RESUMEN
OBJECTIVE: The first aim of this study was to confirm the presence of hypotension blood transfusion reactions and to assess the part of hypotension as a principal event, as defined by the literature but not characterized in French haemovigilance data. As well, recent series of several cases led us to consider a possible incidence increase. STUDY DESIGN: Using a retrospective observation, the haemovigilance data from 2000 to the end of 2007 of two French regions were reviewed. During this period, 1159657 blood units were transfused by nearly 100 hospitals and 3727 adverse reactions observed. RESULTS: One hundred and sixty-eight adverse reactions with hypotension were noticed and analyzed, representing 4.5% of all transfusion reactions and revealing an incidence of 14.5 for 100000 blood units transfused. It turned out to be mostly male recipients, severe reactions and appearing rather in the beginning of transfusions. Although platelets having greater incidence, all types of blood products may be involved. The clinical diagnosis was the following: 40 to 47% were classified as febrile reactions, 13 to 17% were allergic reactions, 8 to 9% were due to immunologic and/or haemolytic reactions, 5 to 7% resulted of cardiologic disorders, 5% resulted of hypovolemic contexts and 22% were unexplained hypotensive transfusion reactions. CONCLUSION: In about three cases out of four, transfusion-induced hypotension was associated with other clinical reactions. Indeed, hypotensive transfusion reactions were identified, having an incidence of 3.2 for 100000 blood units transfused. Furthermore, there was no explanation found for the incidence increase in our region during 2007. A national study was suggested to analyse the national data as well as a prospective study to clear out this type of transfusion reactions.
Asunto(s)
Hipotensión/etiología , Choque/etiología , Reacción a la Transfusión , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Transfusión de Componentes Sanguíneos/efectos adversos , Bradiquinina/metabolismo , Niño , Preescolar , Escalofríos/etiología , Disnea/epidemiología , Disnea/etiología , Femenino , Fiebre/etiología , Francia/epidemiología , Hemólisis , Humanos , Hipersensibilidad/etiología , Hipersensibilidad/fisiopatología , Hipotensión/diagnóstico , Hipotensión/epidemiología , Hipotensión/fisiopatología , Hipotermia/epidemiología , Hipotermia/etiología , Hipotermia/fisiopatología , Lactante , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Choque/epidemiología , Choque/fisiopatología , Adulto JovenRESUMEN
OBJECTIVE: The use of preoperative autologous blood transfusion has dramatically decreased in France. The aim of this study was to evaluate the evolution of practice both of autologous and homologous Red Blood Cells (RBC) concentrates transfusion between 2002 and 2005, and to asses the consequences of the highlighted changes. MATERIAL AND METHODS: Data on blood transfusion are collected and validated nationwide by a network of regional coordinators of haemovigilance. For each hospital, from 2002 to 2005, the annual changes in the number of transfused homologous and autologous RBC have been evaluated. The ratio of preoperative autologous RBC, number of autologous RBC divided by the number of all RBC, has also been calculated. Hospitals have been split into three cohorts, according to their 2005 autologous RBC ratio. For each cohort, correlations between the variations of the number of autologous, homologous and total RBC in each hospital have been studied. RESULTS: Data have been validated for 22 French regions that performed 71.8% of the total French transfusion in 2004. In 2005, 1,831,544 labile blood products have been transfused in 1197 hospitals and clinics among which 379 have used preoperative autologous transfusion. A total of 37,289 autologous RBC have been transfused in 2003, 28,689 in 2004 (-23.1%) and 17,758 in 2005 (-38.1%). The first cohort of 269 hospitals had a ratio of autologous RBC under 3%, the second cohort of 38 hospitals, a ratio between 3 and 6%, while the third cohort of 72 hospitals had transfused 6% or more of autologous RBC. In the two first cohorts, non-surgical activities were so large that it was impossible to assess the changes in surgical use of transfusion. The third cohort, with a ratio of 6% or more, was essentially devoted to surgery (88% of beds). These hospitals and clinics have transfused 13,076 autologous RBC in 2002 and 8583 in 2005 (-34.4%). In this group, there was a statistical correlation between the decrease of autologous RBC and the decrease of total RBC (r(2)=0.36), and no increase in the transfusion of homologous RBC has been observed. During the same period, neither hospitals nor clinics showed any decrease of their surgical activity. The drop of autologous RBC transfusion led to a decrease of the total number of RBC transfused and thus, to a decrease of the global exposure to transfusion hazard. CONCLUSION: The present results confirmed a decline of preoperative autologous transfusion in France, between 2002 and 2005. Meanwhile no supplementary need of homologous RBC has been observed among hospitals, performing surgery that formerly had a high ratio of autologous RBC.
Asunto(s)
Transfusión de Sangre Autóloga/estadística & datos numéricos , Estudios de Cohortes , Francia , Hospitales/estadística & datos numéricos , Cuidados PreoperatoriosRESUMEN
In France, data collection related to blood recipient's viral infectious disease markers pre and post-transfusion is a legal requirement for hospitals. Our study aimed to evaluate the actual modalities of this extensive screening in 2001, six years after the Ministry of health issued recommendations. A questionnaire was sent to the haemovigilance correspondents in hospitals having transfused labile blood products (LBP) in 2001. A total of 1463 hospitals having transfused 85% of LBP in France responded. 82.4% of hospitals have written guidelines for pre-transfusion screening of viral markers, mainly for HIV and hepatitis C. A frozen repository storage is held by 23.9% of hospitals with storage durations between 1 to 40 years. 84% of hospitals have written guidelines for post-transfusion screening. The test prescriptions are mostly done by physicians from clinical services and they include in more than 80% of cases, HIV and HCV markers. Only 12% of hospitals recontact the patient in case of a no show. Even though 77.5% of responding hospitals have labile blood products recipients follow up processes, their effectiveness remains quite low, only 16% of recipients having test results available at the hospital.
Asunto(s)
Anticuerpos Antivirales/sangre , Bancos de Sangre/organización & administración , Transfusión Sanguínea , Tamizaje Masivo/organización & administración , Virosis/diagnóstico , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Biomarcadores , Bancos de Sangre/estadística & datos numéricos , Conservación de la Sangre , Transfusión Sanguínea/legislación & jurisprudencia , Transfusión Sanguínea/estadística & datos numéricos , Criopreservación , Recolección de Datos , Estudios de Seguimiento , Francia , Adhesión a Directriz , Guías como Asunto , Anticuerpos Anti-VIH/sangre , Anticuerpos contra la Hepatitis C/sangre , Administración Hospitalaria , Humanos , Tamizaje Masivo/legislación & jurisprudencia , Tamizaje Masivo/estadística & datos numéricos , Política Organizacional , Evaluación de Programas y Proyectos de SaludRESUMEN
Screening of labile blood products recipients for HIV and HCV has been performed in France since a government recommendation was issued in 1996. It has been designed to get transfusion related contamination of recipients through pre- and post-transfusion serological tests. Since then, residual risk has decreased dramatically and it was suspected that recommendations might sometimes be ignored. A nationwide survey has been done to measure the real screening rate and its cost efficacy ratio. In addition accuracy of tracability and recipients mortality has also been evaluated. A random sample of 1115 labile blood products among all the 1203 378 distributed during first semester of 2001 in France has been drawn. They have been matched with test results obtained in hospital files. Tracability has been considered accurate if name, surname and birth date of recipients were exactly the same both in hospital file and in the file of the Etablissement Français du Sang. A total of 1092 hospital files has been retrieved. Pre transfusion HIV and HCV tests have been performed in 58.5 % of cases, 95 % CI [55.6-61.5], and post-transfusion tests in 30.5 % [28.5-35.5] of cases. Only 19.5% [16.6-22.6] of recipients, not known to be dead 6 months after transfusion, have had both pre and post-transfusion tests. No HIV or HCV contamination has been notified by the Haemovigilance network during the same period. Accuracy rate of tracability was 96.25% [94.9-97.3]. Furthermore 35.8% [33-38.7] of recipients were found dead within 6 months after transfusion. A logistic regression analysis showed that the hospital area, the hospital size (more than 300 beds) and the annual amount of blood bags transfused in it (less than 5000) were factors independently associated with having a full pre and post-transfusion screening. Currently, the screening program may detect 0.14 cases of HIV and 0.05 HCV transfusion related contamination of recipient every year. The total cost of this program is about 20 million euro and the cost per case exceeds 110 million euro. The program will be of no use in case of an emerging transmitable disease. This program does not comply to any evaluation criteria of screening programs and its cost efficacy ratio is very poor.
Asunto(s)
Donantes de Sangre , Transfusión Sanguínea/normas , Tamizaje Masivo/métodos , Francia , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Hepatitis C/prevención & control , Hepatitis C/transmisión , Humanos , Análisis Multivariante , Estudios RetrospectivosRESUMEN
In the Poitou-Charentes area, a regional pilot program was implemented over a two year-period to improve transfusion safety in public and private hospitals. This program consisted in: (i) an evaluation of the transfusion chain in hospitals; (ii) a regional program to guide hospitals in improving the quality process. Five workgroups were set up. Three persons in each hospital should participate in the workgroup: one representing the administration, one the medical staff and one the nursing staff. After a six months follow-up several hospitals were prompted to implement corrective and preventive measures to improve transfusion safety; (iii) a letter was regularly published to contribute to set-up a regional haemovigilance network. Such a quality improvement program revealed to be a relevant method to steer the changing blood transfusion process in hospitals.
Asunto(s)
Transfusión Sanguínea/normas , Recolección de Muestras de Sangre/normas , Francia , Hospitales Privados/normas , Hospitales Públicos/normas , Humanos , Garantía de la Calidad de Atención de Salud , Control de Calidad , Regionalización/normas , SeguridadRESUMEN
Early recommendations on prophylactic transfusion of thrombocytopenic patients involved a standard platelet dose of about 0.5 x 10(11)/10 kg body weight. Given the lack of data supporting this dose, we prospectively studied the dose response to platelet transfusions in adults and children with hematologic malignancies. Each patient received, in similar clinical conditions, a medium, high, and very high dose of fresh (< 24 hours old) ABO-compatible platelets, in the form of apheresis platelet concentrates (APC). For the adults, the medium dose was defined as APC containing between 4 and 6 x 10(11) platelets, the high dose between 6 and 8 x 10(11), and the very high dose > 8 x 10(11); for the children, the three doses corresponded to 2 to 4, 4 to 6, and > 6 x 10(11) platelets. The end points were the platelet increment, platelet recovery, and the transfusion interval, and the results were compared with a paired t-test. Sixty-nine adults and 13 children could be assessed. Recoveries in the adults were similar with the three doses (from 28% to 30%), but the high and very high doses led to a significantly better platelet increment (52 and 61 x 10(9)/L, respectively) than the medium dose (33 x 10(9)/L, P < .01). The main difference was in the transfusion interval, which increased with the dose of platelets transfused, from 2.6 days with the medium dose to 3.3 and 4.1 days with the high and very high doses, respectively (P < .01). The positive effect of the high dose was observed regardless of pretransfusional clinical status, but was more marked in patients with no clinical factors known to impair platelet recovery. In these patients, a platelet dose of 0.07 x 10(11) per kg of body weight led to a transfusion interval of more than 2 days in 95% of cases. In patients with clinical factors favoring platelet consumption, the proportion of transfusions yielding an optimal platelet increment and transfusion interval increased with the dose of platelets. The platelet dose-effect was also significant in the children, in whom the high and very high doses led to 1.5-fold to twofold higher posttransfusion platelet counts and transfusion intervals. We conclude that transfusion of high platelet doses can reduce the number of platelet concentrates required by thrombocytopenic patients and significantly reduce donor exposure.
Asunto(s)
Recuento de Plaquetas , Transfusión de Plaquetas , Enfermedad Aguda , Adolescente , Adulto , Peso Corporal , Trasplante de Médula Ósea , Niño , Femenino , Humanos , Leucemia Mieloide/terapia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Trombocitopenia/terapia , Factores de Tiempo , Resultado del TratamientoRESUMEN
Peripheral blood progenitor cells (PBPC) harvested for autologous transplantation are usually cryopreserved within 2-4 h of collection. However, there are conditions in which it would be useful to freeze PBPC after a liquid storage period. This study was performed to evaluate whether prior storage for just 24 h damages frozen PBPC. First, leukapheresis products were obtained from 9 patients and divided into three fractions. The first fraction was frozen within 2 h and used as a control. The second and the third fractions were stored either at 4 degrees C or at 22 degrees C for 24 h before freezing. Cell counts, CFU-GM values, and pH were studied after collection, after storage, and after cryopreservation. Similar results were obtained at 4 degrees C and 22 degrees C. However, pH decreased most markedly at 22 degrees C. Mean postcryopreservation CFU-GM recoveries were not significantly different and were, respectively, 74.03% (control), 96.39% (4 degrees C), and 80.33% (22 degrees C). These observations were confirmed in an additional study of frozen PBPC collected from 12 patients and previously stored for 24 h at 4 degrees C. These data indicate that blood progenitors may be stored for 24 h and subsequently frozen without quantitative and qualitative impairment.
Asunto(s)
Criopreservación , Trasplante de Células Madre Hematopoyéticas , Células Madre Hematopoyéticas , Neoplasias/terapia , Humanos , Neoplasias/sangreRESUMEN
Fusidic acid is used in hospitals as second-line therapy for multidrug-resistant staphylococcal infections. We report the first fully documented case of fusidic acid induced thrombocytopenia, in a 48-year-old patient. The thrombocytopenia was abrupt and severe but resolved spontaneously 7 d after drug withdrawal. The thrombocytopenia transiently relapsed 6 d later, when fusidic acid was reintroduced. Haemorrhagic signs were observed, but no severe bleeding occurred. Platelet transfusions failed to increase the platelet count. We detected an IgG platelet antibody in the patient's serum, that specifically recognized platelet glycoprotein IIb/IIIa only in the presence of fusidic acid. Fusidic acid induced thrombocytopenia should be considered as a possible cause for the thrombocytopenia frequently seen in the intensive care setting.
Asunto(s)
Antibacterianos/efectos adversos , Ácido Fusídico/efectos adversos , Trombocitopenia/inducido químicamente , Enfermedad Aguda , Resistencia a Múltiples Medicamentos , Humanos , Persona de Mediana EdadRESUMEN
BACKGROUND: The platelet count increases transiently after treatment with polyclonal anti-D in about 50 percent of D+ patients with autoimmune thrombocytopenic purpura (AITP). The effect is usually attributed to macrophage Fc-receptor blockade by antibody-coated red cells. As polyclonal anti-D is in limited supply, prospective testing was performed on a monoclonal anti-D (MoAb D) in such patients. STUDY DESIGN AND METHODS: Seven D+ patients with chronic AITP received MoAb D intravenously at doses of 47 to 95 microg per kg of body weight. Response was assessed by studying platelet count increment. Hemolysis and red cell-bound MoAb D were measured before and after MoAb D administration. RESULTS: MoAb D red cell binding was demonstrated in all patients at a ratio higher than that observed in AITP patients successfully treated with polyclonal anti-D. However, little or no platelet count increment was observed in six patients, while a transient response was observed in only one (platelet count 97 x 10(9)/L before MoAb D infusion and 163 x 10(9)/L 4 days later). Furthermore, because five patients showed signs of hemolysis and two became anemic, higher doses of MoAb D should be used only with caution in patients with AITP. CONCLUSION: The MoAb D used in this study cannot be proposed as an alternative treatment for patients with AITP.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Inmunoglobulinas Intravenosas/uso terapéutico , Púrpura Trombocitopénica Idiopática/terapia , Globulina Inmune rho(D)/inmunología , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , Púrpura Trombocitopénica Idiopática/sangreRESUMEN
We have previously demonstrated that immune platelet destruction observed in an AIDS-free HIV-infected patient was associated with the presence of a cross-reactive antibody recognizing both HIV-glycoprotein (gp)120 and platelet gpIIIa (CD61). We have now investigated the presence of such antibodies in other HIV-infected patients, together with the molecular structure of the cross-reactive epitope. Platelet gpIIb/IIIa antibodies were characterized in sera from HIV-infected patients with immune thrombocytopenic purpura by means of an ELISA and a radio-immunoprecipitation procedure (RIP). The platelet antibodies were purified and tested for their ability to recognize HIV-gp. We also tried to characterize the antibody target epitope on HIV-gp120 using recombinant gp and synthetic peptides. IgG with anti-gpIIb/IIIa activity were detected, by means of an ELISA with purified gpIIb/IIIa, in 101/138 (73%) sera from HIV-infected patients with immune thrombocytopenic purpura. The platelet antibodies were purified from 23 sera by absorption/elution on purified immobilized platelet gpIIb/IIIa, and recognition of gpIIIa was confirmed in eight cases with a RIP. Furthermore, the presence of a cross-reactive antibody between HIV-gp120 and platelet gpIIIa was demonstrated in 18/18 patients (including the eight with a confirmed gpIIIa antibody) by the ability of the serum HIV-gp160/120 antibodies to bind to purified gpIIb/IIIa. The cross-reactive epitope was shown to be independent of the carbohydrate moieties of gp120, since deglycosylation of two recombinant (r)-gp120s did not abolish antibody binding. However, the antibody did not recognize synthetic gp120 peptides spanning 355 of the 516 amino acids of gp120, particularly the four regions exhibiting sequences of four or five consecutive amino acids that are identical between r-gp120 and gpIIIa. Our results thus support the hypothesis that the cross-reactive antibody recognizes the conformational structure of gp120. These results strongly suggest that molecular mimicry between HIV-gp120 and platelet gpIIIa may be important in the pathogenesis of immune thrombocytopenia in AIDS-free HIV-infected patients.
Asunto(s)
Antígenos CD/inmunología , Autoanticuerpos/sangre , Proteína gp120 de Envoltorio del VIH/inmunología , Infecciones por VIH/inmunología , VIH-1/inmunología , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria/inmunología , Glicoproteínas de Membrana Plaquetaria/inmunología , Púrpura Trombocitopénica Idiopática/inmunología , Carbohidratos/inmunología , Reacciones Cruzadas , Epítopos/inmunología , Infecciones por VIH/sangre , Humanos , Integrina beta3 , Púrpura Trombocitopénica Idiopática/sangreRESUMEN
BACKGROUND: CD36 deficiency, which could lead to CD36 isoimmunization, has been reported in the Japanese population. CD36 isoantibody has been involved in platelet transfusion refractoriness. CASE REPORT: A 50-year-old woman originally from Corsica developed severe acute thrombocytopenia after massive transfusion. She was found to be CD36 deficient, and platelet immunoassays revealed a CD36 (Naka) platelet isoantibody. Although the involvement of another mechanism could not be entirely ruled out, the thrombocytopenia was attributed to posttransfusion purpura-like syndrome. The antibody was also involved in platelet transfusion refractoriness. CD36 deficiency was present in two members of the patient's family as well. Flow cytometry studies demonstrated the absence of CD36 expression on the surface of blood monocytes and cultured erythroblasts and megakaryocytes from one of the two CD36-deficient family members studied, but, in the absence of previous immunization, these CD36-deficient patients were not isoimmunized. In contrast, CD36 deficiency was not found in a population of 808 healthy blood donors in the Paris, France, area. CONCLUSION: CD36 isoantibody might be involved in some cases of posttransfusion purpura and platelet transfusion refractoriness. These findings also confirm the extremely low frequency of CD36 deficiency among whites.
Asunto(s)
Antígenos CD36/metabolismo , Isoanticuerpos/sangre , Trombocitopenia/etiología , Reacción a la Transfusión , Plaquetas/inmunología , Antígenos CD36/inmunología , Femenino , Humanos , Persona de Mediana Edad , Trombocitopenia/inmunologíaRESUMEN
Disease recurrence remains the major problem in autologous bone marrow transplantation (BMT) for hematologic malignancies. To improve the therapeutic efficiency of autologous BMT, we investigated the use of autologous marrow activated in vitro with interleukin 2 (IL-2) to generate killer cells for in vivo purging. A feasibility trial was initiated in 5 patients with poor prognosis acute lymphoblastic leukemia, who were transplanted, after marrow ablative therapy, with autologous marrow cultured for 10 days with 10(3) units of IL-2/ml. A highly significant increase in NK activity and an induction of LAK activity were observed after incubation. Patients received 0.64 to 1.56 X 10(8) cultured BM cells/kg and 1.87 to 44.8 x 10(4) CFU-GM/kg. Four patients engrafted and achieved granulocyte counts > 0.5 x 10(9)/l on days 35, 24, 36 and 22 after transplant. Three of these patients showed platelet recovery to > 50 x10(9)/l on days 25, 42 and 40 after transplant. One patient remained thrombocytopenic until relapse. One patient died on day 12 after transplant. This study demonstrates that cultured BM activated with IL-2 can be used successfully for hematological rescue in the clinical setting.
Asunto(s)
Purgación de la Médula Ósea , Trasplante de Médula Ósea , Médula Ósea/inmunología , Interleucina-2/farmacología , Leucemia-Linfoma Linfoblástico de Células Precursoras/cirugía , Médula Ósea/efectos de los fármacos , Médula Ósea/patología , Trasplante de Médula Ósea/inmunología , Trasplante de Médula Ósea/métodos , Células Cultivadas , Niño , Preescolar , Femenino , Supervivencia de Injerto , Humanos , Células Asesinas Naturales/inmunología , Células Asesinas Naturales/patología , Activación de Linfocitos , Masculino , Persona de Mediana Edad , Trasplante AutólogoRESUMEN
The presence of platelet GMP140 (CD62) antibodies was analysed by the MAIPA test in 57 sera from patients with AITP and on platelets from 54 patients with thrombocytopenia of suspected immune origin. A CD62 antibody was found in only one serum. Its specificity was confirmed by an ELISA and a radioimmunoprecipitation procedure using total intact platelets and immuno-purified GMP140. An increased amount of platelet-associated (PA) IgG, due to in vivo fixation of GMP140 and GpIIb/IIIa antibodies, was also found on the patient platelet membrane. suggesting that GMP140 autoantibody may contribute to immune platelet destruction. No increase in PAGMP140 antibody was found on the other 54 platelet suspensions.
Asunto(s)
Autoanticuerpos/análisis , Plaquetas/inmunología , Glicoproteínas de Membrana Plaquetaria/inmunología , Púrpura Trombocitopénica Idiopática/inmunología , Anciano , Antígenos de Plaqueta Humana/inmunología , Ensayo de Inmunoadsorción Enzimática , Humanos , Inmunoglobulina G/análisis , Masculino , Selectina-P , Ensayo de RadioinmunoprecipitaciónRESUMEN
Serum antibodies to hepatitis C virus (HCV) were tested for inpatients undergoing allogeneic BMT to determine the risk of acquiring HCV infection and the role of HCV in posttransplant liver complications. The HCV seroconversion rate was evaluated according to the date of BMT and blood donor screening at the time. Anti-HCV antibodies (anti-HCV) were detected with a second-generation ELISA and confirmed with a second-generation radioimmunoblot assay. All patients received leukocyte-depleted blood products and most received apheresis platelet concentrates. One hundred twenty of 181 consecutive patients transplanted from January 1987 to December 1991 were anti-HCV-negative before BMT, had at least 6 months of follow-up, and were thus evaluated for the seroconversion rate. Before screening for non-A, non-B hepatitis, 14% of the patients seroconverted to HCV (0.44% per unit transfused). After introduction of screening for alanine aminotransferase and antibodies to hepatitis B core antigen the risk of seroconversion was 4% per patient (0.26% per unit). When, in addition, blood was screened for anti-HCV the risk fell to 1.6% (0.03% per unit). Positive anti-HCV status before and after BMT was not predictive of veno-occlusive disease, liver graft-versus-host disease (GVHD), or death due to liver dysfunction. In contrast, the risk of chronic hepatitis was significantly increased.
Asunto(s)
Trasplante de Médula Ósea/estadística & datos numéricos , Hepatitis C/epidemiología , Hepatitis C/transmisión , Adolescente , Adulto , Alanina Transaminasa/sangre , Niño , Femenino , Anticuerpos Antihepatitis/sangre , Hepatitis C/inmunología , Anticuerpos contra la Hepatitis C , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Reacción a la TransfusiónRESUMEN
We report a case of mild, clinically asymptomatic, immune thrombocytopenia after allogenic bone marrow transplantation (BMT) for chronic myeloid leukemia (CML) caused by the presence of a recipient-origin Br(a) antibody that recognized the donor platelets. Although the antibody titer decreased, it remained detectable more than 3 years after BMT. Chimerism studies were performed combining cytogenetics, blood cell phenotype studies, and genomic amplification of hypervariable sequences. Cytogenetic studies and molecular analysis of peripheral blood cells, purified B- and T-lymphocyte subpopulations, and bone marrow colonies showed the hematopoiesis to be of donor origin, but absorption-elution experiments with peripheral RBCs showed a small amount of recipient RBCs. The CML chimeric transcript was also detected by means of polymerase chain reaction on samples collected until day +867 post-BMT. This case shows that recipient-origin platelet alloantibodies can cause thrombocytopenia after BMT and that the persistence of small numbers of recipient cells (even leukemic) is not necessarily associated with hematologic relapse.
Asunto(s)
Antígenos de Plaqueta Humana/inmunología , Plaquetas/inmunología , Trasplante de Médula Ósea/efectos adversos , Quimera/genética , Leucemia Mielógena Crónica BCR-ABL Positiva/terapia , Trombocitopenia/etiología , Adulto , Femenino , Proteínas de Fusión bcr-abl/genética , Humanos , Inmunoglobulina G/sangre , Reacción en Cadena de la Polimerasa , Recurrencia , Factores de TiempoRESUMEN
The efficiency of stored platelet transfusion was evaluated in terms of clinical status in 141 thrombocytopenic patients. In a paired prospective study in which fresh platelets were used as controls, clinical efficiency was assessed on the basis of the ability to increase platelet count (recovery) and the time to the next transfusion (D). In 48 clinically stable patients, recovery of fresh and stored platelets was similar (47% and 41%, respectively) and the interval to the next transfusion was D4 and D3. In contrast, 27 patients who had bacterial infections showed significantly different recoveries (24%/5%) and the interval to the next transfusion was D3/D1 for fresh and stored platelets respectively. Similarly, in 16 patients who were treated concurrently with amphotericin B, 18 other patients with graft-versus-host disease, nine with splenomegaly and four with veno-occlusive disease (VOD), fresh platelets performed better than stored platelets, showing recoveries of 27%/18%, 29%/15%, 16%/3% and 15%/2%. Furthermore, the need for retransfusion within 24 h was significantly increased with stored platelets. In 19 patients with anti-HLA alloimmunization who were transfused with HLA-matched fresh and stored apheresis platelet concentrate (APC), efficiency was similar (38%/36% and D4/D3). This study indicates that the storage induces an impressive decrease in the in-vivo platelet recovery and survival in patients with certain clinical conditions.
Asunto(s)
Conservación de la Sangre , Transfusión de Plaquetas , Trombocitopenia/terapia , Adulto , Anfotericina B/farmacología , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Infecciones Bacterianas/sangre , Femenino , Humanos , Masculino , Recuento de Plaquetas/efectos de los fármacos , Estudios Prospectivos , Trombocitopenia/sangre , Trombocitopenia/inducido químicamente , Factores de TiempoRESUMEN
Transfusion therapy for sickle cell anemia is limited by the development of antibodies to red cell antigens. The aim of this study was to evaluate whether transfusion of blood matched for antigens Rh and Kell would reduce the incidence of alloimmunization. We determined the transfusion history, red cell phenotype and development of alloantibodies in 173 patients with sickle all anemia who received transfusions. Forty nine patients were transfused exclusively with frozen red blood cells (RBL) matched for antigens Rh and Kell; the rate of alloimmunization was 8.2%; antibodies to the Jkb, Jka, Fya and S were developed; 1 patient developed 2 antibodies. In a control group of 124 patients who received standard red blood cells, the rate of alloimmunization was significantly increased to 30.6% (p < 0.05); antibodies against C, E, K, Fya were the most frequently developed and 19 patients (16%) developed antibodies reacting with different antigens. In the 2 groups, alloimmunization occurred after receiving a significantly different number of transfusions: mean 9 in the patients transfused with matched RBC and 32 in the control group. The influence of the kinetics of transfusion was not demonstrated. To assess the effect that racial differences might have on alloimmunization, comparison of the red cell phenotype of patients with that of a panel of unselected blood bank donors was performed: the patients had a significant decrease in the frequency of red cell antigens corresponding to most of the detected alloantibodies JkB, C, S. Fyb, Fya and Kell.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Anemia de Células Falciformes/terapia , Transfusión Sanguínea , Eritrocitos/inmunología , Isoanticuerpos/sangre , Sistema del Grupo Sanguíneo de Kell/inmunología , Isoinmunización Rh/prevención & control , Adolescente , Adulto , Anciano , Anemia de Células Falciformes/sangre , Anemia de Células Falciformes/inmunología , Preescolar , Femenino , Antígenos HLA/inmunología , Humanos , Masculino , Persona de Mediana Edad , FenotipoRESUMEN
Post-transfusion hepatitis C incidence was studied in a series of patients with bone marrow allograft. The risk of HCV seroconversion was evaluated according to the date of grafting and the screening tests carried out in blood donors at this time. Anti-HCV antibodies were screened using Elisa tests of 2d generation and confirmed by Riba tests of 2d generation. Results were analysed. Out of 181 allografted patients from January 1987 to December 1991, 120 patients found anti-HCV negative prior to grafting, with at least six month post-transfusion follow-up were considered as evaluable in terms of HCV seroconversion. All these patients had received leucodepleted blood products and the most of them platelet unit concentrates. Prior to implementation of screening tests for non-A, non-B hepatitis, 14% of patients had seroconverted (0.44% per transfused product); after introduction of the screening for indirect markers (ALAT) and for antibodies directed against the antigen of hepatitis B virus core (anti-HBc), the seroconversion incidence was 4% (0.26% per product). At the present time, since the implementation of anti-HCV screening tests, the risk has reached 1.6% (0.03% per transfused product). 6 patients out of 7 having seroconverted have been developing chronic hepatitis.
Asunto(s)
Trasplante de Médula Ósea , Hepatitis C/etiología , Reacción a la Transfusión , Adolescente , Adulto , Donantes de Sangre , Niño , Femenino , Hepacivirus/inmunología , Anticuerpos Antihepatitis/sangre , Hepatitis C/epidemiología , Hepatitis C/inmunología , Anticuerpos contra la Hepatitis C , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Trasplante HomólogoRESUMEN
Forty-three patients with malignant nonmyeloid diseases underwent peripheral blood stem cell collections on an apheresis system (Spectra, COBE BCT, Lakewood, CO). Collections took place during the white cell (WBC) recovery phase following conditioning chemotherapy. One hundred two procedures were done after chemotherapy alone, and 72 procedures after chemotherapy plus granulocyte-colony-stimulating factor (G-CSF). Four centrifugal separation factors were tested. One and one-half patient blood volumes were processed in each procedure. The mean volume of the collected component was 158 +/- 16 mL. After chemotherapy alone, the procedures provided a mean of 0.8 x 10(8) WBCs per kg and 2.3 x 10(4) colony-forming units-granulocyte macrophage (CFU-GM) per kg of recipient body weight. The mononuclear cell percentage in the components increased with the centrifugal separation factor from 85 to 96 percent. In parallel, platelet contamination increased from 2.1 to 3.8 x 10(11). The collect hematocrit ranged from 1.0 to 2.5 percent (0.01-0.025). The collection efficiency for mononuclear cells and CFU-GM also increased with the centrifugal separation factors from 52 to 70 percent for mononuclear cells and from 55 to 68 percent for CFU-GM. Collections performed after G-CSF-stimulated mobilization were characterized by a higher neutrophil contamination independent of centrifugal separation factor, which gave a mean mononuclear cell percentage of 64 percent in the collected component. The average yield for these procedures was 2 x 10(8) WBCs per kg and 28 x 10(4) CFU-GM per kg.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Células Madre Hematopoyéticas/patología , Neoplasias/sangre , Adulto , Antineoplásicos/uso terapéutico , Eliminación de Componentes Sanguíneos/métodos , Niño , Preescolar , Ensayo de Unidades Formadoras de Colonias , Factor Estimulante de Colonias de Granulocitos/uso terapéutico , Granulocitos/efectos de los fármacos , Hematócrito , Enfermedad de Hodgkin/sangre , Enfermedad de Hodgkin/terapia , Humanos , Lactante , Recuento de Leucocitos , Linfoma no Hodgkin/sangre , Linfoma no Hodgkin/terapia , Macrófagos/efectos de los fármacos , Mieloma Múltiple/sangre , Mieloma Múltiple/terapia , Neoplasias/terapia , Recuento de PlaquetasRESUMEN
The efficiency of stored platelet transfusion was evaluated in terms of clinical status in 136 thrombocytopenic patients. In a paired prospective study in which fresh platelets were used as controls, clinical efficiency was assessed on the basis of the ability to increase platelet count (recovery) and the interval to the next transfusion (D). In 48 clinically stable patients, recovery of fresh and stored platelets was similar (47% and 41% respectively) and the interval to the next transfusion was D4 and D3. In contrast, 27 patients who had bacterial infections showed significantly different recoveries (24%/5%) and the interval to the next transfusion was D3/D1 for fresh and stored platelets respectively. Similarly, in 16 patients who were treated concurrently with Amphotericin B, 18 other patients with graft-versus-host disease, 5 with splenomegaly and 3 with veno-occlusive disease (VOD), fresh platelets performed better than stored platelets, showing recoveries of 27%/18%, 29%/15%, 15%/1%, 22%/3%. Furthermore, the need for retransfusion within 24 hours was significantly increased with stored platelets. In 19 patients with anti-HLA allo-immunization who were transfused with HLA-matched fresh and stored APC, efficiency was similar (38%/36% and D4/D3). This study indicates that the storage has a major detrimental effect on platelet recovery and survival in patients with certain clinical conditions.