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Introduction: We aimed to identify the effects of intraoperative applied leukocyte-poor platelet-rich plasma (LP-PRP) during knee arthroscopy for degenerative lesions involving pain, function and quality of life. Methods: We performed a randomized controlled, double-blind trial (RCT) including 58 patients for arthroscopic knee surgery for cartilage or meniscal degeneration with allocation into the LP-PRP ( n = 24) or control group ( n = 34). During arthroscopy, LP-PRP was injected intra-articular in the intervention group. At baseline, 6 weeks, 6 months and 12 months pain, function, and life quality were assessed. Results: 91 % of enrolled patients were available for 12 months follow-up. Pain was significantly lower in the LP-PRP group (VAS 0.9. vs. 2.3) at 6 ( p = 0.008) but not at 12 months (VAS 1.0 vs. 1.6, p = 0.063). LP-PRP application improved the Lysholm Score at 6 (77.5 vs. 65.6, p = 0.033) and 12 months (83.2 vs.70.0, p = 0.007). Assessment of life quality (SF-36) concerning the physical component summary was significantly higher at 6 weeks (33.9 vs. 25.6, p = 0.001) and 6 months (29.9 vs. 27.1, p = 0.027) in the LP-PRP group but equal at 1 year (31.4 vs. 30.1, p = 0.438). Conclusions: Intraoperative application of LP-PRP may enhance pain reduction and gain of knee function within 6-12 months compared to arthroscopy alone. Level of evidence: II, randomized controlled clinical trial with reduced power. ClinicalTrials.gov identifier: NCT02189408. [ABSTRACT FROM AUTHOR]

Background: Storage duration of red cells has been associated with increased morbidity and mortality following transfusion. This association has been attributed to the loss of deformability of stored red cells leading to deterioration of microvascular perfusion. ATP content is considered a critical determinant of the deformability of stored red cells. Methods: ATP content and deformability were determined after storage for up to 49 days in 40 leukocyte-depleted whole blood units. Red cell deformability was determined using a laser-assisted optical rotational cell analyzer (LORCA®) employing shear stress (SS) ranging from 0.3 to 30 Pa. Deformability was expressed as the elongation index (EI). EI was correlated with ATP content. Results: ATP content decreased from 3.5 to 1.7 mmol/g hemoglobin. EI increased from 0.03 to 0.05 at an SS of 0.3 Pa, and decreased from 0.62 to 0.59 at an SS of 30 Pa. Correlation coefficient (r) of ATP vs. EI at 0.3 Pa ranged from -0.17 to +0.15 during storage. At 30 Pa, r ranged from -0.03 to +0.45. Correlation increased with storage irrespective of SS, and increased with SS irrespective of storage. Conclusions: ATP content is not a valid surrogate marker for red cell deformability and may not reflect in vivo survival of stored red cells. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objectives: Blood transfusion has been shown to have deleterious effect on lung cancer survival, but little data are available that assess whether leukocyte-depleted (LD) blood has a similar adverse effect. Our institution has been using LD red cells since 2001. We sought to determine whether LD blood has an effect on survival after resection of early-stage lung cancer. Methods: From a prospective database, we evaluated all patients with pathologic stage I non–small cell lung cancer. Patients receiving LD blood were compared with those receiving no transfusion. Survival was estimated using the Kaplan-Meier method and compared using the log–rank test. Multivariate analysis by Cox regression was used to identify independent risk factors affecting survival. Results: From 2001 to 2009, 361 patients were evaluated; 63 received LD red cell cell transfusion and 298 received no transfusion. Median follow-up was 48 months. Disease-free survival (P < .001) and overall survival (P < .001) were worse in patients receiving LD blood. Stratifying for stage, disease-free survival continued to be worse with transfusion for stage IA (P = .002) and IB (P = .002). Similarly, overall survival continued to be worse with transfusion for stage IA (P < .001) and IB (P < .001). For disease-free and overall survival, univariate analysis revealed increased age, male gender, anemia, transfusion, and higher stage to be adverse factors, with transfusion and higher stage continuing to be significant adverse factors after multivariate analysis. Conclusions: Our data suggest that transfusion of LD blood is associated with a worse disease-free and overall survival in patients with resected stage I non–small cell lung cancer. [ABSTRACT FROM AUTHOR]

Abstract: Whereas neutrophils are the main phagocytic leukocytes, monocytes and macrophages are actively involved in immunomodulation after infection. Recent studies have demonstrated that neutrophil function is impaired by the state of negative energy balance around parturition, and that cows that develop uterine disease have a greater degree of negative energy balance than healthy cows. The objectives of this study were to compare monocyte gene expression and protein secretion of selected cytokines from calving to 42 d after calving in Holstein cows that did or did not develop uterine disease. Real time quantitative RT-PCR (Tumor necrosis factor-α (TNFα), Interleukin (IL)-1β, IL-6, IL-8 and IL-10) and ELISA (TNFα, IL-1β and IL-8) were used to evaluate cytokine response following in vitro stimulation of blood-derived monocytes with irradiated E. coli. Relative to unstimulated cells, E. coli-stimulated monocytes from cows with metritis had lower gene expression of key pro-inflammatory cytokines than healthy cows from calving to 14 d after calving (TNFα at 0, 7, and 14 d after calving, IL-1β and IL-6 at 7 and 14 d after calving; P < 0.05). There were no significant differences between groups for expression of IL-8 or the anti-inflammatory cytokine IL-10. This was due, in part, to higher gene expression in unstimulated monocytes (TNFα, IL-1β, IL-6 and IL-10) in early lactation from cows with metritis. Expression of mRNA in stimulated cells (relative to housekeeping genes) was lower for TNFα (7 and 14 d postpartum) and for IL-10 (7 and 14 d postpartum) in cows with metritis. Concentration of TNFα was lower in the culture medium of E. coli-stimulated monocytes from cows with metritis than healthy cows at calving and 7 and 21 d after calving (P < 0.05). Circulating cytokine concentrations were not different between groups for IL-8 and were below the limits of detection for TNFα and IL-1β. Cytokine gene expression and production were similar between healthy cows and cows that developed endometritis, diagnosed cytologically at 42 d after calving. We concluded that altered levels of expression and production of pro-inflammatory cytokines postpartum could contribute to impaired inflammatory response and predispose cows to development of metritis. [Copyright &y& Elsevier]

Objective: There is mixed evidence regarding the association of perioperative blood transfusion to disease recurrence and mortality in head and neck cancer patients. Moreover, few investigations have examined the effects of leukocyte-depleted (leukodepleted) red cell transfusion. The presented study was undertaken to ascertain whether perioperative transfusion of leukodepleted blood is associated with recurrence and survival in head and neck cancer surgery patients. Methods: The records of all patients having undergone head and neck surgery for malignant disease between October 1996 and October 2002 were reviewed. Hospital, blood bank, and cancer registry database records were reviewed and data were recorded onto a standardized computer spreadsheet. The primary outcome variable was the number of perioperatively transfused units of allogeneic leukodepleted blood. Multivariate analysis and Cox regression methods were employed. Results: Five hundred twenty patients met the criteria for inclusion in the study. Recurrence and mortality rates were significantly different between transfusion and no-transfusion groups, in favour of the no-transfusion group. In addition to age, T stage, and N stage, multivariate analysis revealed leukodepleted blood transfusion to be an independent predictor of both recurrence (odds ratio 1.6) and survival (hazard ratio 1.5). Conclusion: Perioperative transfusion of leukodepleted blood is associated with higher recurrence rates and decreased survival in head and neck cancer surgery. [ABSTRACT FROM AUTHOR]

Background: Cardiac surgery during an empty beating heart state has proven to be beneficial in myocardial protection. Based on this, we hypothesized that maintaining this state for donor heart preservation would have the same efficacy and a prolonged preservation period. Methods: Part 1: 12 pigs were divided into two groups (n = 6 per group). Donor hearts were preserved in group A by perfusion with leukocyte-depleted blood in the beating state, and in group B, in the traditional hypothermic static state with University of Wisconsin solution. After 8 hours, myocardial samples were obtained to detect myocardial edema, adenosine triphosphate, and ultrastructure. Part 2: 12 donor-recipient swine pairs were randomly allocated to either beating heart preservation with perfusion (group C) or traditional static preservation (group D). Donor hearts were stored for 8 hours after isolation, followed by implantation into recipient animals. Implanted hearts recovered for 120 minutes in an empty and beating state followed by 30 minutes in a working state, after which cardiac function was measured. Results: After preservation, myocardial adenosine triphosphate levels in group A were significantly higher than in group B. However, myocardial water content was not significantly different between these two groups. The damage of myocardial ultrastructure in group A was slight compared with that of group B. The experimental transplant group C showed excellent heart function after implantation when compared with group D. Conclusions: Our study reveals greater effects of donor heart preservation in a beating state rather than simply with hypothermic storage in University of Wisconsin solution. [Copyright &y& Elsevier]

Abstract: Subject: In order to assess the impact of leukocyte reduction, all transfusion reactions reported at Liege Teaching Hospital''s Blood Bank 2 years before and after the implementation of universal leukocyte reduction of red blood cells concentrates which started-up on 1 January 2005 were evaluated. Study design and methods: A retrospective analysis of transfusion reactions from 1 January 2003 to 31stDecember 2006 was undertaken. Data were collected from computerized reports, which were entered as soon as a transfusion reaction was reported. Symptoms were classified in different reaction''s categories. Blood cultures, antibody screening and direct antiglobulin test were performed. Differences between the two time periods, before (2003–2004) and after (2005–2006) universal leukoreduction were determined by the Chi-square test and significance was defined as a p value less than 0.05. Results: During period before the implementation of systematic leukoreduction, 68.7% of red blood cells transfused were leukoreduced. A total of 365 transfusion reactions in 91,996 red blood cells units transfused (0.4%) were reported, of which 266 were classified as febrile non-hemolytic transfusion reactions (72.9%), followed by allergic reactions (7.1%) and miscellaneous reactions (3.8%). When comparing the two-time periods, the rate of all transfusion reactions in general significantly decreased from 0.49 to 0.31% (p <0.001). Therefore, universal leukocyte reduction significantly reduced the rates of febrile non-hemolytic transfusion reactions (0.35% versus 0.24%; p =0.002) and allergic reactions (0.05% versus 0.01%; p <0.001). Conclusion: Universal leukocyte reduction significantly reduced the rate of transfusion reactions. [Copyright &y& Elsevier]

Background: Cerebrospinal fluid (CSF) is potentially altered by iatrogenic blood contamination at the time of sampling due to the addition of blood-associated leukocytes and protein. Objectives: The objective of this study was to assess whether protein concentration, neutrophil percentage, and the presence of activated macrophages, reactive lymphocytes, or eosinophils in CSF samples with low total nucleated cell concentration (TNCC) are affected by blood contamination or associated with central nervous system (CNS) disease. Methods: Case records from the Royal Veterinary College Diagnostic Laboratory were searched retrospectively for dogs with CSF having ≤5 TNCC/μL. TNCC, RBC, and protein concentrations; neutrophil percentage; and the presence of activated macrophages, reactive lymphocytes, and eosinophils were recorded. Results of magnetic resonance imaging (MRI) also were recorded as a marker of CNS disease. Results: Of 906 cases evaluated, 106 (12%) had blood contamination (>500 RBCs/μL) in CSF. Protein concentration and neutrophil percentage were significantly higher and the presence of eosinophils was more likely in blood contaminated vs noncontaminated samples. Non-blood-contaminated samples with activated macrophages or reactive lymphocytes had higher protein concentrations and neutrophil percentages, and those with activated macrophages were more likely to have a positive finding on MRI. Conclusions: Protein concentration, neutrophil percentage, and the presence of eosinophils are significantly affected by blood contamination in canine CSF having low TNCC. Activated macrophages and reactive lymphocytes are not affected by blood contamination, however, and may be useful in identifying dogs with CNS abnormalities. [ABSTRACT FROM AUTHOR]

Background: The present study sought to investigate the relationship between asymptomatic leukocyturia (ASL) and autonomic nervous function by power spectral analysis of the R-R intervals in women. Methods: One hundred and forty-two female outpatients aged 23–91 years were studied. We regarded ASL to be present if two consecutive samples were found to have 10 or more leukocytes/high-power field at ×400 magnification in a centrifuged midstream urine sample. The R-R intervals of all subjects were measured by the wavelet transform analysis system. This system detected R-R variation data distributed in two bands: low-frequency power (LF) (0.04–0.15 Hz) and high-frequency power (HF) (0.15–0.40 Hz). The ratio of LF to HF (LF/HF) was also determined. Post-void residual urine volume was measured using an automated, compact 3-D ultrasound device. Results: The patients with ASL had diabetes mellitus more frequently than those without ASL. Residual urine volume was significantly higher in the former than in the latter, while the HF values in both a recumbent position and a standing position were significantly lower in the former than in the latter ( P = 0.003, P = 0.001, respectively). However, there were no significant differences in LF or LF/HF values in either a recumbent or a standing position between the two groups. The HF values in both a recumbent position and in a standing position were independent indicators of ASL, even after adjustment for age, diabetes mellitus and residual urine volume. Conclusion: The present study reveals the relationship between ASL and impairment of the parasympathetic nervous system in women. [ABSTRACT FROM AUTHOR]

Background and Objectives Leucocyte-derived cytokines accumulate in stored whole blood. Pre-storage leucocyte depletion has reduced cytokine levels and, consequently, febrile non-haemolytic transfusion reactions. As leucocyte filtration and component separation can be performed until 24 h after donation, we hypothesized that within this time, inflammatory cytokines might accumulate. Materials and Methods Serial plasma samples were collected 4, 10 and 20 h after donation and cytokine concentrations were measured. Results Interleukin-8 increased > 20-fold and soluble CD40 ligand > sixfold during the observation time, less pronounced changes for several other mediators were also observed. Conclusion Leucocyte depletion within 10 h of blood donation will reduce the concentrations of pyrogenic mediators. [ABSTRACT FROM AUTHOR]

Several abstracts of studies related to transfusion are presented including "Automated Whole Blood Processing with the ATREUS 2C+ System Exceeds Conventional Preparation Method," C. Lehmann, S. Rummler and T. Lorenzen et al, "Filtration Times of Leukocyte Depleted Red Cell Concentrates," by O. Roehrig, U. Sugg and B. Luz and "Sterility Testing of Blood Components," by T. Muller-Kuller, S. Findhammer and E. Seifried.

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Objectives: The aim of the present paper was to examine the concept of benign ethnic neutropenia and to consider the implications of ethnicity in the current clozapine regulatory system. Method: The case of a young Palestinian man who lost access to clozapine due to a fall in his neutrophil count, is presented herein, and a brief review of ethnic variations in neutrophil levels is given. Results: This patient's clozapine was ceased, with unfortunate consequences, despite his having normal immune function. Conclusion: By using normative haematological data established in white populations, the Australian clozapine regulatory system places some non-white patients at a considerable disadvantage. [ABSTRACT FROM AUTHOR]

Two populations of Atlantic salmon broodstock, previously identified as infectious pancreatic necrosis virus (IPNV) carriers, were screened for IPNV at the time of stripping. Four hundred and ten broodfish were individually sampled of which 91 were detected as IPNV positive by virus culture of sonicated kidney homogenates combined with gonadal fluid, but none tested positive by the blood leucocyte assay. Thirty fish identified as IPNV carriers prior to maturation by the blood leucocyte assay were used in a separate study to compare non-destructive vs. destructive testing methods at stripping. IPNV was not detected using the blood leucocyte method at the time of stripping. RT-PCR and real-time PCR assays failed to detect IPNV from 13 blood samples, the virus was not isolated from milt (0/14) or sonicated ovarian fluid cell pellets (0/16) and only three fish tested positive by the standard culture of kidney homogenates. A third study of Atlantic salmon broodfish compared the IPNV isolation rates prior to maturation with the isolation rates at spawning during 1999–2001. In each year the percentage of IPNV-positive broodfish was significantly lower than in the pre-broodstock sample. While in pre-broodfish samples IPNV was detected by the blood leucocyte assay, no culture isolations or PCR positives were detected from non-destructive samples of the same individual broodfish at stripping. A consistent finding was that even for the kidney assay, the percentage of IPNV-positive fish in carrier populations was higher in pre-broodstock than in broodfish at stripping. These results indicate that destructive kidney sampling is still the most sensitive method for detecting IPNV carrier Atlantic salmon broodfish and that a change in IPNV carrier-status occurs during the maturation period. [ABSTRACT FROM AUTHOR]

Abstract: Background: In December 2004, Pall Corporation initiated voluntary recall of certain filters used for leukocyte-reduction of blood products. Although our center had not used the implicated lots, certain customers reported observing increased hemolysis in the red-cell units (RC) provided by us. The purpose of this study was to determine the level of hemolysis seen in RC produced by our center. Methods: In the first-phase, we evaluated 20 leukocyte-reduced (LR)-RC, those judged by one of our hospitals to have the highest degree of hemolysis (age: 10–30 days; average=16 days). Results were compared to ten randomly selected non-LR-RC (age: 10–19 days; average: 15 days). Samples obtained directly from the RC were tested for hemoglobin (Hb), hematocrit (Hct) and supernatant-Hb. Percent-hemolysis (% hemolysis) was calculated. In the second-phase, the above measurements were made on 70RCs. Ten RCs were studied before and after leukofilteration on day-2 after collection. Ten units each (LR & non-LR) were selected randomly from inventory at days: 15, 30 and 40 after collection (LR-units filtered within 48h). Results: In the first-phase LR-RCs exhibited an average 0.06% hemolysis vs. 0.02% for non-LR units. In the second-phase the average % hemolysis before and after filteration on day-2 (LR: 0.04% & non-LR: 0.04%) was similar. While on days:15 (LR: 0.09%, non-LR: 0.05%) and 30 (LR: 0.16%, non-LR: 0.13%) % hemolysis was slightly more in LR as compared to non-LR. It was the opposite for day 40 (LR: 0.19%, non-LR: 0.31%). However, none of these differences were statistically significant. Conclusions: The % hemolysis increased as the age of the unit increased. There was no significant statistical difference between LR-RC and non-LR-RCs. This data did not confirm our hospitals’ concerns regarding increased hemolysis following LR. [Copyright &y& Elsevier]

The article presents transfusion guidelines for neonates and older children. The transfusion requirements of the neonate are recognized as unique, but there are other groups of children who are regularly transfused and who have very specific transfusion needs. There remains a lack of evidence for many transfusion practices in the neonatal period and childhood, making recommendations difficult in a number of areas. Transfusion practice has advanced since 1994, particularly with respect to safety issues regarding the risk of transfusion transmitted variant Creutzfeldt-Jacob disease (vCJD).

Cites a study published in the journal "Transfusion Medicine," which focuses on blood components and derivatives. Application of real-time polymerase chain reaction in the quantification of low leucocyte numbers; Evaluation of Baxter Intercept System for pathogen reduction of pooled platelets.

Background and Objectives The UK Blood Transfusion Services implemented universal leucocyte depletion of the blood supply in November 1999. To provide statistical process monitoring of these processes, automated methods were introduced to count residual leucocytes (white blood cells) in blood components. Materials and Methods Initially in the National Blood Service (NBS) England, protocols were standardized on the use of LeucoCount reagents with either Becton-Dickinson or Beckman Coulter flow cytometers. Results Standardization of protocols resulted in a decreased intersite variability of red cell samples (from 36% to 9% at a level of 11 and 10 cells/µl, respectively), and 100% of sites (n = 11) fulfilled the validation criteria. However, we also evaluated the use of alternative reagents with the result that reagents from either Becton-Dickinson or Beckman Coulter, used on either a Becton-Dickinson or Beckman Coulter flow cytometer, passed our validation criteria. Conclusions It is critical to include samples from filtered products containing white blood cells in validations of leucocyte enumeration methodology, as results may differ between methods using these samples but not using spiked or fixed material. Standardized gating strategies and optimization methods for flow cytometers are critical for obtaining equivalent results with different reagents and instruments. [ABSTRACT FROM AUTHOR]

Background and Objectives The results of quality monitoring leucocyte counts were analysed nationally for the first 2 years of universal leucocyte depletion (LD), spanning the time-period before and after standardization of the counting and LD methods. The objectives were twofold: first to determine whether the implementation strategy was effective in achieving the LD specification (< 5 × 106 leucocytes in 99% of components with 95% statistical confidence); and second, whether quality monitoring was able to detect potential non-conformance. Materials and Methods Residual leucocytes were counted using Beckman Coulter or Becton Dickinson (BD) flow cytometers and reagents. Data were collected into standardized analysis software (NWA Quality Analyst) for local trend analysis and checks for conformance to process specification, and collated centrally. Analysis was performed for six time-periods between January 1999 and March 2001. Specification failures were analysed to determine the likelihood of extreme failure. Statistical process monitoring was adjusted to suit LD processes. Results Data from red cells in optimal additive solution (OAS), filtered either as whole blood or red cell concentrates, and platelet pools improved significantly over the 2-year period with specification failures falling from 0·35%, 0·48% and 0·56%, respectively, in January–June 1999 to 0·06%, 0·01% and 0·04% in January–March 2001. Specification failures in red cells in OAS LD for the period January–December 2000 showed only 0·02% with a leucocyte count of > 30 × 106 /unit. Extreme failures are now very rare. Monitoring methods have been effective in detecting process change and drift. Conclusion LD performance varies between different LD systems, but monitoring has proved sufficiently robust to detect processes that perform poorly. The chosen specification has been both achievable and appropriate to the... [ABSTRACT FROM AUTHOR]

Leukocyte depletion (LD) by blood product filtration has been shown to be similarly effective to the use of screened, CMV seronegative blood products to prevent CMV disease in CMV seronegative allogeneic stem cell transplant (SCT) patients with CMV seronegative donors. The aim of this retrospective study was to determine the risk for development of CMV infection requiring preemptive therapy and for CMV disease if unscreened products treated by prestorage LD is used. Forty-nine consecutive patients transplanted after June 1995 were included. As a control group, 33 patients transplanted from January 1992 to June 1995 in whom a combination of CMV seronegative and LD blood products were given. All patients were monitored weekly by a leukocyte-based PCR for CMV DNA detection. Preemptive therapy was initiated after two consecutively positive tests. No patient developed CMV disease in either group. CMV DNA was detected in 6/49 (p = NS) in the study group and in 3/33 patients in the historical control group. Two patients in the study group were given preemptive therapy compared to one patient in the control group. This study suggests that the risk for CMV disease and the need for preemptive therapy against CMV is low in CMV seronegative allogeneic SCT patients receiving grafts from CMV seronegative stem cell donors receiving LD blood products. Thus, this strategy can be safely used together with PCR monitoring and preemptive therapy. [ABSTRACT FROM AUTHOR]

Focuses on the arguments related to the proposed universal leucocyte-depletion of blood components. Motivation of health officials in deciding the universal implementation of leucocyte-depletion; Methods of leucocyte-depletion which are commonly used by health practitioners; Maximum storage time preferred by health experts prior to leucocyte-depletion of red cells, platelet concentrate and plasma units.

The aim of this study was to evaluate the quality of leucodepleted (LD) fresh-frozen plasma (FFP) produced using one of five whole blood filters (Baxter RS2000 & RZ2000, NPBI T2926, Macopharma LST1 and Terumo WBSP) or two plasma filters (Pall LPS1 and Baxter FGR7014). Whole blood or plasma was filtered within 8 h of collection at an ambient temperature. Samples were taken pre- and post filtration for analysis of coagulation factors and complement activation (n = 7–12 for each type of filter). All filtered units (209–286 ml) contained < 5 × 106 residual leucocytes and < 30 × 109/l platelets. Statistically significant losses of factors V, VIII, IX, XI and XII and increases in markers of coagulation activation were observed (0–21%), which were dependent on filter type. None of the filters had a significant effect on von Willebrand factor (VWF) multimeric distribution or the activity of VWF and factors II, VII or X. The effect on levels of C3a appeared to be related to the filter surface charge: positively charged filters resulted in C3a generation, whereas negatively charged resulted in C3a removal. None of the observed changes are likely to be clinically significant unless subsequent processing of plasma (such as pathogen inactivation) results in further losses of coagulation factors. [ABSTRACT FROM AUTHOR]

Leucocyte counts of < 5 × 106 per blood transfusion product are currently recommended in the UK in order to reduce transfusion-related infections and febrile reactions. Routine leucocyte depletion, however, requires the development of reliable internal and external quality assurance (EQA) programmes. We report preliminary findings from the UK NEQAS for Low-Level Leucocyte Counting from 18 UK Transfusion Centres over a four month period. Data analysis showed that the IMAGN 2000 had the lowest CVs (range 7.5–36%, mean 16.7) for samples with counts of 5–30 cells/μl when compared to the flow cytometric (range 13.8–88%, mean 29.5) and Nageotte methods (range 20.6–117%, mean 61.8). In addition, laboratories using commercial nuclear stains (LeucoCOUNTTM) had consistently lower CVs than those using ‘in-house’ propidium iodide staining methods. Important differences in flow cytometric gating strategies were also identified. This study highlights the current variability in low level leucocyte counting, especially within the critical range of 5–30 cells/μl (equating to < 5 × 106/l). The acceptance of consensus protocols, including gating strategies and nuclear staining techniques, is required to reduce the observed interlaboratory variation. Finally, we demonstrate that stabilized blood preparations can be successfully used to provide a national/international low-level leucocyte EQA scheme. [ABSTRACT FROM AUTHOR]

Background: This study was done to investigate the effects of blood transfusion on gastrointestinal anastomotic wound healing and leukocyte function. Methods: Closed-colony male Wistar rats were divided into five groups in a group-mixed fashion and underwent laparotomy (the CONT and WB groups) or gastrectomy and gastroduodenostomy (the GAST, GAST/WB and GAST/LDRWB groups). Immediately, they received 3 ml of saline (the CONT and GAST groups) or blood from Wistar donors (the WB and GAST/WB groups, whole blood; the GAST/LDRWB group, a transfusion of irradiated and leukocyte-depleted whole blood). The animals were killed 7 days after surgery. Results: The GAST/WB group had a higher incidence of anastomotic abscess, a lower level of factor XIII and a lower maximum breaking strength than the GAST group. Gastrectomy decreased L-DCL (luminol-dependent chemiluminescence) more than whole-blood transfusion. In the GAST/WB group, L-DCL was severely reduced, while in the GAST/LDRWB group it was roughly equivalent to the level in the GAST group. Conclusions: Whole-blood transfusion increased the incidence of anastomotic abscess and impaired anastomotic wound healing, and these might relate to the reduction of L-DCL. Irradiated and leukocyte-depleted transfusion can improve these effects.Copyright © 2001 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Presents the guidelines for the clinical use of leucocyte-depleted blood components formulated by the British Committee for Standards in Hematology, Blood Transfusion Task Force. Definition of leucocyte-depleted blood components per unit; List of recommended uses for components; Contraindications for leucocyte-depleted components.

It is now widely acknowledged that autologous leucocytes are inappropriately activated during cardiopulmonary bypass (CPB). Removal of these activated leucocytes has been proposed as a clinical intervention. Several papers have recently reported benefits of systemic leucocyte depletion during CPB. There is also evidence that leucocyte-depleted blood cardioplegia is advantageous in the globally ischaemic human heart transplant setting. Recently, a new leucocyte-depleting filter for blood cardioplegia has been developed (Pall, BC1). In this paper, we report on the safety and efficiency of this device in the clinical situation. Fourteen patients undergoing routine cardiac surgery were recruited into this study. The BC1 blood cardioplegia filter was found to be an efficient leucocyte-depleting device, removing in excess of 70% (p = 0.001) of white blood cells, on average, from up to 5.3 litres of blood cardioplegia. The filter removed a small proportion of platelets (typically 11.3%), however, this was not statistically significant and no bleeding problems were encountered. Red cell removal was negligible and was not statistically significant, and no evidence of haemolysis was noted. The filter offered a very low resistance to flow with a mean pressure drop (DeltaP) of 10.8 mmHg at a mean flow rate of 315 ml/min. We conclude that the Pall BC1 filter is a safe and efficient device for use with blood cardioplegia. [ABSTRACT FROM AUTHOR]

Reports on a study to see if an increased frequency of postoperative infection in allogenic blood transfusion can be avoided by intraoperative and postoperative use of leucocyte-depleted blood. Methods of the study; Findings of the study; Interpretation of the findings.

ABSTRACT Primary adrenal lymphoma is rare, but clinically important. We report a unique case of adrenal lymphoma which showed extensive cystic change mimicking a pseudocyst. Seventy-three-year-old man visited our hospital for healthcare check-up, and was found to have a large adrenal cystic mass. He was received adrenalectomy on the impression of an adrenal pseudocyst. On gross examination, the mass was a unilocular cyst with no solid mass formation. Microscopically, the cyst wall had no epithelial lining, but was infiltrated by some atypical large lymphoid tumor cells. The cystic space was filled with coagulative necrotic material with the tumor cell shadow. The most of the tumor cells expressed leukocyte common antigen, CD20, PAX5, Ki-67, and Epstein-Barr virus (EBV)-encoded RNA, which was consistent with EBV-positive diffuse large B-cell lymphoma of the elderly. No extra-adrenal involvement was observed in imaging studies. We concluded that primary adrenal lymphoma should be considered as a rare but important cause of adrenal cysts. [ABSTRACT FROM AUTHOR]

Discusses the cost-effectiveness of leukocyte depletion of red-cell transfusions for patients undergoing cardiac surgery in the Ntherlands. Reduction in post-surgical complications such as mortality and infections; 3.5% mortality within 60 days of transfusion; Pharmaco-economic analysis; Negative correlation of average costs and effects.

Symptoms of fever and/or rigours after transfusion continue to occur commonly in patients receiving platelets leucocyte-reduced after storage. A cohort of 24 consecutive patients who had experienced severe or repeated febrile nonhaemolytic reactions to post-storage leucocyte-reduced platelet transfusions were treated with saline-washed, post-storage leucocyte-reduced platelets. The frequency of reactions declined from 20% of transfusions (n = 191) to 0·6% (n = 331) after instituting saline-washed, post-storage leucocyte-reduced platelet transfusions. These results support the hypothesis that substances present in the supernatant of stored platelet concentrates mediate febrile nonhaemolytic transfusion reactions, and provide one strategy for preventing their occurrence. [ABSTRACT FROM AUTHOR]

Platelet counts were measured before and after red cell transfusions in 30 patients with anaemia and severe thrombocytopenia resulting from haematological diseases. There was a mean reduction of 1.1 × 109/l (P = 0.43) in the platelet count after transfusions of 2–3 units of leucocyte-depleted red cell concentrates (20 patients). However, there was a mean reduction of 2.7 × 109/l (P = 0.03), ≈ 10%, in the platelet count after transfusions of non-leucocyte-depleted red cell concentrates (10 patients). The findings suggest that the forthcoming introduction of universal leucocyte depletion of red cell concentrates will minimize the worsening of thrombocytopenia that occurs in severely thrombocytopenic patients receiving standard non-leucocyte-depleted red cell concentrates. [ABSTRACT FROM AUTHOR]

The article informs that leukoreduction of red blood cell helps in the prevention of human leukocyte antigen (HLA) sensitization in patients receiving organ transplants. It mentions that patients with previous pregnancies or transplants experience HLA sensitization upon nonleukoreduced blood transfusion. It further informs that reintroduction of nonleukoreduced products into the renal transplant patient leads to adverse effects.

The article presents an authors' response to a critique by doctors Marc Russo, Willem Volschenk, and Danielle Santarelli, of the article ''Effectiveness of PRP in the Treatment of Tendinopathy'' published in the issue. Author agrees with critics that the only 1 trial was included and that data available in the scientific literature to date would support the statements relating to the difference between Platelet-Rich Plasma (PRP) preparations.

Discusses the abstract of the research paper 'Clinical Effectiveness of Leukocyte Depleted Platelet Concentrates That Were Stored for Up to 7 Days,' by M.J. Dijkstra-Tiekstra, E.C.M. Hendriks, et al, to be presented at the American Association of Blood Banks' 55th Annual Meeting on October 26-29, 2002.

Background: Universal Leukocyte Reduction (ULR) of blood components can minimize the incidence of many untoward reactions to blood transfusion. However, the cost of this process will be substantial. It has been suggested that the cost might be Offset by a reduction in the incidence of postoperative infection, thereby shortening the length of hospital stay (LOS), thus reducing the total cost of hospital care for transfused patients (pts). Reports of reduced LOS have relied on purely retrospective analyses, without proper control for other confounding factors. Since we instituted a policy of ULR at our 870 bed hospital for a period of 2 years (1992-3), we have the unique opportunity to examine LOS prior to, during and after discontinuing ULR. This capability provides a control for confounding factors that might affect LOS over time. Methods: Transfused patients undergoing coronary artery bypass graft surgery (CABG) were divided into 3 groups: Group 1=1991 (prior to ULR); Group 2=1992-3 (during ULR); and Group 3=1994 (following ULR). Three groups of controls were non-transfused CABG pts during these same time periods (Groups 4, 5 and 6). We examined hospital records to determine LOS, cost of hospital care, and incidence of postoperative infection. Analysis of variance was performed to compare the means among the three groups of pts and controls. Results: A total of 1217 pts received transfusion (Group 1=416, Group 2=404, Group 3=317). Controls were 508 pts (Group 4=152, Group 5=182, Group 6=174). Mean LOS for the transfused groups was 19, 17 and 14 days, respectively (p=0.001). For controls it was 12, 11 and 9 days, respectively (p=0.001). Mean cost of hospital care for transfused pts was: Group 1=$103,000, Group 2=$123,000, Group 3=$121,000 (p=0.001). For controls: Group 4=$66,000, Group 5=$72,000, Group 6=$78,000 (p=0.004). Mean incidence of any postoperative infection was: Group 1=11%, Group 2=13%, Group 3=7% (p=0.04). For controls: Group 4=7%, Group 5=7%, Group 6=2% (p=0.06). Discussion: Although there was a statistically significant reduction in LOS for transfused pts over the study periods, there was no evidence that the 1992-3 time period showed anything other than being an intermediate in the general time trend for decreasing LOS and increasing cost of hospital care. Furthermore, these trends paralleled those of non-transfused control pts. Finally, rates of postoperative infection showed no decline during the ULR years. Conclusion: ULR has been shown to reduce many of the complications of blood transfusion, but our data suggest that the cost may not be offset by reduced LOS and cost of hospital care. [ABSTRACT FROM AUTHOR]

In this article, the author discusses the impact of retransfusion of nonleukoreduced products into renal transplant patients.

The article discusses the case of a 51-year-old women diagnosed with chronic myeloid leukemia, with a leukocyte count of 398,000 per cubic millimeter. Sidestream dark-field (SDF) imaging showed abnormally large gaps between erythrocytes, probably because of leukocytosis. Treatment with hydroxyurea reduced the leukocyte count and the microcirculatory flow pattern returned to normal levels, diminishing the patient's symptoms. Gaps in between erythrocytes normalized and flow in capillaries was restored.

Introduction: Any outward event occurring in a patient following transfusion of whole blood or components is called transfusion reaction. Leukocyte removals from blood components before transfusion prevent or delay leukocyte medicated adverse reactions. Aims and Objectives: Since multi transfused patients like Taalassaemic Patients are prone to develop leukoaggulatinins (transfusion reactions) we studied the effect of transfusion of Red Blood Concentrate, washed Red Blood Concentrate and Leuco depleted Red Blood Concentrate using Opti bags. Materials and Methods: 175 Registered Thalassaemic patients were included in this study. These patients received random transfusion of Red Blood Cell Concentrated, Washed Red Blood Cell Concentrate (twice manual washing) and Leuco Depleted Red Blood Cell Concentrate prepared from Opti bags (using Baxter's Automated Optipress-1 machine) Observations: 5 Patients who received transfusion for Red Blood Cell Concentrate (prepared from double bags) developed transfusion reactions. 1 Patient who received transfusion of washed RBC prepared from Opti bags developed transfusion reaction. Patients who received Leuco Depleted RBC showed no transfusion reaction in our study. Conclusion: Leuco Depleted RBC prepared from Opti Bags (using Baxter's Automated Optipress-1 machine) are effective in minimizing transfusion reaction in multi transfused patients. [ABSTRACT FROM AUTHOR]

The article presents information about LeukoLock total RNA isolation system, recently introduced by Ambion Inc. The system makes use of leukocyte depletion filter technology to isolate leukocytes from whole blood. Ambion's RNAlater is used to stabilize the leukocyte RNA indefinitely. With the help of this system RNA is isolated from the leukocytes through a magnetic bead-based process, producing RNA with low levels of globin messenger RNA.

Discusses the abstract of the research paper 'Leukocyte-Reduced Blood in Open Heart Surgery Patients: Effects on Outcome,' by A.W. Bracey, R. Radovancevic, et al, to be presented at the American Association of Blood Banks' 55th Annual Meeting on October 26-29, 2002.

One assumed benefit of pre-storage leukocyte-reduced (LR) blood components is a decreased rate of febrile non-hemolytic transfusion reactions when compared to the rate using bedside LR components. Our transfusion service adopted universal pre-storage LR red cells and apheresis platelet components during the second quarter of 1999. We compared quarterly reaction rates (per thousand transfusions) during our last seven consecutive quarters (Q3 1999 to Q1 2001) with rates during a baseline period of thirteen consecutive quarters (Q1 1993 through Q1 1996), when only bedside leukocyte reduction was available. Bedside leukocyte reduction during the baseline period was limited to patients with prior febrile reactions and adult or pediatric allogeneic hematopoietic stem cell transplant recipients. Quarterly data from Q2 1996 through Q2 1999 were excluded because pre-storage LR apheresis platelets were used variably during the period, and pre-storage LR red cells were not available. The significance of rate differences between the two periods was tested with the t-test for unequal samples. The results are shown in the table below. Conclusion: Universal pre-storage LR component transfusion resulted in a 48% decrease in febrile reactions compared to bedside LR components. Rates of other reaction categories were not changed significantly. [ABSTRACT FROM AUTHOR]

Background: Residual cells in plasma are of concern because of the possibility of disease transmission and other side effects. Therefore, white blood cell (WBC) reduction by filtration has been implemented in many countries. However, some fractionation institutes do not accept filtered plasma because of fear of loss of clotting factor and complement activation. In this study, a new bowl ('newly design efficiency core') and new software for the PCS2 (Haemonetics) to produce WBC-reduced plasma without filtration were evaluated. Methods: Procedures performed: A) present software and bowl (n=25); B) new software and newly design efficiency core bowl (n=30). In all procedures, the plasma product was tested for residual platelets (automated impedance counter), WBCs (Nageotte hemocytometer) and red blood cells (RBC; Burker hemocytometer) all in 10× concentrated plasma. Results: See table. Conclusion: With the combination of the newly design efficiency core bowl and new software, a significant decrease of residual cells could be achieved. The plasma can be considered as a WBC-reduced product. [ABSTRACT FROM AUTHOR]

Background: We previously reported an unexpectedly higher rate of febrile non-hemolytic transfusion reactions (FNHTRs) in our patient population receiving leukocyte-reduced red blood cells (RBCLRs)(Transfusion 2000,40 (supplement)); this was felt to be due to possible selection bias in patients receiving selective leukoreduction protocols. At that time, we were transfusing ∼60% RBCLR units. In the intervening period, we have increased our inventory of RBCLRs to ∼97.0%. We, therefore, have reassessed the incidence of transfusion reactions (TRs) in patients who received RBCLRs. Methods: From January 1998 through April 2000, our transfusion service issued 31,617 RBCLRs and 54,090 RBCs. From May 2000 through March 2001 we issued 46,724 RBCLRs and 25,328 RBCs. Since April 2000, we have gradually increased our inventory of RBCLRs from ∼60% to ∼97.0% as of March 2001. For the first three months of 2001, we have transfused 9513 RBCLRs and 339 RBCs. All TRs were evaluated. Patients who had both allergic and febrile components were counted as part of both categories. TRs are then reported as a percentage of total units transfused, i.e., RBCLR TRs as a percentage of total RBCLRs transfused. Results: Our current evaluation has shown that as our rate of transfused RBCLRs has increased, our FNHTR rate has decreased. These results are summarized in the table. The overall rate of TRs in RBCLRs has decreased from 0.85% to 0.40%. In RBCLRs, the rate of FNHTRs has decreased from 0.44% to 0.17% (p<0.0005), whereas the rate of allergic TRs has remained unchanged (0.25% vs. 0.15%; p<0.14). Conclusions: As our institution has increased its inventory of RBCLRs to ∼97.0%, selective leukoreduction protocols have been discontinued. This change has removed the selection bias we experienced when evaluating transfusion reactions in the past. As expected, the FNHTR rates have decreased significantly. The reevaluation of our FNHTR rates reaffirms the efficacy of RBCLRs in decreasing the incidence of febrile transfusion reactions. To our knowledge, this is the first clinical assessment of the actual rates of FNHTRs in leukocyte-reduced RBCs. [ABSTRACT FROM AUTHOR]

Background: Transfusion (tx) of red blood cells (rbc) is associated with fever and other signs and symptoms (S&S) in some patients. The effect of leukocyte-reduced (LR) rbc on the incidence (inc) of tx-associated (TA) S&S has not been determined in a prospective, blinded study. The Viral Activation Transfusion Study (VATS) randomly assigned a relatively homogeneous group of patients to receive either unmodified (std) or LR rbc, and offered an opportunity to prospectively assess this question. Methods: rbc < or = 14 days old were tx to HIV and CMV-seropositive, tx-naïve persons requiring tx for anemia. Primary endpoints were survival and change in plasma HIV RNA level 7 days post-tx. The inc of TA S&S were prospectively evaluated using defined criteria, similar methods and reporting among the 11 participating sites. Results: 531 patients were enrolled, 265 in the LR group and 266 in the control arm. The two groups were similar with respect to baseline characteristics and study endpoints. 3,864 rbc units (median age 9 days) were administered during 1,745 tx and were distributed equally among the two study arms. The most frequent signs reported were elevated temperature (16.8%) and hypotension (5.1%).Neither the inc of elevated temperature nor hypotension varied between study arms or as a function of gender, number of units administered per tx, or first vs. subsequent tx, nor was elevated temperature a function of the administration of anti-pyretic before tx. Subjects who reported fever within the week prior to tx were more likely to have TA elevation in temperature (22.4%) than those who did not report fever (12.4%, p < .001). Caregivers reported fewer instances of both elevated temperature (7.3%) and hypotension (2.3%) than were identified by recorded observations on tx records. Among 1556 tx with recorded temperature measurements, the data collector did not indicate a temperature increase on the tx record for 147 (56%) of the 262 tx which had such an increase according to vital signs. Among 1559 tx with both vital signs and tx record data for hypotension, the data collector did not indicate hypotension on the tx record for 114 (83%) of the 137 transfusions which met the vital signs criteria for hypotension. Conclusions: The inc of elevated temperature and hypotension associated with transfusion in this population were unexpectedly high when analysed and reported by defined criteria. Use of LR rbc had no effect on the overall rates of elevated temperature or hypotension associated with tx of rbc, analysed either by defined criteria or by caregivers. The occurrence of preexisting fever was associated with a higher frequency of TA elevated temperature. Caregivers exert personal judgement in the reporting of TA S&S. [ABSTRACT FROM AUTHOR]

Background: There is controversy over whether the use of leukoreduced (LR) blood products reduces hospital length of stay, total hospital charges and postoperative pneumonia and/or wound infection rates in surgical patients. Study Design and Methods: Hospital information systems data were retrospectively analyzed for cardiovascular, orthopedic, digestive disease and general surgery patients who received red cell (RBC) transfusions from July 1, 2000 through December 31, 2000. Most Rh-negative patients received LR RBC during this time due to a mandate from our blood supplier rather than a perceived need for LR blood products; and most Rh positive patients did not. Patients receiving LR RBC by specific physician order were excluded from the analysis. Hospital length of stay, total hospital charges and postoperative pneumonia and/or wound infection rates in the LR (Rh neg) and non-LR (Rh pos) groups were compared using bivariate analysis and regression analysis (controlling for gender, total number of diagnosis codes (severity of disease), total volume of RBC transfused, presence of urinary tract infection, hypertension, diabetes or renal failure, pre operative platelet/hemoglobin/ white blood cell counts, and history of tobacco use.) Results: Of 710 eligible patients, 163 patients received LR RBC. Bivariate analysis demonstrated hospital length of stay to be significantly higher in the LR group (9.1 vs. 7.3 days; p<.01 ). This group also had higher total hospital charges ($73,738 vs. $61,327; p<.001) and higher postoperative pneumonia and/or wound infection rates (14.7% vs. 7.8%; p<.01). However, after controlling for confounding factors, the regression revealed that the only predictor of hospital length of stay and total hospital charges was the total number of ICD-9 codes (severity of disease) at (p<.001). Regression analysis also showed that the only predictor of postoperative pneumonia and/or wound infection rate was pre-operative platelet count (p<.01). Conclusion: After controlling for confounding factors, the use of LR RBC in this group of patients had no effect on length of stay, total charges or postoperative pneumonia and/or wound infection rates. [ABSTRACT FROM AUTHOR]