79 results on '"Hillyer, Christopher D."'
Search Results
2. Discovery of Highly Potent Small Molecule Pan-Coronavirus Fusion Inhibitors.
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Curreli, Francesca, Chau, Kent, Tran, Thanh-Thuy, Nicolau, Isabella, Ahmed, Shahad, Das, Pujita, Hillyer, Christopher D., Premenko-Lanier, Mary, and Debnath, Asim K.
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CORONAVIRUSES ,SARS-CoV-2 ,SMALL molecules ,SARS-CoV-2 Omicron variant ,SARS-CoV-2 Delta variant ,SARS virus ,COVID-19 pandemic - Abstract
The unprecedented pandemic of COVID-19, caused by a novel coronavirus, SARS-CoV-2, and its highly transmissible variants, led to massive human suffering, death, and economic devastation worldwide. Recently, antibody-evasive SARS-CoV-2 subvariants, BQ and XBB, have been reported. Therefore, the continued development of novel drugs with pan-coronavirus inhibition is critical to treat and prevent infection of COVID-19 and any new pandemics that may emerge. We report the discovery of several highly potent small-molecule inhibitors. One of which, NBCoV63, showed low nM potency against SARS-CoV-2 (IC
50 : 55 nM), SARS-CoV-1 (IC50 : 59 nM), and MERS-CoV (IC50 : 75 nM) in pseudovirus-based assays with excellent selectivity indices (SI > 900), suggesting its pan-coronavirus inhibition. NBCoV63 showed equally effective antiviral potency against SARS-CoV-2 mutant (D614G) and several variants of concerns (VOCs) such as B.1.617.2 (Delta), B.1.1.529/BA.1 and BA.4/BA.5 (Omicron), and K417T/E484K/N501Y (Gamma). NBCoV63 also showed similar efficacy profiles to Remdesivir against authentic SARS-CoV-2 (Hong Kong strain) and two of its variants (Delta and Omicron), SARS-CoV-1, and MERS-CoV by plaque reduction in Calu-3 cells. Additionally, we show that NBCoV63 inhibits virus-mediated cell-to-cell fusion in a dose-dependent manner. Furthermore, the absorption, distribution, metabolism, and excretion (ADME) data of NBCoV63 demonstrated drug-like properties. [ABSTRACT FROM AUTHOR] more...- Published
- 2023
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3. Comprehensive phenotyping of erythropoiesis in human bone marrow: Evaluation of normal and ineffective erythropoiesis.
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Yan, Hongxia, Ali, Abdullah, Blanc, Lionel, Narla, Anupama, Lane, Joseph M., Gao, Erjing, Papoin, Julien, Hale, John, Hillyer, Christopher D., Taylor, Naomi, Gallagher, Patrick G., Raza, Azra, Kinet, Sandrina, and Mohandas, Narla more...
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- 2021
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4. Low Seroprevalence of SARS-CoV-2 in Rhode Island blood donors during may 2020 as determined using multiple serological assay formats.
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Nesbitt, Daniel J., Jin, Daniel P., Hogan, Joseph W., Yang, Jenny, Chen, Haidee, Chan, Philip A., Simon, Melissa J., Vargas, Matthew, King, Ewa, Huard, Richard C., Bandy, Utpala, Hillyer, Christopher D., and Luchsinger, Larry L. more...
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SARS-CoV-2 ,COVID-19 ,SEROPREVALENCE ,BLOOD donors ,ANTIBODY titer - Abstract
Background: Epidemic projections and public health policies addressing Coronavirus disease (COVID)-19 have been implemented without data reporting on the seroconversion of the population since scalable antibody testing has only recently become available.Methods: We measured the percentage of severe acute respiratory syndrome- Coronavirus-2 (SARS-CoV-2) seropositive individuals from 2008 blood donors drawn in the state of Rhode Island (RI). We utilized multiple antibody testing platforms, including lateral flow immunoassays (LFAs), enzyme-linked immunosorbent assays (ELISAs) and high throughput serological assays (HTSAs). To estimate seroprevalence, we utilized the Bayesian statistical method to adjust for sensitivity and specificity of the commercial tests used.Results: We report than an estimated seropositive rate of RI blood donors of approximately 0.6% existed in April-May of 2020. Daily new case rates peaked in RI in late April 2020. We found HTSAs and LFAs were positively correlated with ELISA assays to detect antibodies specific to SARS-CoV-2 in blood donors.Conclusions: These data imply that seroconversion, and thus infection, is likely not widespread within this population. We conclude that IgG LFAs and HTSAs are suitable to conduct seroprevalence assays in random populations. More studies will be needed using validated serological tests to improve the precision and report the kinetic progression of seroprevalence estimates. [ABSTRACT FROM AUTHOR] more...- Published
- 2021
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5. Seroprevalence of anti-SARS-CoV-2 antibodies in a cohort of New York City metro blood donors using multiple SARS-CoV-2 serological assays: Implications for controlling the epidemic and "Reopening".
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Jin, Daniel K., Nesbitt, Daniel J., Yang, Jenny, Chen, Haidee, Horowitz, Julie, Jones, Marcus, Vandergaast, Rianna, Carey, Timothy, Reiter, Samantha, Russell, Stephen J., Kyratsous, Christos, Hooper, Andrea, Hamilton, Jennifer, Ferreira, Manuel, Deng, Sarah, Straus, Donna, Baras, Aris, Hillyer, Christopher D., and Luchsinger, Larry L. more...
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PANDEMICS ,SEROPREVALENCE ,SARS-CoV-2 ,BLOOD donors ,ENZYME-linked immunosorbent assay ,SERODIAGNOSIS ,IMMUNOGLOBULINS ,VIRAL antibodies - Abstract
Projections of the stage of the Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) pandemic and local, regional and national public health policies to limit coronavirus spread as well as "reopen" cities and states, are best informed by serum neutralizing antibody titers measured by reproducible, high throughput, and statically credible antibody (Ab) assays. To date, a myriad of Ab tests, both available and FDA authorized for emergency, has led to confusion rather than insight per se. The present study reports the results of a rapid, point-in-time 1,000-person cohort study using serial blood donors in the New York City metropolitan area (NYC) using multiple serological tests, including enzyme-linked immunosorbent assays (ELISAs) and high throughput serological assays (HTSAs). These were then tested and associated with assays for neutralizing Ab (NAb). Of the 1,000 NYC blood donor samples in late June and early July 2020, 12.1% and 10.9% were seropositive using the Ortho Total Ig and the Abbott IgG HTSA assays, respectively. These serological assays correlated with neutralization activity specific to SARS-CoV-2. The data reported herein suggest that seroconversion in this population occurred in approximately 1 in 8 blood donors from the beginning of the pandemic in NYC (considered March 1, 2020). These findings deviate with an earlier seroprevalence study in NYC showing 13.7% positivity. Collectively however, these data demonstrate that a low number of individuals have serologic evidence of infection during this "first wave" and suggest that the notion of "herd immunity" at rates of ~60% or higher are not near. Furthermore, the data presented herein show that the nature of the Ab-based immunity is not invariably associated with the development of NAb. While the blood donor population may not mimic precisely the NYC population as a whole, rapid assessment of seroprevalence in this cohort and serial reassessment could aid public health decision making. [ABSTRACT FROM AUTHOR] more...
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- 2021
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6. Escape from neutralizing antibodies by SARS-CoV-2 spike protein variants.
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Weisblum, Yiska, Schmidt, Fabian, Fengwen Zhang, DaSilva, Justin, Poston, Daniel, Lorenzi, Julio C. C., Muecksch, Frauke, Rutkowska, Magdalena, Hoffmann, Hans-Heinrich, Michailidis, Eleftherios, Gaebler, Christian, Agudelo, Marianna, Cho, Alice, Zijun Wang, Gazumyan, Anna, Cipolla, Melissa, Luchsinger, Larry, Hillyer, Christopher D., Caskey, Marina, and Robbiani, Davide F. more...
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- 2020
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7. COVID19 antibody detection using lateral flow assay tests in a cohort of convalescent plasma donors.
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Ragnesola, Brett, Jin, Daniel, Lamb, Christopher C., Shaz, Beth H., Hillyer, Christopher D., and Luchsinger, Larry L.
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COVID-19 ,IMMUNOGLOBULINS ,IMMUNOGLOBULIN M ,SEROCONVERSION ,SERODIAGNOSIS ,RISK exposure ,CONVALESCENT plasma - Abstract
Objective: COVID19 has caused a global and ongoing pandemic. The need for population seroconversion data is apparent to monitor and respond to the pandemic. Using a lateral flow assay (LFA) testing platform, the seropositivity in 63 New York Blood Center (NYBC) Convelescent Plasma (CP) donor samples were evaluated for the presence of COVID19 specific IgG and IgM. Results: CP donors showed diverse antibody result. Convalescent donor plasma contains SARS-CoV-2 specific antibodies. Weak antibody bands may identify low titer CP donors. LFA tests can identify antibody positive individuals that have recovered from COVID19. Confirming suspected cases using antibody detection could help inform the patient and the community as to the relative risk to future exposure and a better understanding of disease exposure. [ABSTRACT FROM AUTHOR] more...
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- 2020
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8. How did we rapidly implement a convalescent plasma program?
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Budhai, Alexandra, Wu, Annie A., Hall, Lucette, Strauss, Donna, Paradiso, Sarai, Alberigo, Jill, Hillyer, Christopher D., Jett, Betsy, Tobian, Aaron A. R., Bloch, Evan M., Sachais, Bruce S., and Shaz, Beth H. more...
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COVID-19 pandemic ,INVESTIGATIONAL drugs ,RANDOMIZED controlled trials ,BLOOD donors ,PATIENT advocacy ,STRATEGIC planning ,CONVALESCENT plasma - Abstract
Since the beginning of the COVID-19 pandemic, the use of convalescent plasma as a possible treatment has been explored. Here we describe our experience as the first U.S. organization creating a COVID-19 convalescent plasma program to support its use through the single-patient emergency investigational new drug, the National Expanded Access Program, and multiple randomized controlled trials. Within weeks, we were able to distribute more than 8000 products, scale up collections to more than 4000 units per week, meet hospital demand, and support randomized controlled trials to evaluate the efficacy of convalescent plasma treatment. This was through strategic planning; redeployment of staff; and active engagement of hospital, community, and public health partners. Our partners helped with donor recruitment, testing, patient advocacy, and patient availability. The program will continue to evolve as we learn more about optimizing the product. Remaining issues to be resolved are antibody titers, dose, and at what stage of disease to transfuse. [ABSTRACT FROM AUTHOR] more...
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- 2020
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9. Ten years of TRALI mitigation: measuring our progress.
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Vossoughi, Sarah, Gorlin, Jed, Kessler, Debra A., Hillyer, Christopher D., Van Buren, Nancy L., Jimenez, Alexandra, and Shaz, Beth H.
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BLOOD transfusion reaction ,U.S. states - Abstract
Background: Transfusion-related acute lung injury (TRALI) is a leading cause of transfusion-associated mortality for which multiple mitigation strategies have been implemented over the past decade. However, product-specific TRALI rates have not been reported longitudinally and may help refine additional mitigation strategies.Study Design and Methods: This retrospective multicenter study included analysis of TRALI rates from 2007 through 2017. Numerators included definite or probable TRALI reports from five blood centers serving nine states in the United States. Denominators were components distributed from participating centers. Rates were calculated as per 100,000 components distributed (p < 0.05 significant).Results: One hundred four TRALI cases were reported from 10,012,707 components distributed (TRALI rate of 1.04 per 100,000 components). The TRALI rate was 2.25 for female versus 1.08 for male donated components (p < .001). The TRALI rate declined from 2.88 in 2007 to 0.60 in 2017. From 2007 to 2013, there was a significantly higher TRALI rate associated with female versus male plasma (33.85 vs. 1.59; p < 0.001) and RBCs (1.97 vs. 1.15; p = 0.03). From 2014 through 2017, after implementation of mitigation strategies, a significantly higher TRALI rate only from female-donated plateletpheresis continued to be observed (2.98 vs. 0.75; p = 0.04).Conclusion: Although the TRALI rates have substantially decreased secondary to multiple strategies over the past decade, a residual risk remains, particularly with female-donated plateletpheresis products. Additional tools that may further mitigate TRALI incidence include the use of buffy coat pooled platelets suspended in male donor plasma or platelet additive solution due to the lower amounts of residual plasma. [ABSTRACT FROM AUTHOR] more...- Published
- 2019
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10. Donor incentives improve cardiovascular disease risk profile and donation rates.
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Goel, Ruchika, Kessler, Debra, Nandi, Vijay, Ortiz, Caroline, Hillyer, Christopher D., and Shaz, Beth H.
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DIRECTED blood donations ,BLOOD donors ,CARDIOVASCULAR diseases ,BLOOD collection ,DONOR blood supply ,CARDIOVASCULAR disease prevention ,COMPARATIVE studies ,LONGITUDINAL method ,RESEARCH methodology ,MEDICAL cooperation ,MOTIVATION (Psychology) ,RESEARCH ,RESEARCH funding ,HEALTH self-care ,SELF-evaluation ,PSYCHOSOCIAL factors ,EVALUATION research - Abstract
Background: Blood centers may offer point-based reward systems or cardiovascular disease (CVD) screening to incentivize donors. However, combining these incentives to improve CVD risk and blood donation rates has not been studied.Study Design and Methods: Study was a three-arm prospective controlled trial: Group 1, control (routine points, no CVD screening); Group 2, CVD screening with routine points; and Group 3, CVD screening plus incentive double points. The primary objective was to determine if double versus routine incentive points led to improvement or maintenance of CVD risk profile assessed using self-reported changes in 1) reading food labels for calorie and fat content, 2) exercising daily, 3) reduced fat intake, and 4) increase in eating fruits and vegetables. Outcomes were compared at first and final (2-year) follow-up visits. As secondary outcome, median blood donation rates before enrollment and during study were compared.Results: A total of 570 donors (290 in Group 1, 134 in Group 2, 146 Group 3) were selected. At first follow-up visit, 71.4% in Group 3 versus 62.0% in Group 2 subjects reported at least one of four positive behavioral changes (p < 0.001). Increase in reading food labels for calorie and fat content was the most common change and higher in Group 3 (Group 3 from 60.9% to 79.1%; Group 2 from 67.6% to 77.5%; p < 0.001). Final evaluation showed significant increase in self-reported exercise in Group 3 only (from baseline 52.9% to 68.3%; p < 0.05). Group 3 reported higher increase in median number of donations/year during study enrollment (6.8 [IQR, 4.3-12] vs. baseline 4.6 [IQR, 3.2-7.1] donations/year) than Group 2 (5.6 [IQR, 4.2-10.5] vs. baseline 4.9 [IQR, 3.5-10.2]) and Group 1 (4.4 [IQR, 2.7-8.0] vs. baseline 4.4 [IQR, 2.5-6.0] donations/year; p < 0.001).Conclusion: Positive donor reinforcement (double vs. routine points) resulted in better self-reported health maintenance behavior and increased donation rates. [ABSTRACT FROM AUTHOR] more...- Published
- 2019
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11. Donor incentives improve cardiovascular disease risk profile and donation rates.
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Goel, Ruchika, Kessler, Debra, Nandi, Vijay, Ortiz, Caroline, Hillyer, Christopher D., and Shaz, Beth H.
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BLOOD donors ,CARDIOVASCULAR diseases ,FOOD labeling ,VEGETABLES ,FRUIT - Abstract
BACKGROUND Blood centers may offer point‐based reward systems or cardiovascular disease (CVD) screening to incentivize donors. However, combining these incentives to improve CVD risk and blood donation rates has not been studied. STUDY DESIGN AND METHODS Study was a three‐arm prospective controlled trial: Group 1, control (routine points, no CVD screening); Group 2, CVD screening with routine points; and Group 3, CVD screening plus incentive double points. The primary objective was to determine if double versus routine incentive points led to improvement or maintenance of CVD risk profile assessed using self‐reported changes in 1) reading food labels for calorie and fat content, 2) exercising daily, 3) reduced fat intake, and 4) increase in eating fruits and vegetables. Outcomes were compared at first and final (2‐year) follow‐up visits. As secondary outcome, median blood donation rates before enrollment and during study were compared. RESULTS: A total of 570 donors (290 in Group 1, 134 in Group 2, 146 Group 3) were selected. At first follow‐up visit, 71.4% in Group 3 versus 62.0% in Group 2 subjects reported at least one of four positive behavioral changes (p < 0.001). Increase in reading food labels for calorie and fat content was the most common change and higher in Group 3 (Group 3 from 60.9% to 79.1%; Group 2 from 67.6% to 77.5%; p < 0.001). Final evaluation showed significant increase in self‐reported exercise in Group 3 only (from baseline 52.9% to 68.3%; p < 0.05). Group 3 reported higher increase in median number of donations/year during study enrollment (6.8 [IQR, 4.3‐12] vs. baseline 4.6 [IQR, 3.2‐7.1] donations/year) than Group 2 (5.6 [IQR, 4.2‐10.5] vs. baseline 4.9 [IQR, 3.5‐10.2]) and Group 1 (4.4 [IQR, 2.7‐8.0] vs. baseline 4.4 [IQR, 2.5‐6.0] donations/year; p < 0.001). CONCLUSION: Positive donor reinforcement (double vs. routine points) resulted in better self‐reported health maintenance behavior and increased donation rates. [ABSTRACT FROM AUTHOR] more...
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- 2019
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12. Impact of predictive scoring model and e-mail messages on African American blood donors.
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Bachegowda, Lohith S., Timm, Brad, Dasgupta, Pinaki, Hillyer, Christopher D., Kessler, Debra, Rebosa, Mark, France, Christopher R., and Shaz, Beth H.
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EMAIL ,BLOOD donors ,AFRICAN American social life & customs ,PREDICTION models ,BLOOD transfusion ,SICKLE cell anemia ,PATIENTS ,ALGORITHMS ,BLACK people - Abstract
Background: Expanding the African American (AA) donor pool is critical to sustain transfusion support for sickle cell disease patients.Study Design and Methods: The aims were to: 1) apply cognitive computing on donation related metrics to develop a predictive model that effectively identifies repeat AA donors, 2) determine whether a single e-mail communication could improve AA donor retention and compare retention results on higher versus lower predictive score donors, and 3) evaluate the effect of e-mail marketing on AA donor retention with culturally versus nonculturally tailored message.Results: Between 2011 and 2012, 30,786 AA donors donated blood at least once on whom predictive repeat donor scores (PRDSs) was generated from donor-related metrics (frequency of donations, duration between donations, age, blood type, and sex). In 2013, 28% (8657/30,786) of 2011 to 2012 donors returned to donate on whom PRDS was validated. Returning blood donors had a higher mean PRDS compared to nonreturning donors (0.649 vs. 0.268; p < 0.001). In the e-mail pilot, high PRDS (≥0.6) compared to low PRDS (<0.6) was associated with 89% higher donor presentation rate (p < 0.001), 20% higher e-mail opening rate (p < 0.001), and, specifically among those who opened the e-mail, 159% higher presentation rate (p < 0.001). Finally, blood donation rate did not differ (p = 0.79) as a function of generic (n = 9312, 1.4%) versus culturally tailored (n = 9326, 1.3%) message.Conclusion: Computational algorithms utilizing readily available donor metrics can identify highly committed AA donors and in conjunction with targeted e-mail communication has the potential to increase the efficiency of donor marketing. [ABSTRACT FROM AUTHOR] more...- Published
- 2017
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13. Storage characteristics of multiple-donor pooled red blood cells compared to single-donor red blood cell units.
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Mathur, Aabhas, Chowdhury, Raquibul, Hillyer, Christopher D., Mitchell, W.Beau, and Shaz, Beth H.
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ERYTHROCYTES ,BLOOD products ,BIOLOGICALS ,BLOOD donors ,BLOOD transfusion ,ADENOSINE triphosphate metabolism ,BLOOD collection ,COMPARATIVE studies ,HEMAPHERESIS ,RESEARCH methodology ,MEDICAL cooperation ,QUALITY control ,RESEARCH ,TIME ,EVALUATION research ,ACYCLIC acids - Abstract
Background: Each unit of blood donated is processed and stored individually resulting in variability in the amount of red blood cells (RBCs) collected, RBC properties, and the 24-hour posttransfusion RBC survivability. As a result, each unit differs in its ability to deliver oxygen and potentially its effects on the recipient. The goal of this study was to investigate the storage of pooled RBCs from multiple donors in comparison to control standard RBC units.Study Design and Methods: Two units of irradiated, leukoreduced RBCs of same ABO, D, E, C, and K antigen phenotype were collected from each of five donors using apheresis. One unit from each donor was pooled in a 2-L bag and remaining units were used as controls. After being pooled, RBCs were separated in five bags and stored at 4°C along with the controls. Quality indexes were measured on Days 2, 14, and 28 for all the units.Results: Adenosine triphosphate assays for both pooled and controls showed a slight decrease from Day 2 to Day 28 (pooled/control from 5.22/5.24 to 4.35/4.33 µmol/g hemoglobin [Hb]). 2,3-Diphosphoglycerate was successfully rejuvenated for all RBC units on Day 28 (pooled 11.46 µmol/g Hb; control 11.86 µmol/g Hb). The results showed a nonsignificant difference between pooled and control units, with a general trend of lower standard deviation for pooled units when compared to controls.Conclusion: Pooled units have reduced unit-to-unit variability. Future exploration of their immunogenicity is required before using pooled units for transfusion. [ABSTRACT FROM AUTHOR] more...- Published
- 2016
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14. Riboflavin and ultraviolet light for pathogen reduction of murine cytomegalovirus in blood products.
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Keil, Shawn D., Saakadze, Natia, Bowen, Richard, Newman, James L., Karatela, Sulaiman, Gordy, Paul, Marschner, Susanne, Roback, John, and Hillyer, Christopher D.
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CYTOMEGALOVIRUSES ,BLOOD products ,VITAMIN B2 ,EFFECT of ultraviolet radiation on viruses ,CYTOMEGALOVIRUS diseases ,CYTOMEGALOVIRUS disease prevention ,BLOOD platelets ,LABORATORY mice ,INFECTIOUS disease transmission ,HERPESVIRUS diseases ,DNA analysis ,ANIMAL experimentation ,BLOOD plasma ,BLOOD platelet transfusion ,BLOODBORNE infections ,COMPARATIVE studies ,DNA ,RESEARCH methodology ,MEDICAL cooperation ,MICE ,PATHOGENIC microorganisms ,PHOTOSENSITIZERS ,RESEARCH ,SPLEEN ,ULTRAVIOLET radiation ,VIRUSES ,VIRAL load ,EVALUATION research ,IMMUNOCOMPROMISED patients ,PHARMACODYNAMICS ,PREVENTION - Abstract
Background: Two studies were performed to test the effectiveness of riboflavin and ultraviolet (UV) light treatment (Mirasol PRT, Terumo BCT) against murine cytomegalovirus (MCMV). The first study utilized immune-compromised mice to measure the reduction of cell-free MCMV. A second study used a murine model to evaluate the ability of Mirasol PRT to prevent transfusion-transmitted (TT)-MCMV infection.Study Design and Methods: Human plasma was inoculated with MCMV and then treated with Mirasol PRT. The viral titer was measured using an infectious dose 50% assay in nude mice. Mice were euthanized on Day 10 posttransfusion, and their spleens were tested for the presence of MCMV DNA using polymerase chain reaction (PCR). Mirasol PRT was also evaluated to determine its effectiveness in preventing TT-MCMV in platelets (PLTs) stored in PLT additive solution. PLTs were inoculated with either cell-associated MCMV or cell-free MCMV and then treated with Mirasol PRT. Mice were transfused with treated or untreated product and were euthanized 14 days posttransfusion. Blood and spleens were assayed for MCMV DNA by real-time-PCR.Results: Using nude mice to titer MCMV, a modest 2.1-log reduction was observed in plasma products after Mirasol PRT treatment. TT-MCMV was not observed in the mouse transfusion model when either cell-free or cell-associated MCMV was treated with Mirasol PRT; MCMV transmission was uniformly observed in mice transfused with untreated PLTs.Conclusions: These results suggest that using riboflavin and UV light treatment may be able to reduce the occurrence of transmission of human CMV from infectious PLTs and plasma units. [ABSTRACT FROM AUTHOR] more...- Published
- 2015
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15. Evaluating a program to increase blood donation among racial and ethnic minority communities in New York City.
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Frye, Victoria, Caltabiano, Melinda, Kessler, Debra A., Schaffler, Harvey, Reboza, Mark, Hillyer, Christopher D., and Shaz, Beth H.
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BLOOD donors ,MINORITIES ,SICKLE cell anemia ,THALASSEMIA ,LEUKEMIA ,ERYTHROCYTES ,PATIENTS - Abstract
Background Individuals with sickle cell disease ( SCD), thalassemia, and leukemia often require frequent transfusion and run the risk of red blood cell ( RBC) alloimmunization. To prevent alloimmunization or when alloimmunization is present, phenotype-matched and antigen-negative RBCs are transfused. To increase the probability of a phenotypic match, donors and recipients should share the same racial and/or ethnic background. Because the majority of patients with SCD are of African and Hispanic or Latino descent, a donor base of racial and ethnic minority donors providing an adequate supply of antigen-negative RBC units that can be phenotypically matched is required to meet the needs of frequently transfused patients. Study Design and Methods The New York Blood Center began the Precise Match program in 2005 to increase donations among African American and Hispanic/ Latino donors by 150 incremental units per month. To evaluate the program, we conducted a systematic analysis of program documentation, focus group results, and collections data by race and ethnicity over time. Results The program achieved 75% of the operationalized goal of a 150-unit-per-month increase; 75% of donors were first-time donors, with deferral rates at new drives as high as 50%. Significant time and effort was involved in cultivating the community connections that facilitated new drives. Conclusions Although Precise Match fell short of targets, it served as a foundation for relationships with diverse communities. Further research is needed to understand better how to increase minority donation using existing infrastructure and in the face of market pressures to collect blood as efficiently as possible. [ABSTRACT FROM AUTHOR] more...
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- 2014
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16. The value of area-based analyses of donation patterns for recruitment strategies.
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James, Adelbert B., Josephson, Cassandra D., Shaz, Beth H., Schreiber, George B., Hillyer, Christopher D., and Roback, John D.
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BLOOD donors ,DONOR blood supply ,BLOOD collection ,ZIP codes - Abstract
Background Lack of ready access to a donation site may be a potential barrier to or influence the frequency of blood donations. In this study, we applied geographic analysis to blood donor behavior and use of different donation sites. Study Design and Methods The study population consisted of blood donors who gave whole blood in Georgia between 2004 and 2008. Zip code, city, and county of donor's residence were matched with the addresses of their donation sites. Donors were dichotomized as either nonmetro Atlanta or metro Atlanta residents. Six donation site categories were defined: donation within the same or a different zip code, within the same or a different city, and within the same or a different county. Logistic regression was used to compare donations by zip code, city, and county. Results The study population consisted of 402,692 blood donors who donated 1,147,442 whole blood units between 2004 and 2008, more than half of whom (56.4%) resided in the metro Atlanta area. The majority of donors were white (75.0%) and female (55.7%). In nonmetro Atlanta, repeat donors were more likely to have donated at fixed sites (p < 0.001). In metro Atlanta, repeat donors were more likely to have donated at a mobile site than at a fixed site (p < 0.001). Conclusion Geographic and demographic differences in blood donation patterns exist. The locations of donor residences and blood donation sites influence donor behaviors. Understanding the geographic influence on donation patterns provides an important tool for optimizing donor recruitment strategies. [ABSTRACT FROM AUTHOR] more...
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- 2014
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17. Blood transfusion and breast milk transmission of cytomegalovirus in very low-birth-weight infants: a prospective cohort study.
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Josephson, Cassandra D, Caliendo, Angela M, Easley, Kirk A, Knezevic, Andrea, Shenvi, Neeta, Hinkes, Michael T, Patel, Ravi M, Hillyer, Christopher D, and Roback, John D
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- 2014
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18. Blood Transfusion and Breast Milk Transmission of Cytomegalovirus in Very Low-Birth-Weight Infants A Prospective Cohort Study.
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Josephson, Cassandra D., Caliendo, Angela M., Easley, Kirk A., Knezevic, Andrea, Shenvi, Neeta, Hinkes, Michael T., Patel, Ravi M., Hillyer, Christopher D., and Roback, John D.
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- 2014
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19. Cardiovascular disease risk assessment and prevention in blood donors.
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Kessler, Debra A., Ortiz, Caroline, Grima, Kathleen, Vlahov, David, Nandi, Vijay, Jones, Robert, Hillyer, Christopher D., and Shaz, Beth H.
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PUBLIC health ,CARDIOVASCULAR diseases ,BLOOD donors ,MEDICAL screening ,PERIODIC health examinations ,BODY mass index ,BLOOD pressure - Abstract
BACKGROUND: Blood centers have Implemented public health initiatives, including cardiovascular disease (CVD) screening, to improve donor and com-munity health and serve as an incentive to donate. STUDY DESIGN AND METHODS: CVD risk screening and counseling were performed at mobile blood drives in diverse neighborhoods. Risk factors were determined by point-of-care testing (total cholesterol, high-density lipoprotein, and hemoglobin A1c levels), interviews, and physical examinations (body mass index, waist circum-ference, and blood pressure). Results were confiden-tially relayed to participant by health counselors. A 60-day follow-up survey was sent to some participants. RESULTS: Over 11 months, 2406 participants (44% male; mean age 28 ± 16; 67% minority racial/ethnic group) were screened at 290 mobile drives. A total of 92% of participants had medical insurance. A total of 14% had none, 26% one, 33% two, and 27% three or more risk factors. A total of 72% of teenage participants had at least one risk factor. A total of 18% of partici-pants who were taking medications for risks were poorly controlled. A total of 15% had newly identified risks. A total of 711 participants completed follow-up survey: 21% sought medical care, 51% were motivated to change their lifestyle, 81% were pleased with screen-ing, 48% were more likely to donate, and 62% recom-mended donation to friends and family because of the screening. CONCLUSION: CVD risk screening and counseling can occur during a mobile blood drive. A majority of partici-pants screened had risk factors. Follow-up surveys showed that the program was well received. Further studies are planned to evaluate long-term effects of the program on donor health and donor return rates. [ABSTRACT FROM AUTHOR] more...
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- 2012
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20. Demographic differences in estimated blood donor eligibility prevalence in the United States.
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James, Adelbert B., Hillyer, Christopher D., and Shaz, Beth H.
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DONOR blood supply ,BLOOD donors ,BLOOD collection ,HISPANIC Americans - Abstract
BACKGROUND: The prevalence of blood donor eligibility factors has a major impact on the availability of blood donors and thus the blood supply in the United States. The prevalence of these factors may differ between demographic groups and thus help explain the differences in blood donation rates. STUDY DESIGN AND METHODS: The study population (18-69 years old who were African American [AA], white, or Hispanic) was 185,073,489. Forty eligibility factors determined by US Food and Drug Administration's Code of Federal Regulations and AABB Standards for Blood Banks and Transfusion Services were used to calculate whole blood donation eligibility rates. Eligibility data were obtained from the 2007 to 2008 National Health and Nutrition Examination Survey, National Ambulatory Medical Care Survey, US Census Bureau, and Centers for Disease Control and Prevention. Eligibility rates were determined by race/ethnicity, sex, and age groups (18-39 and 40-69 years). RESULTS: In 2007 to 2008, 122 million Americans (65.9% of the study population and 41.0% of the total US population) were estimated to be eligible to donate blood in the United States. Significant differences in eligibility rates by demographic characterizers were determined (p < 0.001): AAs (36.5%), whites (46.4%), and Hispanics (40.7%); males (45.4%) and females (42.7%); individuals 18 to 39 years old (35.8%); and individuals 40 to 69 years old (32.9%). CONCLUSIONS: AAs were significantly less eligible to donate blood than whites and Hispanics. Disparities in donor eligibility exist by race/ethnicity, sex, and age groups. [ABSTRACT FROM AUTHOR] more...
- Published
- 2012
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21. 2-(Diethylhexyl)phthalate in blood bags: is this a public health issue?
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Shaz, Beth H., Grima, Kathleen, and Hillyer, Christopher D.
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DIETHYLHEXYL phthalate ,DONOR blood supply ,ERYTHROCYTES ,BLOOD platelets ,GENITAL diseases ,BEHAVIOR disorders ,OBESITY risk factors - Abstract
In this article, the author discusses the role and effect of 2-(diethylhexyl) phthalate (DEHP) in blood storage bags. They note that DEHP as a plasticizer helps to increase bag flexibility, red blood cell (RBC) survival, and platelet (PLT) storage's oxygen permeability. However, they assert that DEHP poses potential damage to the environment and adverse health effects due to its toxicity including disorders of reproductive system, behavioral disorders, and an increase risk for obesity. more...
- Published
- 2011
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22. Pathophysiology of Early Trauma-Induced Coagulopathy: Emerging Evidence for Hemodilution and Coagulation Factor Depletion.
- Author
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Shaz, Beth H., Winkler, Anne M., James, Adelbert B., Hillyer, Christopher D., MacLeod, Jana B., and Dutton, Richard P.
- Published
- 2011
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23. Residual risk of D alloimmunization: is it time to feel safe about platelets from D+ donors?
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Shaz, Beth H. and Hillyer, Christopher D.
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BLOOD transfusion ,ERYTHROCYTES ,BLOOD platelets ,BLOOD cells - Abstract
The article comments on the risks associated with transfusion of D+ blood components, particularly red blood cells (RBCs) and blood platelets (PLTs), to D- individuals. It is said that due to the possibility of D sensitization, such transfusion to D- individuals, especially females of childbearing potential, has been a subject of concern. Reference is made to the article "Platelet transfusions from D+ donors to Dpatients: a ten year follow-up study of 1014 patients," by J. Cid et al. more...
- Published
- 2011
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24. Contribution of attitudinal factors to blood donation in African American church attendees.
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James, Adelbert B., Demmons, Derrick G., Schreiber, George B., Hillyer, Christopher D., and Shaz, Beth H.
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PSYCHOLOGY of African Americans ,BLOOD donors ,BLOOD collection ,HEALTH equity ,LOGISTIC regression analysis ,COMMUNITY health services - Abstract
Historically, African Americans have a general mistrust for the health care system that has contributed to significant health disparities. The goal of this study was to evaluate whether this distrust among African Americans affects attitudes toward blood donation. Fifteen African American churches in metropolitan Atlanta participated in an 81-item self-administered survey. The questionnaire assessed barriers and motivators for, and knowledge and beliefs about, blood donation in African Americans. Bivariate analysis and logistic regression models were performed. A total of 930 individuals responded to the survey. This group was 99% African Americans, 71% female, and 84% college educated, 54% with a household income of at least $50,000 and mean age of 47 ± 14 years. Donation history was 3% current donors, 46% lapsed donors, and 40% nondonors. Respondents who trusted versus distrusted hospitals had more knowledge of the blood supply and less fear of donation and were more likely to respond to blood needs of the community. In a multivariate logistic regression model, donors were more likely to trust hospitals (p = 0.003) and were more likely to have participated in research (p < 0.001) than nondonors. African American distrust of the health care system is associated with decreased likelihood of previous blood donation. This may be secondary to donor centers being viewed as a component of the health care system. Building trust between donor centers and African American community by ensuring the safety of donation may increase African American blood donation rates. [ABSTRACT FROM AUTHOR] more...
- Published
- 2011
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25. Transfusion medicine as a profession: evolution over the past 50 years.
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Shaz, Beth H. and Hillyer, Christopher D.
- Subjects
BLOOD transfusion ,20TH century medical history ,BLOOD collection ,BLOOD banks ,PHYSICIANS - Abstract
The article focuses on the history of blood banking and transfusion medicine profession. It states that physicians were initially focused on technical and consultative medical aspects including blood collection, proper use of blood products, and blood collection. The first blood bank was established by Bernard Fantus at Cook County Hospital. It also mentions that the House of Delegates of the American Medical Association adopted the requirement of a physician during blood transfusion in 1963. more...
- Published
- 2010
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26. Receiver operating characteristic curve analysis of circulating blood dendritic cell precursors and T cells predicts response to extracorporeal photopheresis in patients with chronic graft-versus-host disease
- Author
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Akhtari, Mojtaba, Giver, Cynthia R., Ali, Zahir, Flowers, Christopher R., Gleason, Charise L., Hillyer, Christopher D., Kaufman, Jonathan, Khoury, H. Jean, Langston, Amelia A., Lechowicz, Mary Jo, Lonial, Sagar, Renfroe, Heather M., Roback, John D., Tighiouart, Mourad, Vaughn, Louette, and Waller, Edmund K. more...
- Subjects
GRAFT versus host disease ,DENDRITIC cells ,T cells ,BLOOD transfusion ,ANTIGEN presenting cells - Abstract
One proposed mechanism of extracorporeal photopheresis (ECP) in reducing chronic graft-versus-host disease (cGVHD) is alteration in numbers of circulating dendritic cells (DCs). This hypothesis was tested by correlating numbers of DC precursors and T cells in the blood before and during ECP therapy with response of cGVHD. Twenty-five patients with cGVHD were treated with ECP. Data were collected with emphasis on blood cellular markers, clinical response to ECP, and overall survival. Fourteen patients (56%) responded and had better 2-year survival than nonresponders (88% vs. 18%, p = 0.003). Responders had higher baseline circulating myeloid DC (mDC) and plasmacytoid DC precursors and CD4+ and CD8+ T cells compared with nonresponders. Receiver operating characteristic curve analyses showed that the best baseline cutoff values to predict response to ECP were mDC counts of 3.7 cells/µL (79% sensitivity, 82% specificity) and CD4+ T-cell counts of 104 cells/µL (71% sensitivity, 82% specificity). CD4+ T cells declined in responders over time, but not in nonresponders, and no significant changes were seen in CD8 T-cell or DC numbers over a 12-month period in responder or nonresponder groups. Higher baseline numbers of circulating DCs and T cells may predict clinical response to ECP in patients with cGVHD. [ABSTRACT FROM AUTHOR] more...
- Published
- 2010
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- View/download PDF
27. Minority donation in the United States: challenges and needs.
- Author
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Shaz BH, Hillyer CD, Shaz, Beth H, and Hillyer, Christopher D
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- 2010
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28. Effects of storage duration and volume on the quality of leukoreduced apheresis-derived platelets: implications for pediatric transfusion medicine.
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Winkler, Anne M., Sheppard, Chelsea A., Culler, Elizabeth E., Myers, Robert L., Duncan, Alexander, Castillejo, Marta-Inés, Hillyer, Christopher D., and Josephson, Cassandra D.
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BLOOD transfusion ,BLOOD platelets ,COLLAGEN ,LACTATES ,HEMAPHERESIS ,DATA analysis - Abstract
BACKGROUND: Platelet (PLT) storage adversely affects PLT structure and function in vitro and is associated with decreased PLT recovery and function in vivo. In pediatric transfusion medicine, it is not uncommon for small residual volumes to remain in parent units after aliquot preparation of leukoreduced apheresis-derived PLTs (LR-ADP). However, limited data exist regarding the impact of storage on residual small-volume LR-ADP. STUDY DESIGN AND METHODS: Standard metabolic testing was performed on residual volumes of LR-ADP after aliquot removal and PLT aggregometry using a dual agonist of ADP and collagen was performed on stored, small-volume aliquots (10-80 mL) created from an in vitro model of PLT storage. RESULTS: Seventy-seven LR-ADP underwent metabolic (n = 67) or metabolic and aggregation (n = 10) studies. All products maintained a pH value of more than 6.89 throughout storage. Lactate and pCO
2 increased proportionally with longer storage time. Regardless of acceptable metabolism during storage, aggregation in 10- to 20-mL aliquots was impaired by Day 4 and aliquots less than 40 mL demonstrated the most dramatic decrease in aggregation from baseline. CONCLUSIONS: Despite maintenance of acceptable metabolic conditions, residual volumes of LR-ADP develop impaired aggregation in vitro that may adversely affect PLT survival and function in vivo. At volumes below 40 mL, LR-ADP revealed reduced aggregation. As a result, it is recommended to monitor and record volumes of LR-ADP used for pediatric transfusion. Moreover, once LR-ADP attain a volume of 50 mL or less on Day 4 or Day 5 of storage, consider discarding these products until their in vivo efficacy can be studied. [ABSTRACT FROM AUTHOR] more...- Published
- 2010
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29. Hepatitis C virus prevalence and clearance among US blood donors, 2006-2007: associations with birth cohort, multiple pregnancies, and body mass index.
- Author
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Murphy EL, Fang J, Tu Y, Cable R, Hillyer CD, Sacher R, Triulzi D, Gottschall JL, Busch MP, Murphy, Edward L, Fang, Junyong, Tu, Yongling, Cable, Ritchard, Hillyer, Christopher D, Sacher, Ronald, Triulzi, Darrell, Gottschall, Jerome L, Busch, Michael P, and Retrovirus Epidemiology Donor Study more...
- Abstract
Background: During the period 1992-1993, the prevalence of hepatitis C virus (HCV) antibodies (anti-HCV) among US blood donors was 0.36%, but contemporary data on the prevalence of antibody to HCV and the prevalence of HCV RNA are lacking.Methods: We performed a large, cross-sectional study of blood donors at 6 US blood centers during 2006-2007. Anti-HCV was measured with enzyme-linked immunosorbent assay followed by immunoblot, and HCV RNA was measured with nucleic acid testing. Adjusted odds ratios (aORs) were derived using multivariable logistic regression.Results: Of 959,281 donors, 695 had anti-HCV detected (prevalence, 0.072%). Of those with anti-HCV, 516 (74%) had test results positive for HCV RNA, and 179 (26%) had test results that were negative for HCV RNA. Compared with the prevalence during the period 1992-1993, prevalence during 2006-2007 was lower and peaked in older age groups. Anti-HCV was associated with a body mass index (BMI) >30 (aOR, 0.6; 95% confidence interval [CI], 0.5-0.8), and among women, it was associated with higher gravidity (aOR for 5 vs 0 pregnancies, 3.2; 95% CI, 1.9-5.4). HCV RNA negative status was associated with black race (aOR, 0.4; 95% CI, 0.2-0.7), having more than a high school education (aOR, 1.6; 95% CI, 1.1-2.4), and BMI >30 (aOR, 2.4; 95% CI, 1.4-3.9).Conclusions: Decreasing HCV prevalence is most likely attributable to culling of seropositive donors and a birth cohort effect. We found new associations between anti-HCV prevalence and gravidity and obesity. Recently discovered genetic factors may underlie differences in HCV RNA clearance in black donors. [ABSTRACT FROM AUTHOR] more...- Published
- 2010
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- View/download PDF
30. Hepatitis C Virus Prevalence and Clearance among US Blood Donors, 2006-2007: Associations with Birth Cohort, Multiple Pregnancies, and Body Mass Index.
- Author
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Murphy, Edward L., Junyong Fang, Yongling Tu, Cable, Ritchard, Hillyer, Christopher D., Sacher, Ronald, Triulzi, Darrell, Gottschall, Jerome L., and Busch, Michael P.
- Subjects
HEPATITIS C virus ,IMMUNOGLOBULINS ,BLOOD donors ,MULTIPLE pregnancy ,RNA ,LOGISTIC regression analysis ,BODY mass index ,FIRE assay ,PARITY (Obstetrics) - Abstract
Background. During the period 1992-1993, the prevalence of hepatitis C virus (HCV) antibodies (anti-HCV) among US blood donors was 0.36%, but contemporary data on the prevalence of antibody to HCV and the prevalence of HCV RNA are lacking. Methods. We performed a large, cross-sectional study of blood donors at 6 US blood centers during 2006- 2007. Anti-HCV was measured with enzyme-linked immunosorbent assay followed by immunoblot, and HCV RNA was measured with nucleic acid testing. Adjusted odds ratios (aORs) were derived using multivariable logistic regression. Results. Of 959,281 donors, 695 had anti-HCV detected (prevalence, 0.072%). Of those with anti-HCV, 516 (74%) had test results positive for HCV RNA, and 179 (26%) had test results that were negative for HCV RNA. Compared with the prevalence during the period 1992-1993, prevalence during 2006-2007 was lower and peaked in older age groups. Anti-HCV was associated with a body mass index (BMI) >30 (aOR, 0.6; 95% confidence interval [CI], 0.5-0.8), and among women, it was associated with higher gravidity (aOR for ⩾5 vs 0 pregnancies, 3.2; 95% CI, 1.9-5.4). HCV RNA negative status was associated with black race (aOR, 0.4; 95% CI, 0.2-0.7), having more than a high school education (aOR, 1.6; 95% CI, 1.1-2.4), and BMI >30 (aOR, 2.4; 95% Cl, 1.4- 3.9). Conclusions. Decreasing HCV prevalence is most likely attributable to culling of seropositive donors and a birth cohort effect. We found new associations between anti-HCV prevalence and gravidity and obesity. Recently discovered genetic factors may underlie differences in HCV RNA clearance in black donors. [ABSTRACT FROM AUTHOR] more...
- Published
- 2010
- Full Text
- View/download PDF
31. Prevalence of HLA antibodies in remotely transfused or alloexposed volunteer blood donors.
- Author
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Kakaiya, Ram M., Triulzi, Darrell J., Wright, David J., Steele, Whitney R., Kleinman, Steven H., Busch, Michael P., Norris, Philip J., Hillyer, Christopher D., Gottschall, Jerome L., Rios, Jorge A., Carey, Patricia, and Glynn, Simone A. more...
- Subjects
BLOOD donors ,HLA histocompatibility antigens ,IMMUNOGLOBULINS ,BLOOD transfusion ,LUNG abnormalities - Abstract
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. STUDY DESIGN AND METHODS: Transfusion and pregnancy history was obtained from consenting donors. HLA Class I and II antibody testing was performed by multiantigen bead Luminex platform. Cutoff values for Class I and II antibodies used normalized background ratios of 10.8 and 6.9, respectively. Linear probability models were used to evaluate potential associations between HLA alloimmunization and donor characteristics. RESULTS: A total of 7920 donors (2086 males and 5834 females) were tested. HLA antibody prevalence did not significantly differ between 895 transfused (1.7%) and 1138 nontransfused males (1.0%; odds ratio [OR], 1.75; 95% confidence interval [CI], 0.80-3.82]. Prevalence in 45 transfused nulliparous females (4.4%; 95% CI, 0.1%-11.8%) was not different from the 1.6% prevalence in 1732 nontransfused nulliparous females (OR, 2.94; 95% CI, 0.68-12.74). Transfused parous females had higher prevalence than nontransfused counterparts (p = 0.004; OR, 1.39; 95% CI, 1.07-1.80). In a linear probability model, the estimated additive risk of transfusion-induced alloimmunization was only 0.8% (95% CI, −0.2% to 1.8%; p = 0.10). Donor transfusion history showed that 58% of transfusions occurred more than 10 years previously. CONCLUSION: Transfused volunteer blood donors do not appear to have a significantly higher prevalence of HLA antibodies than their nontransfused counterparts. Thus, in an effort to reduce TRALI risk, ascertaining past history of transfusion and testing these donors for HLA antibodies is not necessary. [ABSTRACT FROM AUTHOR] more...
- Published
- 2010
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32. The potential impact of selective donor deferrals based on estimated blood volume on vasovagal reactions and donor deferral rates.
- Author
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Rios, Jorge A., Junyong Fang, Yongling Tu, Wright, David J., Spencer, Bryan, Hillyer, Christopher D., Hillyer, Krista L., Eder, Anne F., and Benjamin, Richard J.
- Subjects
BLOOD donors ,HYPOVOLEMIC anemia ,STATURE ,RACE - Abstract
BACKGROUND: Whole blood donation in the United States is restricted in volume to 10.5 mL/kg or less in an effort to prevent hypovolemic reactions, but still may exceed more than 15% of a donor's estimated blood volume (EBV). We analyzed the association of EBV with prefaint and systemic vasovagal reactions (SVRs) among whole blood donors and the potential impact of an EBV-based deferral policy. STUDY DESIGN AND METHODS: Independent predictors for prefaint reactions and SVRs were assessed by multivariate logistic regression analysis on 591,177 unique donors participating in the Retrovirus Epidemiology Donor Study-II study. RESULTS: Young age (16 years old odds ratio [OR], 3.70; 95% confidence interval [CI], 2.78-4.94), low EBV (<3.5 L OR, 3.30; 95% CI, 2.57-4.23), and first-time donation status (OR, 2.33; 95% CI, 2.03-2.67) were the strongest predictors for SVRs, with similar trends seen for prefaint reactions. Sex, height, race, blood center, and donation site were weakly associated predictors. A total of 5.6% of all donors had an EBV of less than 3.5 L and experienced 12.5% of all prefaint reactions and 14.5% of SVRs. The highest reaction rates were seen in donors less than 23 years old with an EBV of less than 3.5 L who comprised 2.7% of all donors, who were mostly female (99.9%), and who experienced 8.8% of prefaint reactions and 11.0% of SVRs. CONCLUSION: Young age, low EBV, and first-time donation status are the major correlates of prefaint reactions and SVRs, suggesting that high school and college donors are at particular risk. Deferral of donors with low EBV who are less than 23 years old may offer a rational approach to protecting donors at greater risk of reactions without jeopardizing the adequacy of the blood supply. [ABSTRACT FROM AUTHOR] more...
- Published
- 2010
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33. Consensus recommendations of pediatric transfusion medicine objectives for clinical pathology residency training programs.
- Author
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Sanchez, Rosa, Sloan, Steven R., Josephson, Cassandra D., Ambruso, Daniel R., Hillyer, Christopher D., and O'Sullivan, Patricia
- Subjects
BLOOD transfusion ,CLINICAL pathology ,PEDIATRICS ,CONSENSUS (Social sciences) ,MEDICAL education - Abstract
BACKGROUND: Pediatric transfusion medicine (PTM) is a subspecialty of transfusion medicine with no formal training program and few specialists. The Pediatric Transfusion Medicine Academic Awardees (PedsTMAA) group surveyed PTM content experts to identify relevant objectives for the first formal PTM curriculum. STUDY DESIGN AND METHODS: Eight North American PTM experts were invited to participate in a two-step consensus process. PTM-related objectives compiled from a review of existing training documents were organized into a survey. Experts were asked to rate each objective for relevancy for a clinical pathology trainee. Content validity indexes (CVIs) and asymmetric confidence intervals (ACIs) of expert ratings and analysis of respondents' comments were used to identify relevant objectives. RESULTS: Six experts participated and reviewed 117 objectives. Based on content validity criteria (CVI ≥ 0.83 and lower-limit 95% ACI ≥ 3), a total of 65 objectives were considered relevant. Twenty-three objectives were rated “very relevant” by all the experts while some proposed objectives were determined to be not relevant, out of date, or inappropriate for a resident trainee level. CONCLUSIONS: The PedsTMAA group identified 65 objectives for a PTM curriculum. Twenty-three represent a clear core set of objectives and should be considered for clinical pathology training. The next step is to consider the teaching strategies and evaluation methods that will be employed to best deliver this content addressing competency in medical knowledge. [ABSTRACT FROM AUTHOR] more...
- Published
- 2010
- Full Text
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34. Procedure-specific preoperative red blood cell preparation and utilization management in pediatric surgical patients.
- Author
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Schmotzer, Christine L., Brown, Amy E., Roth, Steven, Johnson, Jennifer, Ines-Castillejo, Marta, Reisner, Andrew, Hillyer, Christopher D., and Josephson, Cassandra D.
- Subjects
ERYTHROCYTES ,PEDIATRIC surgery ,SPINAL fusion ,CRANIOTOMY ,CRANIOSYNOSTOSES - Abstract
BACKGROUND: Data-driven practices in preoperative red blood cell (RBC) preparation for pediatric surgical procedures are not well established. Adaptation of established adult preparation guidance methods to pediatric populations may improve perioperative RBC utilization. STUDY DESIGN AND METHODS: A retrospective audit of preoperative RBC preparation volumes (Vp) and intraoperative RBC transfusion volumes (Vt) for pediatric surgical procedures was undertaken at a large children's hospital from January to June 2006. RBC preparation-to-transfusion volume (mL/kg) ratios (P:T) were calculated for all surgeries, subspecialties, and select procedures. P:T equals Vp divided by Vt. Resulting P:Ts were compared to a target P:T of 2:1. A model for maximum procedure-specific Vp (Vp-max) defined Vp-max as the RBC transfusion volume able to meet the needs of 80% of patients undergoing an individual surgical procedure. Vp-max values were applied to the study data set to predict the impact on P:Ts and Vp. RESULTS: RBCs were prepared for 332 surgical procedures and transfused during 113 procedures. P:T was 3.5:1 for total surgical procedures (subspecialty range, 2.7:1-46:0), exceeding the 2:1 target. Vp-max modeling for spinal fusion, craniotomy for neoplasia, craniotomy for seizure, and craniosynostectomy yielded P:T ratios of 1.5:1, 1.5:1, 1.7:1, and 1.0:1, respectively, predicting a 30% decrease in Vp for these four surgical procedures. CONCLUSIONS: P:Ts for pediatric surgical procedures at this institution indicate potentially excessive preoperative RBC preparations. Determination of data-driven procedure-specific Vp may increase the efficiency of preoperative RBC preparation practices. [ABSTRACT FROM AUTHOR] more...
- Published
- 2010
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35. HLA alloimmunization is associated with RBC antibodies in multiply transfused patients with sickle cell disease.
- Author
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McPherson, Marianne E., Anderson, Alan R., Castillejo, Marta-Inés, Hillyer, Christopher D., Bray, Robert A., Gebel, Howard M., and Josephson, Cassandra D.
- Published
- 2010
- Full Text
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36. Storage of murine red blood cells enhances alloantibody responses to an erythroid-specific model antigen.
- Author
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Hendrickson, Jeanne E., Hod, Eldad A., Spitalnik, Steven L., Hillyer, Christopher D., and Zimring, James C.
- Subjects
BLOOD cells ,ANTIGENS ,CLINICAL trials ,CLINICAL medicine ,BLOOD transfusion - Abstract
BACKGROUND: Red blood cell (RBC) alloimmunization can be a serious complication of blood transfusion, but factors influencing the development of alloantibodies are only partially understood. Within FDA-approved time limits, RBCs are generally transfused without regard to length of storage. However, recent studies have raised concerns that RBCs stored for more than 14 days have altered biologic properties that may affect medical outcomes. To test the hypothesis that storage time alters RBC immunogenicity, we utilized a murine model of RBC storage and alloimmunization. STUDY DESIGN AND METHODS: Blood from transgenic HOD donor mice, which express a model antigen (hen egg lysozyme [HEL]) specifically on RBCs, was filter leukoreduced and stored for 14 days under conditions similar to those used for human RBCs. Fresh or 14-day-stored RBCs were transfused into wild-type recipients. The stability of the HOD antigen and posttransfusion RBC survival were analyzed by flow cytometry. RBC alloimmunization was monitored by measuring circulating anti-HEL immunoglobulin levels. RESULTS: Transfusion of 14-day-stored, leukoreduced HOD RBCs resulted in 10- to 100-fold higher levels of anti-HEL alloantibodies as detected by enzyme-linked immunosorbent assay than transfusion of freshly collected, leukoreduced RBCs. RBC expression of the HOD antigen was stable during storage. CONCLUSIONS: These findings demonstrate that HOD murine RBCs become more immunogenic with storage and generate the rationale for clinical trials to test if the same phenomenon is observed in humans. Length of storage of RBCs may represent a previously unappreciated variable in whether or not a transfusion recipient becomes alloimmunized. [ABSTRACT FROM AUTHOR] more...
- Published
- 2010
- Full Text
- View/download PDF
37. Increased number of coagulation products in relationship to red blood cell products transfused improves mortality in trauma patients.
- Author
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Shaz, Beth H., Dente, Christopher J., Nicholas, Jeffrey, MacLeod, Jana B., Young, Andrew N., Easley, Kirk, Qiang Ling, Harris, Robert S., and Hillyer, Christopher D.
- Subjects
BLOOD platelet transfusion ,RED blood cell transfusion ,BLOOD coagulation ,BLOOD plasma ,MORTALITY ,TRAUMA centers - Abstract
BACKGROUND: Recent data from military and civilian centers suggest that mortality is decreased in massive transfusion patients by increasing the transfusion ratio of plasma and platelet (PLT) products, and fibrinogen in relationship to red blood cell (RBC) products during damage control resuscitation and surgery. This study investigates the relationship of plasma:RBC, PLT:RBC, and cryoprecipitate:RBC transfusion ratios to mortality in massively transfused patients at a civilian Level 1 trauma center. STUDY DESIGN AND METHODS: Demographic, laboratory, transfusion, and outcome data were collected prospectively from February 1, 2007, to January 31, 2009, and retrospectively from February 1, 2005, to January 31, 2007, on all injured patients who underwent massive transfusion (defined as ≥10 RBC products within 24 hr). Mortality was analyzed in relation to the plasma:RBC, PLT:RBC, and cryoprecipitate:RBC transfusion ratios using both univariate and multivariate analyses. RESULTS: A total of 214 patients received massive transfusion secondary to traumatic injury. High versus low transfusion ratios were associated with improved 30-day survival: plasma:RBC 59% versus 44%, p = 0.03; PLT:RBC 63% versus 33%, p < 0.01; and cryoprecipitate:RBC 66% versus 41%, p < 0.01. By multivariable stepwise logistic regression analysis, increased plasma:RBC (p = 0.02) and PLT:RBC (p = 0.02), and decreased age (p = 0.02), ISS (p < 0.01) and total RBCs (p = 0.03) were statistically associated with improved 30-day survival. CONCLUSIONS: In the civilian setting, plasma, PLT, and cryoprecipitate products significantly increased 30-day survival in trauma patients. Future prospective randomized clinical trials are required to determine the optimal transfusion ratios. [ABSTRACT FROM AUTHOR] more...
- Published
- 2010
- Full Text
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38. Minority and foreign-born representation among US blood donors: demographics and donation frequency for 2006.
- Author
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Murphy, Edward L., Shaz, Beth, Hillyer, Christopher D., Carey, Patricia, Custer, Brian S., Hirschler, Nora, Fang, Junyong, and Schreiber, George B.
- Subjects
BLOOD donors ,MINORITIES ,BLOOD transfusion ,DONOR blood supply - Abstract
BACKGROUND: Historically, minority populations have represented only a small proportion of US blood donors, but recent trends in immigration and potential blood shortages emphasize the need for recruitment strategies to increase minority donations. STUDY DESIGN AND METHODS: Donation data from a network of six US blood centers for 2006 were analyzed. Race/ethnicity, country of birth, and educational attainment data were collected specifically for the study and assessed for their influence on donation behavior. Logistic regression was used to determine independent associations with repeat donors status and annual donation frequency. RESULTS: A total of 1,288,998 donations from 729,068 donors were studied; most donors had data on race/ethnicity (97.1%) and country of birth (93.1%). The proportion of minority donors differed by blood center, with African American donors (16%) most common at the Southeastern blood center and Asian (12%), Hispanic (13%), and foreign-born donors (13%) most common at the Northern California blood center. Minority donors and those born in Mexico or Latin America were younger than white donors. Minority and non–US-born donors were less likely than white and US-born donors to be repeat donors (odds ratio [OR], 0.60-0.78), and most were less likely to give two or more annual donations (OR, 0.82-1.11). CONCLUSION: Minority and Mexico/Latin America–born donors represent a younger and often first-time donor population compared to white and US-born donors, but their annual donation frequency was only slightly lower than white and US-born donors. Increasing the retention and donation frequency of minorities will be important for supplementing the blood supply. [ABSTRACT FROM AUTHOR] more...
- Published
- 2009
- Full Text
- View/download PDF
39. The effect of previous pregnancy and transfusion on HLA alloimmunization in blood donors: implications for a transfusion-related acute lung injury risk reduction strategy.
- Author
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Triulzi, Darrell J., Kleinman, Steven, Kakaiya, Ram M., Busch, Michael. P., Norris, Philip J., Steele, Whitney R., Glynn, Simone A., Hillyer, Christopher D., Carey, Patricia, Gottschall, Jerome L., Murphy, Edward L., Rios, Jorge A., Ness, Paul M., Wright, David J., Carrick, Danielle, and Schreiber, George B. more...
- Subjects
BLOOD transfusion ,PREGNANCY ,IMMUNIZATION ,BLOOD donors ,LUNG injuries ,DISEASE risk factors - Abstract
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. STUDY DESIGN AND METHODS: A total of 8171 volunteer blood donors were prospectively recruited by six US blood centers from December 2006 to May 2007. Donors provided a detailed history of pregnancy and transfusion and a sample for HLA Class I and II antibody testing by multiantigen bead flow analysis. RESULTS: A total of 8171 donors were enrolled; 7920 (96.9%) had valid HLA antibody test results and 7841 (99%) of those had complete pregnancy and transfusion information. The prevalence of any HLA antibody was similar in nontransfused (n = 1138) and transfused (n = 895) men, 1.0% versus 1.7% (p = 0.16). HLA antibodies were detected in 17.3% of all female donors (n = 5834) and in 24.4% of those with a history of previous pregnancy (n = 3992). The prevalence of HLA antibodies increased in women with greater numbers of pregnancy: 1.7% (zero), 11.2% (one), 22.5% (two), 27.5% (three), and 32.2% (four or more pregnancies; p < 0.0001). CONCLUSION: HLA Class I and Class II antibodies are detectable at low prevalence in male donors regardless of transfusion and in female donors without known immunizing events. The prevalence of HLA antibodies increases significantly with more pregnancies. These data will allow blood centers to estimate the impact of HLA antibody testing as a potential TRALI risk reduction measure. [ABSTRACT FROM AUTHOR] more...
- Published
- 2009
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40. Transfusion management of sickle cell patients during bone marrow transplantation with matched sibling donor.
- Author
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McPherson, Marianne E., Anderson, Alan R., Haight, Ann E., Jessup, Paula, Castillejo, Marta-Inés, Hillyer, Christopher D., and Josephson, Cassandra D.
- Subjects
BLOOD transfusion ,SICKLE cell anemia ,BONE marrow transplantation ,SIBLINGS ,BLOOD banks ,BLOOD donors ,PATIENTS - Abstract
BACKGROUND: Sickle cell disease (SCD) patients have unique transfusion considerations during bone marrow transplantation (BMT), including prophylaxis against stroke and alloimmunization. Characterization of transfusion requirements is important for blood bank and clinician patient management. STUDY DESIGN AND METHODS: A retrospective analysis of red blood cell (RBC) and platelet (PLT) transfusion of SCD patients during myeloablative matched sibling donor (MSD) BMT at one institution from 1993 to 2007 was performed. Patient characteristics (RBC blood group antibodies, ABO-incompatible donor, BMT-related morbidity) and transfusion practices (RBC phenotype matching, transfusion threshold, and blood age) were assessed for effect on total RBC transfusion volumes. RESULTS: Twenty-seven patients received MSD BMT with 96% survival and 0% rejection. Six alloimmunized patients received RBCs with extended phenotype matching (C, c, E, e, K, Fy
a , Jkb ), 14 nonalloimmunized received limited matching (C, c, E, e, K), and 7 did not have phenotype matching. Among 26 survivors, a median seven RBC transfusions (range, 3-15) and 13.5 PLT transfusions (range, 4-48) per patient were administered, equivalent to 64 mL/kg RBCs (range, 22-122 mL/kg) and 106 mL/kg PLTs (range, 26-343 mL/kg). BMT-related morbidity predicted increased RBC transfusions (p = 0.006). Venoocclusive disease was associated with greater RBC (p = 0.016) and PLT transfusion volumes (p = 0.016). Greater phenotype matching was associated with decreased RBC transfusions (p = 0.0247). CONCLUSIONS: SCD patients have high transfusion support during MSD BMT. Communication of BMT complications to the blood bank is essential for transfusion inventory management. Phenotype matching decreased RBC transfusions in this cohort and warrants further investigation in SCD transfusion therapy. [ABSTRACT FROM AUTHOR] more...- Published
- 2009
- Full Text
- View/download PDF
41. A novel mouse model of red blood cell storage and posttransfusion in vivo survival.
- Author
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Gilson, Christopher R., Kraus, Teresa S., Hod, Eldad A., Hendrickson, Jeanne E., Spitalnik, Steven L., Hillyer, Christopher D., Shaz, Beth H., and Zimring, James C.
- Subjects
ERYTHROCYTES ,PATHOLOGICAL physiology ,BLOOD testing ,GREEN fluorescent protein ,BLOOD cells - Abstract
BACKGROUND: Storage of red blood cells (RBCs) is necessary for an adequate blood supply. However, reports have identified potential negative sequelae of transfusing stored RBCs. An animal model would be useful to investigate the pathophysiology of transfusing stored RBCs. However, it has been reported that storage of rat RBCs in CPDA-1 resulted in an unexpected sudden decline in posttransfusion survival. A mouse model of RBC storage and transfusion was developed to assess survival kinetics of mouse RBCs. STUDY DESIGN AND METHODS: RBCs expressing green fluorescent protein were collected in CPDA-1, filter leukoreduced, adjusted to a 75% hematocrit, and stored at 4°C. At weekly intervals, stored RBCs were transfused into C57BL/6 recipients. RBC survival was measured by flow cytometry and chromium-51 labeling. Phosphatidylserine externalization and CD47 expression was also evaluated. RESULTS: Mean 24-hour survivals of transfused RBCs were 99, 91, 64, 54, 30, and 18% after 0, 7, 14, 21, 28, and 35 days of storage, respectively. Stored RBCs showed an initial rapid clearance with subsequent extended survival. Increased surface phosphatidylserine and decreased CD47 expression were also observed. CONCLUSIONS: Mouse RBCs showed a progressive decline in survival, as a function of storage time, unlike the precipitous loss of viability reported for rat RBCs. Moreover, changes in the measured surface markers were analogous to trends reported for human RBCs. Together, these findings provide an initial characterization of a novel mouse model of RBC storage with the potential to serve as an experimental platform for studying the pathophysiologic consequences of transfusing stored RBCs. [ABSTRACT FROM AUTHOR] more...
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- 2009
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42. The spleen plays a central role in primary humoral alloimmunization to transfused mHEL red blood cells.
- Author
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Hendrickson, Jeanne E., Saakadze, Natia, Cadwell, Chantel M., Upton, JasonW., Mocarski, Edward S., Hillyer, Christopher D., and Zimring, James C.
- Subjects
SPLEEN ,ERYTHROCYTES ,IMMUNOGLOBULINS ,TRANSPLANTATION of organs, tissues, etc. ,PATHOGENIC microorganisms - Abstract
BACKGROUND: Several differences exist between antigens on transfused red blood cells (RBCs) and other immunogens, including anatomical compartmentalization. Whereas antigens from microbial pathogens and solid organ transplants drain into local lymph nodes, circulating RBCs remain segregated in the peripheral circulation, where they are consumed by antigen-presenting cells (APCs) in the spleen and liver. Accordingly, it was hypothesized that the splenic APCs play a central role in primary alloimmunization to transfused RBCs. STUDY DESIGN AND METHODS: Recipient mice were splenectomized and transfused with transgenic RBCs expressing the membrane-bound hen egg lysozyme (mHEL) model RBC antigen. In some experiments, mHEL-specific CD4+ T cells were adoptively transferred into recipient mice to allow investigation of helper T-cell responses. Unmanipulated or sham-splenectomized mice served as controls. Recombinant murine cytomegalovirus expressing mHEL (mHEL-MCMV) was used as a control non-RBC immunogen. Humoral responses were measured by mHEL-specific enzyme-linked immunosorbent assay and flow cytometric–based RBC cross-match. RESULTS: Control animals synthesized detectable anti-HEL immunoglobulin (Ig)G after a single mHEL RBC transfusion. mHEL-specific CD4+ T cells underwent robust expansion, and adoptive transfer of CD4+ T cells resulted in a 1000-fold increase in anti-HEL IgG. In contrast, minimal anti-HEL IgG was detectable in splenectomized mice, mHEL-specific CD4+ T cells did not proliferate, and adoptive transfer did not increase anti-HEL IgG. However, anti-HEL IgG response after exposure to mHEL-MCMV was equivalent in control and splenectomized mice. DISCUSSION: Together, these findings illustrate the distinct properties of transfused RBCs as immunologic stimuli, with the spleen playing a critical role in primary RBC alloimmunization at the level of CD4+ T-cell activation. [ABSTRACT FROM AUTHOR] more...
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- 2009
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43. Critical evaluation of informed consent forms for adult and minor aged whole blood donation used by United States blood centers.
- Author
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Shaz, Beth H., Demmons, Derrick G., and Hillyer, Christopher D.
- Subjects
INFORMED consent (Medical law) ,BLOOD transfusion ,BLOOD banks ,ETHICS ,EVALUATION - Abstract
BACKGROUND: Blood donation is a medical procedure with attendant risks, and thus blood donors should undergo acceptable informed consent. There are no guidelines for the informed consent forms (ICFs) for whole blood donors or for parental consent forms (PCFs) for minor age blood donors. The goal of the study was to determine if the majority of the generally accepted elements of informed consent are provided to volunteer allogeneic whole blood donors in the United States. STUDY DESIGN AND METHODS: ICFs and PCFs along with their accompanying general information forms (GIFs) from nonmilitary blood collection establishments for allogeneic whole blood donation were collected throughout the United States and scored using a system based on the essential elements of informed consent derived from guidelines of consent for research subjects. The overall score for each ICF and PCF was obtained. RESULTS: Twenty-one ICFs and 37 PCFs from 48 states representing major collection centers within the United States were scored. The mean score for the common essential elements ICFs was 35 percent (range, 10%-80%) and for PCFs was 46 percent (range, 10%-90%). CONCLUSION: None of the whole blood allogeneic donation informed consents surveyed contained all the common essential or specific blood donation information desired. There is a need for national guidelines for the informed consent process for both the donor and the parent of a minor to ensure adequate information is specified. [ABSTRACT FROM AUTHOR] more...
- Published
- 2009
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44. Pediatric transfusion medicine: development of a critical mass.
- Author
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Hillyer, Christopher D., Mondoro, Traci Heath, Josephson, Cassandra D., Sanchez, Rosa, Sloan, Steven R., and Ambruso, Daniel R.
- Subjects
PEDIATRICS ,BLOOD transfusion ,MEDICINE ,THERAPEUTICS ,CHILD health services ,MEDICAL care - Abstract
Many significant events have occurred in the recent past that beg a broad audience to address the question “What is pediatric transfusion medicine?” Herein, we list some of these events and their relevance below and attempt to provide an answer for this question. Indeed, several issues regarding the subspecialty of pediatric transfusion medicine (PTM) are particularly timely, and it appears that a critical mass, or a nidus capable of becoming a critical mass, is developing in PTM. [ABSTRACT FROM AUTHOR] more...
- Published
- 2009
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45. Discrete Toll-like receptor agonists have differential effects on alloimmunization to transfused red blood cells.
- Author
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Hendrickson, Jeanne E., Roback, John D., Hillyer, Christopher D., Easley, Kirk A., and Zimring, James C.
- Subjects
RED blood cell transfusion ,ENDOTOXINS ,CELL receptors ,ANIMAL experimentation ,IMMUNOHEMATOLOGY ,ANTIBODY diversity - Abstract
BACKGROUND: Factors influencing alloimmunization to transfused red blood cells (RBCs) are not well understood. Utilizing a murine model, we have recently reported that RBC alloimmunization is enhanced by recipient treatment with viral-like polyinosinic polycytidylic acid (poly(I:C)). To determine whether a different subtype of inflammation also enhances RBC alloimmunization, we investigated the effects of the bacterial endotoxin lipopolysaccharide (LPS) on alloimmunization. STUDY DESIGN AND METHODS: Mice were treated with poly(I:C) or LPS; in select experiments, the precursor frequency of naïve antigen-specific CD4+ T cells was increased using T cells from T-cell receptor transgenic mice. Recipients were transfused with leukoreduced RBCs expressing the membrane-bound hen egg lysozyme (mHEL) antigen, and alloimmunization was measured by anti-HEL immunoglobulin G responses using enzyme-linked immunosorbent assay and flow cytometric cross-match. Costimulatory molecule expression was examined on antigen-presenting cells (APCs) by flow cytometry. RESULTS: Increased expression of costimulatory molecules on APCs was seen after treatment with either poly(I:C) and LPS. In contrast to the enhancement of RBC alloimmunization observed after treatment with poly(I:C), LPS not only failed to enhance but also actively suppressed alloimmunization, even in the presence of increased mHEL-specific CD4+ T cells (p < 0.001 LPS vs. control). CONCLUSIONS: These data demonstrate that the regulation of RBC alloimmunization by inflammatory stimuli is complex, including enhancement by a viral-like stimulus and suppression by a bacterial-type stimulus. The mechanism(s) are unlikely to involve variation in the costimulatory molecules studied, because only subtle differences on APCs were observed after treatment with poly(I:C) and LPS. [ABSTRACT FROM AUTHOR] more...
- Published
- 2008
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46. The American Red Cross donor hemovigilance program: complications of blood donation reported in 2006.
- Author
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Eder, Anne F., Dy, Beth A., Kennedy, Jean M., Notari IV, Edward P., Strupp, Annie, Wissel, Mary Ellen, Reddy, Ramakrishna, Gibble, Joan, Haimowitz, Marcia D., Newman, Bruce H., Chambers, Linda A., Hillyer, Christopher D., and Benjamin, Richard J. more...
- Subjects
DIRECTED blood donations ,BLOOD donors ,BLOOD collection ,MEDICAL care ,BLOOD transfusion - Abstract
BACKGROUND: The American Red Cross (ARC) initiated a comprehensive donor hemovigilance program in 2003. We provide an overview of reported complications after whole blood (WB), apheresis platelet (PLT), or automated red cell (R2) donation and analyze factors contributing to the variability in reported complication rates in our national program. STUDY DESIGN AND METHODS: Complications recorded at the collection site or reported after allogeneic WB, apheresis PLT, and R2 donation procedures in 36 regional blood centers in 2006 were analyzed by univariate and multivariate logistic regression. RESULTS: Complications after 6,014,472 WB, 449,594 PLT, and 228,183 R2 procedures totaled 209,815, 25,966, and 12,282 (348.9, 577.5, and 538.3 per 10,000 donations), respectively, the vast majority of which were minor presyncopal reactions and small hematomas. Regional center, donor age, sex, and donation status were independently associated with complication rates after WB, PLT, and R2 donation. Seasonal variability in complications rates after WB and R2 donation correlated with the proportion of donors under 20 years old. Excluding large hematomas, the overall rate of major complications was 7.4, 5.2, and 3.3 per 10,000 collections for WB, PLT, and R2 procedures, respectively. Outside medical care was recorded at similar rates for both WB and automated collections (3.2 vs. 2.9 per 10,000 donations, respectively). CONCLUSION: The ARC data describe the current risks of blood donation in a model multicenter hemovigilance system using standardized definitions and reporting protocols. Reported reaction rates varied by regional center independently of donor demographics, limiting direct comparison of different regional blood centers. [ABSTRACT FROM AUTHOR] more...
- Published
- 2008
- Full Text
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47. Transfusion recipient epidemiology and outcomes research: possibilities for the future.
- Author
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Hillyer, Christopher D., Blumberg, Neil, Glynn, Simone A., and Ness, Paul M.
- Subjects
BLOOD transfusion ,EPIDEMIOLOGY ,BLOOD banks ,BLOOD collection ,CARDIOVASCULAR diseases risk factors - Abstract
The National Heart, Lung, and Blood Institute (NHLBI) supports major research programs related to the field of transfusion medicine, which encompass blood banking, the practice of transfusion medicine itself, and cellular therapies. Specific programmatic elements have included 1) the Transfusion Medicine/Hemostasis Clinical Trials Network (TMH CTN) charged with conducting clinical trials in transfusion medicine and hemostasis; 2) the Retrovirus Epidemiology Donor Study–II (REDS-II), which includes domestic and international efforts dedicated to blood donor safety and blood availability issues; 3) the Specialized Centers of Clinically Oriented Research (SCCOR) in Transfusion Biology and Medicine that include two major projects, the Biologic and Immunologic Aspects of Transfusion Medicine Program and the Transfusion and Lung Injury Program, and 4) the Transfusion Therapy Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair (FOCUS), a Phase III clinical trial that has as its major goal to determine whether a more aggressive transfusion strategy in surgery patients with cardiovascular disease (or risk factors) is associated with improved functional recovery and decreased risk of adverse postoperative outcomes. Notably, none of these programs supports epidemiologic and clinical outcomes research focused on transfusion recipients. Thus, on October 31, 2007, a Working Group on Transfusion Recipient Epidemiology and Outcomes Research was convened by the NHLBI. This group was asked to discuss the current status of the field, identify critical research needs, and make recommendations to the NHLBI program staff. [ABSTRACT FROM AUTHOR] more...
- Published
- 2008
- Full Text
- View/download PDF
48. Adverse Reactions to Allogeneic Whole Blood Donation by 16- and 17-Year-Olds.
- Author
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Eder, Anne F., Hillyer, Christopher D., Dy, Beth A., Notari IV, Edward P., and Benjamin, Richard J.
- Subjects
BLOOD transfusion reaction ,BLOOD donors ,HEALTH of high school students ,ORGAN donation ,MEDICAL care research ,SAFETY - Abstract
The article presents a study assessing potential adverse reactions to allogeneic whole blood donations by those aged 16 and 17 compared to older blood donors. The setting and design of the study which collected data from nine American Red Cross blood donation centers is detailed. Researchers measured the rate of systemic and phlebotomy-related donor complications per 10,000 collections, mostly from high school blood drives. Results revealed a higher incidence of blood donor-related complications among younger donors. more...
- Published
- 2008
- Full Text
- View/download PDF
49. Transfusion-induced autoantibodies and differential immunogenicity of blood group antigens: a novel hypothesis.
- Author
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Zimring, James C., Spitalnik, Steven L., Roback, John D., and Hillyer, Christopher D.
- Subjects
BLOOD transfusion ,AUTOANTIBODIES ,ANTIGENS ,IMMUNOGLOBULINS ,HYPOTHESIS - Abstract
Blood bank serology has identified hundreds of red blood cell (RBC) antigens contained within numerous blood group systems. Although most blood group antigens are defined by amino acid polymorphisms in the extracellular domain of membrane proteins, it is also possible that additional nonexofacial polymorphisms (NEPs) may exist within cytoplasmic or transmembrane domains. To assess this possibility, we analyzed several blood group molecules by searching the SNPper database for nonsynonymous single-nucleotide polymorphisms. We report the identification of a number of NEPs in the Kell, Kidd, and Duffy molecules. Because the identified NEPs are not exposed on the surface of intact RBCs and are, thus, not accessible to recipient antibodies, they would neither be detected by blood bank serology in vitro, nor would they be recognized targets in hemolytic transfusion reactions in vivo. The presentation of peptides containing NEPs by recipient MHC Class II molecules, however, would nevertheless produce helper T-cell epitopes. In addition to identifying NEPs in human blood group molecules, we explore a novel hypothesis that the presence of NEPs contributes to the immunogenicity of blood group antigens. We further hypothesize that NEPs provide a mechanism by which transfusion can lead to anti-RBC autoantibodies, which are known to occur in humans after transfusion. The scientific basis, existing evidence, approaches to testing, and predicted biology of this hypothesis are presented. [ABSTRACT FROM AUTHOR] more...
- Published
- 2007
- Full Text
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50. Nonfatal intravascular hemolysis in a pediatric patient after transfusion of a platelet unit with high-titer anti-A.
- Author
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Harris, Shealynn B., Josephson, Cassandra D., Kost, Christine B., and Hillyer, Christopher D.
- Subjects
BLOOD platelet transfusion ,HEMOLYSIS & hemolysins ,ANTIGENS ,ETIOLOGY of diseases ,JUVENILE diseases ,PEDIATRICS - Abstract
BACKGROUND: In the pediatric population, hemolysis after out-of-group platelet (PLT) transfusion is a potentially fatal event that is thought to be underrecognized. Group A patients transfused with group O single-donor PLTs (SDPs) with “high-titer” anti-A are at greatest risk for hemolysis. STUDY DESIGN AND METHODS: A clinical and serologic evaluation of a pediatric patient with hemolysis of initially unknown etiology was conducted. Retrospective testing for anti-A titer of an admission sample and a transfused group O SDP was performed. RESULTS: The group A patient (previously group O) was found to have a history of engrafted major ABO-mismatched hematopoietic peripheral blood progenitor cell transplant (HPBPCT). Immune-mediated intravascular hemolysis with a delayed presentation was determined. Testing identified passive anti-A in the patient's plasma and high-titer anti-A (IgG 4096, IgM 256) in the group O SDP unit. CONCLUSION: Hemolysis after out-of-group SDP transfusion may be delayed in presentation and, thus, clinically unrecognized. When evaluating these cases, the limitations of routine type and screen for detection of passive anti-A must be considered. Group A individuals with a history of engrafted major ABO-mismatched HPBPCT potentially have increased susceptibility to hemolysis from group O SDP transfusion due to their lack of tissue and soluble A antigen. [ABSTRACT FROM AUTHOR] more...
- Published
- 2007
- Full Text
- View/download PDF
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