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Background and Objectives Red blood cell (RBC) storage systems are licensed based on their ability to prevent haemolysis and maintain RBC 24-h in vivo recovery. Preclinical testing includes measurement of RBC ATP as a surrogate for recovery, 2,3-diphosphoglycerate (DPG) as a surrogate for oxygen affinity, and free haemoglobin, which is indicative of red cell lysis. The reproducibility of RBC ATP, DPG and haemolysis measurements between centres was investigated. Materials and Methods Five, 4-day-old leucoreduced AS-1 RBC units were pooled, aliquotted and shipped on ice to 14 laboratories in the USA and European Union (EU). Each laboratory was to sample the bag twice on day 7 and measure RBC ATP, DPG, haemoglobin and haemolysis levels in triplicate on each sample. The variability of results was assessed by using coefficients of variation (CV) and analysis of variance. Results Measurements were highly reproducible at the individual sites. Between sites, the CV was 16% for ATP, 35% for DPG, 2% for total haemoglobin and 54% for haemolysis. For ATP and total haemoglobin, 94 and 80% of the variance in measurements was contributed by differences between sites, and more than 80% of the variance for DPG and haemolysis measurements came from markedly discordant results from three sites and one site, respectively. In descending order, mathematical errors, unvalidated analytical methods, a lack of shared standards and fluid handling errors contributed to the variability in measurements from different sites. Conclusions While the methods used by laboratories engaged in RBC storage system clinical trials demonstrated good precision, differences in results between laboratories may hinder comparative analysis. Efforts to improve performance should focus on developing robust methods, especially for measuring RBC ATP.

Serum specimens submitted for confirmation of hepatitis B antigen (HBsAg) reactivity were tested by counterelectrophoresis (CEP) and by three modifications of the solid phase radioimmunoassay "sandwich" technique (SPRIA). In addition, the specificity of each reaction was determined for two of the SPRIA test methods. One hundred seventy-five of the 688 specimens were reactive by all techniques and a further 60 ere specifically reactive by two of modifications of SPRIA. An additional five specimens were positive by a third SPRIA modification. The primary SPRIA technique, using a homologous guinea pig antibody sandwich, detected 184 nonspecific reactive samples. With the same test done at 45C with a reduced incubation time, there were only 37 nonspecific reactive samples. None of the nonspecific samples was detected when the SPRIA technique used a heterologous guinea pig-human antibody sandwich. The results provide a basis for estimating the effectiveness of the SPRIA technique for HBsAg testing.

The purpose of this study was to determine if the removal of most of the leukocytes and platelets would affect the in vitro characteristics of stored red blood cells (RBC). Fresh RBC concentrates prepared by removing platelet-rich plasma and filtration through Imugard IG 500 filters were compared with unmanipulated units after storage for up to 56 days. The filtered units were significantly better after 56 days storage for supernatant K+ (p = 0.001), hemolysis (p = 0.05), total vesicle membrane protein shed (p = 0.03), and RBC morphology score (p = 0.04). These differences occurred even though ATP levels were well maintained in both groups. The measurements that did not differ significantly were pH, hematocrit, ATP, 2,3-DPG, glucose and supernatant Na+. It is suggested that enzymes, leukotrienes, catecholamines and eicosanoids released by degenerating leukocytes and platelets may be inimical to RBC. Some may act as agonists on alpha-adrenergic and cholinergic muscarinic receptors present on RBC membranes.

Sera and questionnaires were evaluated retrospectively from 128 volunteer blood donors whose blood had been implicated in cases of clinically recognized post-transfusion hepatitis in recipients of one- or two-unit blood transfusion between 1971 and 1977. Serologic markers of hepatitis B virus (HBV) infection were found in 23 percent, compared to 9.7 percent of 3,230 prospective blood donors. The prevalence of antibody to hepatitis A virus was similar among implicated donors (44%), prospective donors (58%), and among those implicated donors with (41%) and without (44%) HBV markers. Among implicated donors, none had a history at the time of donation of having had clinically recognizable hepatitis, 93 percent had no history of prior blood transfusion, and 80 percent had normal hepatic enzymes. Data from this study confirm that non-A, non-B hepatitis has been a common form of posttransfusion hepatitis in recent years, since 77 percent of these implicated donors had no HBV serologic markers. In addition, these donors could not be distinguished by age, race, sex, history of clinical hepatitis or of prior blood transfusion, or in most cases by hepatic enzyme levels.

Sixteen patients who received Konyne for bleeding episodes or for hemostasis during surgical procedures were evaluated for signs of posttransfusion hepatitis. Four patients died from their primary disease. Of the remaining 12 patients at risk, six patients developed posttransfusion hepatitis. Sera from four of the six patients with hepatitis were positive for the hepatitis B antigen (HBAg). Aliquots of Konyne from the specific lot (K4797) implicated in three cases of HBAg-positive hepatitis were negative for HBAg by immunodiffusion, immunoelectroosmophoresis, and radioimmunoassay. The high incidence of hepatitis associated with Konyne considerably limits the use for this specialized coagulation factor concentrate. HBAg screening by available technics does not necessarily detect Konyne preparations capable of transmitting HBAg-positive hepatitis.

Resume Anti-Jka etait la cause d'une forme legere de la maladie hemolytique du nouveau-ne. Zusammenfassung Anti-Jka-Antikorper haben eine leichte Form des Morbus haemolyticus neonatorum hervorgerufen.

Summary The eighth child of a woman who had received five pints of blood in the past was born with mild erythroblastosis foetalis due to anti-Duffy(anti-Fya). The specificity of the antibodies on the infant's erythrocytes was established by elution. The maternal antibody was shown to be a gamma globulin by neutralization studies. Seven additional cases of erythroblastosis due to anti-Fya were culled from the files of other laboratories making a total of eleven known to the authors. It is suggested that anti-Fya is a more frequent cause of haemolytic disease of the newborn than was suspected. Reume: Le huitieme enfant d'une femme qui avait regu, de par le passe, 5 ampoules de sang, presenta a la naissance une maladie hemolytique peu grave due a un anticorps anti-Fya. Ce dernier put etre elue des hematies de l'enfant, et l'etude du serum maternel montra, par des tests de neutralisation, qu'il s'agissait d'une gamma globuline. Sept autres cas d'erythroblastose due a l'anti-Fya ont ete recueillis dans les listes d'autres laboratoires, ce qui fait un total de onze cas connus des auteurs. Ceux-ci sont par consequent d'opinion que l'anti-Fya est une cause plus frequente de maladie hemolytique du nouveau-ne qu'on ne le pensait jusqu'a maintenant. Zusammenfassung Das achte Kind einer Frau, welche fruher 5 Vollblutkonserven erhalten hatte, wurde mit einem Anti-Fya-bedingten leichten Morbus haemolyticus neonatorum geboren. Mit den kindlichen Erythrozyten wurde ein Elutionsversuch durchgefuhrt, wobei die Spezifitatsbestimmungder Antikorper bestatigt werden konnte. Die mutterlichen Antikorper zeigten die Antigenstruktur von γ-Globulinen. Auser dem erwahnten Fall wurden aus dem Untersuchungsgut anderer Laboratorien 7 weitere Falle ermittelt. Die Autoren kennen heute 11 Falle von Anti-Fya-bedingtem Morbus haemolyticus neonatorum. Es ist deswegen naheliegend, anzunehmen, das Anti-Fya-bedingte Morbus haemolyticus-Falle haufiger vorkommen, als bisher vermutet wurde.

Summary Anti-N was found in the serum of a healthy blood donor of group MN. The behavior of the donor's blood group antigens and the anti-N appeared to be straightforward. The only explanation suggested is that the antibody was of heterologous origin. Resume Un anti-N a ete trouve dans le serum d'un donneur de sang en bonne sante de groupe MN. Le comportement des antigenes de groupe sanguin de ce donneur et l'anti-N est tout â fait net. La seule explication possible semble etre que cet anticorps soit d'origine heterologue. Zusammenfassung Im Serum eines Spenders mit den Gruppen MN wurde ein Anti-N gefunden. Die MN-Antigene wie auch der Antikorper entsprechen der Norm. Moglicherweise beruht der Antikorper auf einem heterologen Antigenstimulus.

Platelet concentrates prepared from freshly drawn blood were infused into patients with thrombocytopenic complicating disease. All exhibited a prolonged bleeding time, no clot retraction of a whole blood clot, platelet counts between 20,000 to 100,000 per cu. mm., usually, abnormal platelet ultrastructure and prothrombin consumption times under 15 seconds. Detection of platelet antibodies was attempted and the ultrastructure with a differential platelet count under the electron microscope of the patient's own platelets was documented. The platelet concentrates were given and it was possible to follow the fate of the donor's platelets by ultrastructural changes. Parallel studies of the coagulation mechanisms of the patients were followed serially. We found that some platelets survived up to seven days, although in some patients, platelets circulated but did not survive. Therefore immediate circulation of platelets cannot be equated with survival. In one patient with hypersplenism and a positive platelet agglutinin test no transfused platelets appeared to circulate. The ultrastructure of transfused platelets is greatly altered in bleeding patients. In the two patients with aplastic anemia and one with leukemia surviving platelets circulated which did not enter into the mechanisms of prothrombin activation, but which continued to circulate for some days with no improvement in the prothrombin consumption time over the pretransfusion level. Ultra-structural studies of these platelets showed that the circulating platelets possessed their granules which contain platelet factor 3 activity. The differential platelet count under the electron miscroscope becomes abnormal as the donor platelets are stored. Our work suggests that the ultrastructure and differential platelet count of a platelet concentrate must be essentially normal for survival to be achieved. We confirmed the work of others indicating that donor platelets do not survive if stored or, if the recipient has detectable platelet antibodies. Donor platelets did not survive in some patients for reasons we could not explain. This may be dependent on utilization of platelets in hemostatic plugs, in thrombin production or for the endothelial supporting function but to date we cannot estimate to what extent or in what fashion a thrombocytopenic patient utilizes donor platelets.

Blood collected by 11 Red Cross Regional Blood Centers were screened by the method of agar gel diffusion (AGD) for the presence of hepatitis-B antibody. Of the 185,134 units tested, 114 were found to be positive for HBAb by the Regional Centers and were forwarded to National Special Projects Laboratory for confirmation. Only five out of 114 samples revealed lines of identity with a control anti-HBAg when reacted with a pool of plasma positive for hepatitis-B antigen that was different from that which was provided to the Centers. Apparently, the precipitation reactions observed by the Centers were largely due to the antithrombin antibodies in the donors' sera reacting with the residual thrombin used by the manufacturer to convert HBAg positive plasma to serum. We conclude that the incidence of hepatitis-B antibody as measured by agar gel diffusion in the Red Cross Blood donor population was extremely low.