensive disorders of pregnancy (HDP), gestational age and birth weight were significantly associated with RDW at birth. SGA, BPD and red blood cell (RBC) transfusion before DOL 14 were associated with RDW at DOL 14. BPD and RBC transfusion before DOL 14 were associated with RDW at DOL 28. Compared with non-BPD infants, mean RDW at birth DOL 14 (21.1% vs. 17.6%, P < 0.001) and DOL 28 (22.2% vs. 18.2%, P < 0.001) were significantly higher in BPD infants. Multivariate analysis revealed that RDW at DOL 28 was significantly higher in BPD infants (P = 0.001, odds ratio 1.63; 95% CI 1.22–2.19). Receiver operating characteristic analysis for RDW at DOL 28 in infants with and without BPD yielded an area under the curve of 0.87 (95% CI 0.78–0.91, P < 0.001). RDW at DOL 28 with mild BPD (18.3% vs. 21.2%, P < 0.001), moderate BPD (18.3% vs. 21.2%, P < 0.001), and severe BPD (18.3% vs. 23.9%, P < 0.001) were significantly higher than those with non-BPD, respectively. Furthermore, there are significant differences of RDW at DOL 28 between mild, moderate, and severe BPD. In summary, we conclude that RDW at DOL 28 could serve as a biomarker for predicting BPD and its severity. The mechanism by which RDW at DOL 28 is associated with the pathogenesis of BPD needs further elucidation. [ABSTRACT FROM AUTHOR]

Platelets parameters including platelet count (PLT), plateletcrit (PCT), mean platelet volume (MPV) and platelet distribution width (PDW) are associated with various physiological and pathological functions in various disease. However, few studies have addressed whether perinatal factors may be associated with platelet parameters at birth in a large cohort of late preterm and term neonates. The aim of this study to investigate perinatal factors affecting platelet parameters in late preterm and term neonates. We retrospectively investigated platelet parameters including PLT, PCT, MPV, and PDW on the first day of life in 142 late preterm and 258 term neonates admitted to our NICU from 2006 through 2020. PLT, MPV, PCT, PDW on Day 0 did not significantly differ between the two groups. In term neonates, multivariate analysis revealed that PCT correlated with being small for gestational age (SGA) (β = -0.168, P = 0.006), pregnancy induced hypertension (PIH) (β = -0.135, P = 0.026) and male sex (β = -0.185, P = 0.002). PLT was associated with SGA (β = -0.186, P = 0.002), PIH (β = -0.137, P = 0.024) and male sex (β = -0.166, P = 0.006). In late preterm neonates, multivariate analysis revealed that PLT were associated with PIH, whereas no factors associated with PDW and MPV were found. In all patients studied, chorioamnionitis (CAM) was significantly associated with MPV (CAM = 10.3 fL vs. no CAM = 9.7 fL, P<0.001). Multivariate analysis showed that SGA, male sex and PIH were associated with PCT and PLT. This study demonstrates that different maternal and neonatal complications affect platelet parameters in late preterm and term neonates. [ABSTRACT FROM AUTHOR]

Background: Although disseminated intravascular coagulation (DIC) is a critical disease, there is few gold standard interventions in neonatal medicine. The aim of this study is to reveal factors affecting neonatal DIC at birth and to assess the effectiveness of rTM and FFP for DIC in neonates at birth. Methods: We retrospectively evaluated DIC score on the first day of life in neonates with underlying conditions associated with DIC. DIC in neonates was diagnosed according to Japan Society of Obstetrical, Gynecological & Neonatal Hematology 2016 neonatal DIC criteria. Results: Comparing neonates with DIC scores of ≥3 (n = 103) to those < 3 (n = 263), SGA, birth asphyxia, low Apgar score, hemangioma, hydrops, PIH, and PA were statistically increased. Among 55 neonates underwent DIC treatment, 53 had birth asphyxia and 12 had intraventricular hemorrhage. Forty-one neonates received FFP or a combination of FFP and antithrombin (FFP group), while 14 neonates received rTM or a combination of rTM, FFP, and antithrombin (rTM group). DIC score before treatment in the rTM group was significantly higher than in the FFP group (4.7 vs 3.6, P < 0.05). After treatment, DIC scores in both groups were significantly reduced on Day 1 and Day 2 (P < 0.05). Conclusions: Among various factors associated with DIC in neonates at birth, birth asphyxia is particularly significant. Furthermore, rTM in combination with FFP therapy was effective for neonatal DIC at birth. [ABSTRACT FROM AUTHOR]

Chimerism analysis after allogeneic hematopoietic stem cell transplantation serves to confirm engraftment, indicate relapse of hematologic malignancy, and attribute graft failure to either immune rejection or poor graft function. Short tandem repeat PCR (STR-PCR) is the prevailing method, followed by quantitative real-time PCR (qPCR), with detection limits of 1–5% and 0.1%, respectively. Chimerism assays using digital PCR or next-generation sequencing, both of which are more sensitive than STR-PCR, are increasingly used. Stable mixed chimerism is usually not associated with poor outcomes in non-malignant diseases, but recipient chimerism may foretell relapse of hematologic malignancies, so higher detection sensitivity may be beneficial in such cases. Thus, the need for and the type of intervention, e.g., immunosuppression regimen, donor lymphocyte infusion, and/or salvage second transplantation, should be guided by donor chimerism in the context of the feature and/or residual malignant cells of the disease to be treated. [ABSTRACT FROM AUTHOR]

To date, few studies have investigated whether perinatal factors affect coagulation parameters at birth in preterm and term neonates. We retrospectively investigated coagulation factors on day 1 in 609 consecutive neonates admitted to our neonatal intensive care unit between January 2010 and December 2017. We measured coagulation factors on day 1 using peripheral blood samples. Multivariate analysis revealed that prothrombin time–international normalized ratio correlated with intraventricular hemorrhage ( p  = 0.000; β  = 0.180) and placental abruption (PA; p  = 0.000; β  = 0.142). Activated partial thromboplastin time (aPTT) correlated with birth weight (BW; p  = 0.000; β  =  − 0.217), gestational age (GA; p  = 0.000; β  =  − 0.282), and PA ( p  = 0.000; β  = 0.181). Fibrinogen concentration was associated with respiratory distress syndrome ( p  = 0.007; β  =  − 0.114), pregnancy-induced hypertension ( p  = 0.000; β  =  − 0.141), and Apgar score at 1 minute ( p  = 0.043; β  = 0.147). Furthermore, the level of d-dimer inversely correlated with Apgar score at 5 minutes ( p  = 0.049). Finally, antithrombin III levels positively correlated with GA ( p  = 0.000) and BW ( p  = 0.000). Thus, maternal and neonatal complications affect coagulation parameters in preterm and term neonates. [ABSTRACT FROM AUTHOR]

Background: The DEL phenotype is the D variant expressing the least amounts of D antigen per red cell. Asian‐type DEL (RHD:c:1227G > A) is the most prevalent DEL in East Asia without any anti‐D alloimmunization reported before. We investigated the first observation of an anti‐D in any DEL phenotype, reported in the Japanese language at a 1987 conference, only 3 years after the discovery of DEL. Methods: We contacted the proband 35 years after the initial report. Standard hemagglutination, adsorption/elution, and flow cytometry tests were performed, as was nucleotide sequencing for the RHD, RHCE, and HLA class I and class II genes. Results: The healthy multiparous Japanese woman, a regular blood donor, still had the anti‐D of titer 8 representing an alloantibody by standard serologic methods. Unexpectedly, she carried an Asian‐type DEL without any additional RHD gene variation. All 12 HLA alleles identified were known in the Japanese population. Interestingly, one of her HLA‐DRB1 and a variant of her HLA‐DQB1 alleles had previously been associated with anti‐D immunization. Conclusion: We described an allo‐anti‐D, maintained for more than three decades, in an Asian‐type DEL. The combination of two implicated HLA alleles were rare and could have contributed to the anti‐D immunization. Continued monitoring of anti‐D immunization events in patients with DEL is warranted, and we discuss possible mechanisms for further study. As only this single observation has been recognized in the last 35 years, the current recommendation is affirmed: Individuals with Asian‐type DEL should be treated as Rh D‐positive for transfusion and Rh immune prophylaxis purposes. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article by Renshaw and colleagues in the September 2010 Archives of the journal.

On January 17, 1995, a magnitude 7.3 earthquake occurred in southern Hyogo Prefecture, a substantially urban area of Japan's main island, Honshu. Now known as the Hanshin-Awaji Earthquake, this disaster damaged or destroyed 639 686 houses and took 6434 lives. Within the disaster area, the Japanese Red Cross (JRC) Hyogo Blood Center had regional responsibilities for collecting, testing, processing, storing, and distributing blood components, including red blood cells (RBCs), fresh frozen plasma (FFP) and platelet concentrates (PLTs). Platelet shakers collapsed, forcing the discard of 103 PLT bags (1125 units) that could not be temperature-controlled or agitated. RBCs and FFP in refrigerated and frozen storage, respectively, remained in temperature control with the help of dry ice imported from non-affected areas. Local blood collection was suspended and replaced by products from other blood centers. Local demand for blood components decreased to 66% of comparable pre-quake demand. Emergent supplies rather than reserved supplies of blood components were markedly increased after the earthquake. Communication infrastructure damage prompted JRC Hyogo Blood Center to send blood delivery vehicles loaded with RBCs and FFP on a circuit of main hospitals in the affected area. Local blood donation and processing resumed 20 days after the quake. In retrospect, a nationally coordinated system of production and distribution demonstrated JRC's ability to meet transfusion demand after the 1995 Hanshin-Awaji Earthquake, and prompted changes in anticipation of subsequent disasters. [ABSTRACT FROM AUTHOR]

Background: Breast milk, nature's optimum source of nutrition for infants, can contain undesirable microorganisms that cause severe morbidity. After an outbreak of multidrug‐resistant Escherichia coli among neonates receiving breast milk donated by another mother in our neonatal intensive care unit (NICU), we were motivated to develop a high‐grade breast milk pasteurizer (BMP) designed to thaw and pasteurize breast milk at 63°C for 30 min in a sealed bag without having to open the bag or immerse it in water. Methods: Pre‐existing bacteria and spiked cytomegalovirus (CMV) were measured pre‐ and post‐pasteurization in frozen breast milk donated by mothers of children admitted to the NICU. Results: Among 48 breast milk samples (mean ± standard deviation [SD]), pre‐existing bacterial counts of 5.1±1.1 × 104 colony forming units (cfu)/mL decreased to less than 10 cfu/mL (below detection level) in 45 samples after pasteurization for 30 min. In three samples, 10–110 cfu/mL persisted. As no CMV was detected in any of the 48 samples, CMV at ≥5 × 104 pfu/mL was spiked into 11 breast milk samples. After just 10 min of pasteurization, infectious CMV was not detected (threshold <50 pfu/mL) in any sample. Conclusion: A new BMP was shown to pasteurize milk effectively with more than a 3‐log reduction of microorganisms. Compared to conventional pasteurizers, this device reduces the effort involved in pasteurizing breast milk, avoids various contamination risks, and may reduce the risk of infectious disease transmission via breast milk. [ABSTRACT FROM AUTHOR]

Chimerism analysis is a surrogate indicator of graft rejection or relapse after allogeneic hematopoietic stem cell transplantation (HSCT). Although short tandem repeat PCR (STR-PCR) is the usual method, limited sensitivity and technical variability are matters of concern. Quantitative PCR-based methods to detect single nucleotide polymorphisms (SNP-qPCR) are more sensitive, but their informativity and quantitative accuracy are highly variable. For accurate and sensitive chimerism analysis, a set of KMR kits (GenDx, Utrecht, Netherlands), based on detection of insertions/deletions (indels) by qPCR, have been developed. Here, we investigated informativity and validated the accuracy of KMR kits in Japanese donor/recipient pairs and virtual samples of DNA mixtures representative of Japanese genetic diversity. We found that at least one recipient-specific marker among 39 KMR-kit markers was informative in all of 65 Japanese donor/recipient pairs. Moreover, the percentage of recipient chimerism estimated by KMRtrack correlated well with ratios of mixed DNA in virtual samples and with the percentage of chimerism in HSCT recipients estimated by STR-PCR/in-house SNP-qPCR. Moreover, KMRtrack showed better sensitivity with high specificity when compared to STR-PCR to detect recipient chimerism. Chimerism analysis with KMR kits can be a standardized, sensitive, and highly informative method to evaluate the graft status of HSCT recipients. [ABSTRACT FROM AUTHOR]

Previously, two international surveys have addressed the wider application of platelet collection by apheresis technology and practical issues of platelet transfusion. A questionnaire was sent to persons with leadership roles related to blood banking and transfusion medicine in their countries/areas/centers, to document the implementation of modern technologies for platelet manufacturing, preservation, and transfusion risk reduction. Responses to the questionnaire finally came from 52 contributors in 40 countries/areas. Adult platelet doses ranged between 2.0×1011 and 3.0×1011 (median 2.5×1011). In approximately 10 % of centers, apheresis platelets comprised more than 90 % of the platelet inventory. More than 70 % of centers adopted universal or near universal leukocyte-reduction by filtration, apheresis, or both. Almost 20 % of centers irradiated all platelet products. Cold-stored platelets were rarely reported; only 3 centers produce such components for 1 % to 5 % of their supply. The use of platelet additive solution was reported by 18 responders (45 %), mainly in Europe, USA, and Australasia. Bacterial detection systems were reported by 18 responders from around the globe. One fatality was reported after transfusion of a platelet product contaminated with Bacillus cereus , whereas no sequelae were observed after transfusion of >350 platelet products contaminated by Cutibacteriae. Pathogen-reduction/pathogen-inactivation technology has been adopted in 15 centers, with little or no extended expiration period. Export of platelets across national borders was extremely rare. With this addition to the literature on platelet transfusion, considerable heterogeneity in collection, processing, and transfusion can be seen across the globe, through which readers may adopt, and adapt, best practices for their unique local circumstances. [ABSTRACT FROM AUTHOR]

Background: As Japan's aging society needs more blood, young students comprise a progressively smaller portion of the donor pool. To ensure a safe and sustainable blood supply, it is crucial to select suitable donors. This study aims to evaluate donor deferral rates, causes of deferral, and characteristics of deferred Japanese students. Methods: Computerized records of blood centers in northern Japan (Miyagi and Fukushima Prefectures) from March 2010 through March 2011 were retrospectively analyzed. Results: Among 231,361 individuals visiting during the 12-month period, 24,778 were students. Of these, 19,193 (77%) attempted donation, and 5,585 (23%) were deferred. Low hemoglobin, questionnaire-based interview decisions, and medication were the main reasons for temporary deferral. Age, sex, and blood center location were associated with low hemoglobin; donation history and blood center location were associated with medication-based deferral. The odds ratio among female students deferred for low hemoglobin was 35.48 with a 95% CI of 27.74-45.38. Conclusions: These results suggest that continued efforts are needed to motivate deferred potential donors to return, to prevent low hemoglobin especially among females, and to review medical interview decisions, while paying close attention to regional differences. © 2014 S. Karger GmbH, Freiburg [ABSTRACT FROM AUTHOR]

Background: Anti‐M is frequently observed as a naturally occurring antibody of little clinical significance. Naturally occurring anti‐M is often found in children although the specific triggers of production, persistence, and evanescence of anti‐M have yet to be elucidated. Methods: In a retrospective, multicenter, nationwide cohort survey conducted from 2001 to 2015, alloantibody screening was performed before and after transfusion in 18,944 recipients younger than 20 years. Recipients were categorized into six cohorts based on their age at transfusion; within and among these cohorts, allo‐anti‐M was analyzed in regard to its production, persistence, and evanescence. Results: In 44 patients, anti‐M detected before and/or after transfusion was an age‐related phenomenon, with a median age of 2 years and an interquartile range of 1–3 years; anti‐M was most frequently detected in a cohort of children 1 to <5 years (0.77%, 31 of 4035). At least five patients were presumed to have concurrent infections. Among 1575 adolescents/young adults (15 to <20 years), no anti‐M was detected. Of 29 patients with anti‐M prior to transfusion, the antibody fell to undetectable levels in 17 recipients (89.5%, of whom at least 13 received only M‐negative red cells) after anywhere from 5 days to 5.8 years; anti‐M persisted in 2, and was not tested in 10. Only 15 recipients (0.08%) produced new anti‐M after transfusion. Conclusion: Naturally occurring anti‐M is a phenomenon of younger ages, predominantly between 1 and 3 years. After transfusion, it often falls to undetectable levels. [ABSTRACT FROM AUTHOR]

Frameshifts in the Calreticulin (CALR) exon 9 provide a recurrent driver mutation of essential thrombocythemia (ET) and primary myelofibrosis among myeloproliferative neoplasms (MPNs). Here, we generated knock-in mice with murine Calr exon 9 mimicking the human CALR mutations, using the CRISPR-Cas9 method. Knock-in mice with del10 [Calrdel10/WT (wild−type) mice] exhibited an ET phenotype with increases of peripheral blood (PB) platelets and leukocytes, and accumulation of megakaryocytes in bone marrow (BM), while those with ins2 (Calrins2/WT mice) showed a slight splenic enlargement. Phosphorylated STAT3 (pSTAT3) was upregulated in BM cells of both knock-in mice. In BM transplantation (BMT) recipients from Calrdel10/WT mice, although PB cell counts were not different from those in BMT recipients from CalrWT/WT mice, Calrdel10/WT BM-derived macrophages exhibited elevations of pSTAT3 and Endothelin-1 levels. Strikingly, BMT recipients from Calrdel10/WT mice developed more severe pulmonary hypertension (PH)—which often arises as a comorbidity in patients with MPNs—than BMT recipients from CalrWT/WT mice, with pulmonary arterial remodeling accompanied by an accumulation of donor-derived macrophages in response to chronic hypoxia. In conclusion, our murine model with the frameshifted murine Calr presented an ET phenotype analogous to human MPNs in molecular mechanisms and cardiovascular complications such as PH. [ABSTRACT FROM AUTHOR]

Background: During storage, the potassium level of red blood cell (RBC) components increases, especially after irradiation. Neonates are prone to hyperkalemia, for example, non‐oliguric hyperkalemia, so using potassium adsorption filters during transfusion may be helpful. To overcome dilution of RBC components caused by saline priming of existing potassium adsorption filters, a downsized potassium adsorption filter for neonates (PAF‐n, Kawasumi Laboratories Inc., Tokyo, Japan) was developed. Study Design and Methods: To assess the performance of PAF‐n, its adsorption efficiency and RBC recovery rate were evaluated by testing pre‐filtration and serial post‐filtration (0‐30 mL, 30‐60 mL, 60‐90 mL, and 90‐120 mL) samples from 8 RBC components. Results: The average potassium adsorption rate of the PAF‐n was 90.5% ± 0.78%, and never less than 89.0% in any of 8 RBC components. RBC recovery rates were 99.3% ± 1.12%. Conclusion: The PAF‐n showed an effective potassium ability with negligible RBC dilution. [ABSTRACT FROM AUTHOR]

Background: Human T-cell lymphotropic virus type 1 (HTLV-1), the causative agent of adult T-cell leukaemia/lymphoma (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), is endemic in sub-Saharan Africa (SSA) and poses a high morbidity and mortality risk. Its prevalence in the general population is poorly understood. The potential for prevention motivated us to do a systematic review and meta-analysis of population-based studies to estimate the prevalence of HTLV-1 in SSA.Methods: A comprehensive, no-limit search was conducted in EMBASE, PubMed, Web of Science and the Cochrane Library from their inception dates to March 2019. Population-based studies presenting data on HTLV-1 in sub-Saharan Africa were included. Pooled prevalence was estimated using a random-effects meta-analysis.Results: A total of 21 studies were included, representing 42 297 participants. The pooled HTLV-1 seroprevalence was 3.19% (95% CI 2.36-4.12%) with variations across year of study. Prevalence of HTLV-1 positively correlated with year of study (β = 0.0036, P = 0.007). Participants from Central, Western and Southern Africa had a seroprevalence of 4.16% (95% CI 2.43-6.31%), 2.66% (95% CI 1.80-3.68%) and 1.56% (95% CI 0.48-3.15%), respectively.Conclusions: Our findings suggest that HTLV-1 infection is a public health concern in SSA and highlight the need to implement effective preventive programmes and interventions aimed at reducing the burden of this common yet neglected infection. [ABSTRACT FROM AUTHOR]

Background and objective: Human T‐cell lymphotropic viruses (HTLV) 1 and 2 are endemic in sub‐Saharan Africa (SSA), transfusion‐transmissible and causally linked to various severe diseases. However, even in SSA countries with moderate to high endemicity, routine blood donor screening for HTLV is rarely, if ever, performed. Information on seroprevalence is limited. The aim of this review is to establish the prevalence of HTLV‐1 and HTLV‐1/2 among blood donors in sub‐Saharan Africa. Materials and Methods: We systematically reviewed databases including EMBASE, MEDLINE and the Cochrane database library from their inception to June 2018. Studies presenting data on HTLV prevalence among blood donors in sub‐Saharan Africa were included. A random‐effect meta‐analysis was conducted on all eligible studies. Results: A total of 25 studies were included, representing 74 119 blood donors, of whom over 80% (61 002) were only tested for HTLV‐1. The evidence base was high and moderate in quality. The pooled prevalence of the 17 studies that screened only for HTLV‐1 and the nine studies that screened for HTLV‐1/2 was 0·68 (95% CI: 0·29–1·60) and 1·11 (95% CI: 0·47–2·59) per 100 blood donors, respectively. Conclusion: The prevalence of HTLV‐1 infection among blood donors is relatively low. The current review is intended to inform debates and decisions about best practices to prevent transfusion‐transmitted HTLV in sub‐Saharan Africa. Further work is required to determine the risk of infections by transfusion and the cost‐effectiveness of any new measures such as routine screening. [ABSTRACT FROM AUTHOR]

Idiopathic normal pressure hydrocephalus (iNPH) is a dementia-inducing disorder. Primary cause of iNPH is speculated to be a reduction of cerebrospinal fluid (CSF) absorption, which secondarily induces hydrocephalus, compression of brain, and reduction of CSF production. Patients are treated by surgically inserting a shunt to deliver excess CSF to the abdominal cavity. The prognosis for cognitive improvement after shunt surgery has been difficult to predict. We therefore investigated various CSF proteins, hoping to find a biomarker predictive of cognitive performance one to two years after shunt surgery. CSF proteins of 34 iNPH and 15 non-iNPH patients were analysed by Western blotting, revealing two glycan isoforms of transferrin (Tf); ‘brain-type’ Tf with N -acetylglucosaminylated glycans and ‘serum-type’ Tf with α2, 6-sialylated glycans. Brain-type Tf levels decreased in iNPH but rapidly returned to normal levels within 1–3 months after shunt surgery. This change was positively correlated with recovery from dementia, per Mini-Mental State Examination and Frontal Assessment Battery scores at 11.8 ± 7.7 months post-operation, suggesting that brain-type Tf is a prognostic marker for recovery from dementia after shunt surgery for iNPH. Histochemical staining with anti-Tf antibody and an N -acetylglucosamine-binding lectin suggests that brain-type Tf is secreted from choroid plexus, CSF-producing tissue. [ABSTRACT FROM AUTHOR]

Background Spontaneous intracranial hypotension (SIH) is caused by cerebrospinal fluid (CSF) leakage. Definitive diagnosis can be difficult by clinical examinations and imaging studies. Methods SIH was diagnosed with the following criteria: (i) evidence of CSF leakage by cranial magnetic resonance imaging (MRI) findings of intracranial hypotension and/or low CSF opening pressure; (ii) no recent history of dural puncture. We quantified CSF proteins by ELISA or Western blotting. Results Comparing with non-SIH patients, SIH patients showed significant increase of brain-derived CSF glycoproteins such as lipocalin-type prostaglandin D synthase (L-PGDS), soluble protein fragments generated from amyloid precursor protein (sAPP) and “brain-type” transferrin (Tf). Serum-derived proteins such as albumin, immunoglobulin G, and serum Tf were also increased. A combination of L-PGDS and brain-type Tf differentiated SIH from non-SIH with sensitivity 94.7% and specificity 72.6%. Conclusion L-PGDS and brain-type Tf can be biomarkers for diagnosing SIH. General significance L-PGDS and brain-type Tf biosynthesized in the brain appears to be markers for abnormal metabolism of CSF. [ABSTRACT FROM AUTHOR]

Background: Autoimmune hemolytic anemia (AIHA) is caused by autoantibodies to red blood cells (RBCs), which can be panreactive and/or specific to Rh/other blood group antigens. We report a severe case of AIHA after bone marrow transplantation (BMT) due to autoanti-D triggered by reactivation of Epstein-Barr virus (EBV) infection. A combined strategy of D- RBC transfusion and administration of anti-CD20 monoclonal antibody (MoAb) resolved the hemolysis.Case Report: A 33-year-old male underwent allogeneic BMT from an ABO-identical and HLA-matched unrelated male donor. Five months later, while having mild chronic graft-versus-host disease, he manifested AIHA, with a hemoglobin (Hb) level of 5.1 g/dL on AIHA Day 2 (Posttransplant Day 156) and was refractory to D+ RBCs, with a Hb level of 2.4 g/dL on AIHA Day 6. Anti-D-like autoantibodies (titer 1280, subclass immunoglobulin G1 , monocyte monolayer assay 28.7%) and panreactive (titer 40) were identified. Changing the RBC transfusion strategy to D- increased his Hb level to 6.7 g/dL on Day 10. Administration of anti-CD20 MoAb mitigated EBV-related B-cell proliferation and reduced anti-D autoantibody titer to 320 by Day 16 with normalized Hb concentration after 6 months.Conclusion: In severe AIHA, when standard treatment and regular RBC transfusions are ineffective, transfusion of RBCs lacking the target antigen(s) of autoantibodies and administration of anti-CD20 MoAb should be considered. [ABSTRACT FROM AUTHOR]

Background Pediatric apheresis for peripheral blood stem cell transplantation should be carried out with due concern for low corporeal blood volume and vulnerability to hypocalcemia-related complications, hypovolemic shock, and hypervolemic cardiac overload. Study Design And Methods We retrospectively investigated a total of 267 apheresis procedures from 1990 to 2013 on 93 children between 0 and 10 years old, including 89 patients and 4 healthy donors, with body weights of 6.3 to 44.0 kg. Results The median CD34+ cell yield per apheresis procedure was 2.3 × 10 6 CD34+ cells/kg (0.2–77.9 × 10 6 CD34+ cells/kg). Adverse events occurred in 11.6% of procedures (n = 31), including mild perivascular pain (n = 12), emesis (n = 9), hypotension (n = 3), urticaria (n = 2), numbness (n = 2), chest pain (n = 1), facial flush (n = 1), and abdominal pain (n = 1). Among hypotensive events, shock in a 9.6 kg one-year-old boy required emergency treatment in 1996. Thereafter, we adopted continuous injection of calcium gluconate, ionized calcium monitoring, central venous catheter access and circuit priming with albumin in addition to concentrated red cells. Since then we have had fewer complications: 16.4% per apheresis during 1990–1997 versus 5.8% during 1998–2013. No healthy pediatric donors suffered from any late-onset complications related to apheresis or G-CSF administration. Conclusion By employing appropriate measures, peripheral blood stem cell apheresis for small children can have an improved safety profile, even for children weighing <10 kg. [ABSTRACT FROM AUTHOR]

Background: Thyroid nodules and cancers are rare in children compared with adults. However, after the 1986 Chernobyl Nuclear Power Plant accident, a rapid increase in childhood thyroid cancer was observed. To avoid any confusion and misunderstanding of data obtained in Fukushima after the 2011 nuclear accident, baseline prevalence of thyroid nodules and cancers should be carefully assessed with standardized criteria systematically, and comprehensively applied to the population perceived to be at risk. Aims: Under the official framework of the Fukushima Health Management Survey, the thyroids of children in Fukushima were examined using ultrasound, and the results collected in the first four years after the nuclear accident were analyzed in order to establish a baseline prevalence of childhood thyroid abnormalities, especially cancer. Subjects and methods: Of 367,685 people aged 18 years or younger as of April 1, 2011, who were living in Fukushima Prefecture at the time of the accident, 300,476 underwent thyroid ultrasound screening. Of those, 2108 subjects with thyroid nodules were further examined using an advanced ultrasound instrument, with standardized criteria applied to determine the need for fine-needle aspiration cytology (FNAC). FNAC results determined the need for surgery and histological confirmation of the cytological diagnosis. Results: Of the 2108 rescreened subjects, 543 underwent FNAC, of whom 113 were diagnosed with malignancy or suspected malignancy. Subsequently, 99 patients underwent surgical resection, revealing 95 cases of papillary thyroid cancer, three poorly differentiated cancers, and one benign nodule. The overall prevalence of childhood thyroid cancer in Fukushima was determined to be 37.3 per 100,000 with no significant differences between evacuated and non-evacuated areas. Thyroid cancer patients had external exposure estimates of <2.2 mSv during the first four months. Conclusions: The high prevalence of childhood thyroid cancer detected in this four-year study in Fukushima can be attributed to mass screening. It clearly exceeds what is found incidentally anywhere else. Direct comparisons with any other results, even those from cancer registries, are not meaningful because of differences in methodology. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background Recent evidence from alcohol and trauma studies suggests that disasters are associated with increases in the consumption of alcohol. The Great East Japan Earthquake and the associated nuclear disaster have continued to affect the mental health of evacuees from Fukushima. This study aimed to extend these findings by examining the relationship between drinking behaviors and the risk of mental illness after the compound disaster. Methods We conducted the Mental Health and Lifestyle Survey with 56,543 evacuees. Kessler's K6 was used to assess the risk of mental illness, and logistic regression models were applied to analyze how drinking behavior patterns influence the risk of serious mental illness after adjustment for confounding variables. Results Logistic regression analysis evidenced that beginning heavy and light drinkers had the highest and a higher risk of serious mental illness, respectively. Individuals who were nondrinkers pre- and postdisaster had the lowest proportional risk of mental illness. Abstainers also had some risk to their mental health after the compound disaster. Conclusions The results of this study highlight that beginning drinkers have a high risk of serious mental illness. Thus, mental health professionals should pay attention to the drinking behaviors of evacuees, which might predict increased risk of serious mental illness and consequently indicate a need for psychological intervention. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Case report We describe a hemodialysis (HD) patient who successfully underwent total hip arthroplasty with autologous blood transfusion (ABT). There were several problems with collecting ABT in this setting. Discussion A literature search for HD patients and ABT produced 8 articles describing 29 patients. Higher doses of erythropoietin stimulating agents were used to collect ABT than for a typical HD session. In 75% of the cases autologous blood was collected just after HD to collect better quality blood. The optimal clinical procedures for ABT in HD patients need to be clarified. [ABSTRACT FROM AUTHOR]

Oxytocin is a neuropeptide synthesized in the hypothalamus. In addition to its role in parturition and lactation, oxytocin mediates social behavior and pair bonding. The possibility of using oxytocin to modify behavior in neurodevelopmental disorders, such as autism spectrum disorder, is of clinical interest. Microglia are tissue-resident macrophages with roles in neurogenesis, synapse pruning, and immunological mediation of brain homeostasis. Recently, oxytocin was found to attenuate microglial secretion of proinflammatory cytokines, but the source of this oxytocin was not established. This prompted us to investigate whether microglia themselves were the source. We examined oxytocin expression in human and murine brain tissue in both sexes using immunohistochemistry. Oxytocin mRNA expression and secretion were examined in isolated murine microglia from wild type and oxytocin-knockout mice. Also, secretion of oxytocin and cytokines was measured in cultured microglia (MG6) stimulated with lipopolysaccharide (LPS). We identified oxytocin expression in microglia of human brain tissue, cultured microglia (MG6), and primary murine microglia. Furthermore, LPS stimulation increased oxytocin mRNA expression in primary murine microglia and MG6 cells, and oxytocin secretion as well. A positive correlation between oxytocin and IL-1β, IL-10 secretion emerged, respectively. This may be the first demonstration of oxytocin expression in microglia. Functionally, oxytocin might regulate inflammatory cytokine release from microglia in a paracrine/autocrine manner. • Oxytocin is expressed in human and murine microglia. • Oxytocin is secreted from primary and cultured microglia cell line, MG6. • Lipopolysaccharide treatment increases oxytocin mRNA expression in microglia. • Oxytocin secretion from MG6 positively correlates with IL-1β and IL-10 secretion. [ABSTRACT FROM AUTHOR]

Background 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. Study Design and Methods We investigated 188 collections and products from autologous (patient) and allogeneic (donor) subjects and analyzed a subset of 89 allogeneic collections and products. Twenty-nine subjects who received apheresis for 2 consecutive days using both programs were also evaluated with a paired crossover comparison. Results The two programs processed similar volumes, but run time was longer with Spectra- Auto. Yield and efficiency of CD34+ cell collection were similar between these programs in the whole cohort, although white blood cell ( WBC) and mononuclear cell ( MNC) yields were higher with Spectra- MNC. In the allogeneic cohort, yield and efficiency of WBC collection were greater in Spectra- MNC. However, collected WBCs, MNCs, and CD34+ cells were similar between these programs in paired comparison. Regardless of program, preapheresis peripheral WBC, MNC, and CD34+ cell counts correlated with the number of cells collected. In contrast, preapheresis WBC counts in the whole cohort were negatively correlated with collection efficiencies of CD34+ cells in Spectra- MNC but not Spectra- Auto. The products collected using Spectra- MNC contained more contaminating platelets ( PLTs) than Spectra- Auto, with a corresponding reduction in postdonation circulating PLTs. Conclusion Spectra- MNC and Spectra- Auto showed distinct features that should be considered on a case-by-case basis. Similar investigations should be undertaken as new collection platforms are introduced. [ABSTRACT FROM AUTHOR]

Abstract: Background and objectives: To ensure an adequate and safe blood supply, it is crucial to select suitable donors according to stringent eligibility criteria. This study aims to evaluate donor deferral rates, causes of deferral, and characteristics of deferred Japanese donors. Materials and methods: Computerized records of blood centers in Miyagi and Fukushima Prefectures from March 2010 through March 2011 were retrospectively analyzed. Results: Among 231,361 individuals presenting during this period, 186,513 had complete data. Of these 160,763 (86%) attempted donation and 25,750 (14%) were deferred. The overall proportion of deferrals was higher among those less than 20years old (24% vs 13%, P <0.0001), female (26% vs 7%, P <0.0001), and first-time donors (28% vs 12%, P <0.0001). Factors that were significantly associated with deferral status were female sex [Odds ratio (OR)=4.40], first-time donation attempt (OR=2.42), and donation at Fukushima blood centers (OR=0.57). Main reasons for temporary deferral were low hemoglobin and questionnaire-based interview decisions. Conclusions: First-time and female were more frequently deferred whereas those presented at Fukushima blood centers were less frequently deferred. Low hemoglobin was the major contributor for female donors. Strategies to minimize deferral are needed to ensure an adequate and safe blood supply. [Copyright &y& Elsevier]

Abstract: We report the death of a 61-year-old Japanese man massively transfused during and after emergency aortic surgery. Postoperative on day 8, he died after cardiac arrest associated with hyperkalemia. Indirect antiglobulin testing demonstrated both anti-Dib and anti-E antibodies pre-transfusion, and elevation of their titers as the delayed hemolytic transfusion reaction evolved. Monocyte monolayer assay (induction of reactive monocytes) and flow cytometry (increase of IgG1 and/or IgG3) gave evidence of the clinical significance of both antibodies. Anti-Dib must be considered when an antibody to a high incidence antigen is found in Japanese and other Mongoloid populations. [Copyright &y& Elsevier]

Context.--An increasing number of medical centers can collect bone marrow, peripheral blood, or umbilical cord stem cells. Pathology laboratories should accommodate this trend, but investment in additional equipment may be impractical. Objectives.--To compare CD34+ cell counting results by using 2 widely available flow cytometry systems, with and without the use of a separate hematology analyzer (ie, single-platform versus dual-platform methodologies). Design.--Whole blood and peripheral blood stem cell (PBSC) samples were analyzed from 13 healthy allogeneic PBSC donors and 46 autologous PBSC donors with various malignancies. The Cytomics FC500 (Beckman Coulter, Fullerton, California) was compared with the FACSCalibur (BD Biosciences, San Jose, California). Dual-platform CD34+ cell counting incorporated data from a KX-21 hematology analyzer (Sysmex, Kobe, Japan). Results.--Subtle differences in CD34+ cell counting between 2 systems and 2 methods did not achieve statistical significance. Conclusion.--Different systems and methods for CD34+ cell enumeration, properly validated, can support care for patients undergoing transplants and provide meaningful data for multicenter studies or meta-analyses. [ABSTRACT FROM AUTHOR]

BACKGROUND: Screening blood donors for hepatitis C virus (HCV) antibody has effectively mitigated transfusion transmission of HCV. We conducted a post hoc analysis to clarify the impact of donor screening on a general population of reproductive-age females and their offspring. STUDY DESIGN AND METHODS: Anti-HCV screening in Japan started in late-1989. In a cohort studied between May 1990 and November 2004, a total of 22,664 consecutive serum samples from pregnant women were screened for anti-HCV. Reactive samples were further tested for HCV RNA. Linear structural regression was applied to identify causal relationships. RESULTS: Anti-HCV–reactive rates declined significantly by two measures. First, among women known to have been transfused, rates fell from 14.8% to 3.1% with the implementation of anti-HCV screening (p < 0.01). Nevertheless, this is 10 times higher than the 0.3% reactive rate seen in a similar cohort of nontransfused women. Second, rates fell from 1.8% among women born in 1955 or before to 0.3% for women born in 1966 or later (p < 0.01). Among 103 anti-HCV–reactive women, 31 (30%) had been transfused and another 17 (17%) had other identifiable risk factors. The remaining 55 (53%) had no clear risk factor. Blood transfusion accounted for 19% of anti-HCV acquisition, by path analysis. Only one infant in this cohort was vertically infected with HCV. CONCLUSION: Anti-HCV screening of donated blood and hygienic improvements have markedly decreased HCV infection of pregnant women with a transfusion history; however, 70% of anti-HCV–reactive women were deemed to be infected via routes other than transfusion. [ABSTRACT FROM AUTHOR]

Maternal alloantibody-mediated hemolytic disease of the fetus and newborn (HDFN) ranges from no or mild symptoms to severe hydrops and intrauterine fetal demise. Hemolytic anti-D-mediated HDFN proceeds via a long-known mechanism, to which three other pathways to fetal/neonatal anemia may be added: (0) Fetal erythrocyte destruction can proceed by extravascular phagocytosis. (1) An apoptotic pathway has been described for anti-Kell, and anti-Ge3. (2) Erythropoietic suppression may arise from altered or deformed erythroblast architecture in anti-M-mediated disease. (3) Clonal escape from erythropoietic suppression is hypothesized to arise from maternal anti-Jra immune pressure, albeit this requires further elucidation. Alloantibody-mediated anemic disease of the fetus and newborn (ADFN) is a designation we favor for cases when hemolysis or hyperbilirubinemia are not the dominant features, such as those provoked by anti-Kell, anti-Ge3, anti-M, and anti-Jra. [ABSTRACT FROM AUTHOR]