A new tool in white blood cell reduction for packed red cells:5 Log depletion

The recent development of new filters used for leucocyte reduction aims at restricting the number of leucocytes to a threshold where their undesirable effects can be minimized or excluded. In this paper we describe the performance of a new filter named BIO R01 MAX and claimed by the manufacturer to perform 5 Log₁₀ depletion. The results show that the efficiency of the filter reached 5 Log₁₀ depletion and the absolute number of white blood cells in the post-filtration units is always less than 2 × 10₄ with considerable safety in the prevention of transfusion reactions.     

Preparation of white cell-depleted red cells for 42-day storage using an integral in-line filter

A new blood pack system for the preparation of white cell-depleted red cells was studied. The system is a modified additive-solution quadruple-unit blood pack that incorporates a cellulose-acetate fiber depth filter in-line between the AS-3 additive bag and the CP2D collection bag. Mean +/- SD white cell removal from 156 units processed under standard production conditions was 97.7 +/- 2.7 percent; residual white cells were 1.1 +/- 1.0 x 10(8) per unit. Red cell loss was 10.0 +/- 1.0 percent (n = 43). Mean platelet removal was 80.9 percent from units from which platelet concentrates were not prepared (n = 47). Microaggregates did not form during storage, and hemolysis of filtered red cells was lower than that of unfiltered controls. Filtered AS-3 red cells stored for 42 days had a 51Cr survival of 80.1 +/- 5.7 percent (mean +/- SD) as compared with 78.9 +/- 6.2 percent for unfiltered controls (n = 17). This in-line filter system provides white cell-depleted, microaggregate-free red cells that can be stored for 42 days.     

用脉冲式方法降低PICC输注浓缩红细胞导管堵塞率的比较分析

目的探讨用脉冲式方法降低PICC输注浓缩红细胞导管堵塞率的效果。方法将85例应用三向瓣膜式PICC输注浓缩红细胞的患者随机分为两组,试验组患者在输注浓缩红细胞过程中脉冲式冲管1次,对照组患者直接输注浓缩红细胞,观察并记录两组患者PICC导管堵塞的发生率。结果两组应用PICC输注浓缩红细胞过程中,试验组导管堵塞发生率低,差别有统计学意义(P<0.001)。结论用脉冲式方法冲管可降低PICC输注浓缩红细胞导管堵塞发生率。     

Efficacy and safety of a polyester leukocyte removal filter for whole blood and red cell concentrate filtration

Patients receiving multiple whole blood transfusions often experience adverse clinical symptoms caused by leukocytes. In the present study, the efficacy and safety of a polyester filter for leukocytes (Sepacell R-500) was evaluated. Donor units of whole blood and red cell concentrate stored for varying lengths of time were filtered. Emphasis was placed on humoral parameters indicative of release and/or activation reactions of granulocytes (neutral proteinase elastase, lysozyme, aggregation, chemiluminescence) and erythrocytes (lactate dehydrogenase, plasma haemoglobin). Nonspecific adsorption effects were investigated by plasma protein determinations (albumin, alpha 2-macroglobulin). A complete blood cell count as well as values of haemoglobin and haematocrit were determined. Sepacell R-500 proved to be a highly efficient filter to the leukocyte depletion of blood. Our results of erythrocyte and granulocyte related humoral parameters provided no significant evidence of filtration mediated activation or releasing reactions of clinical consequence.     

Microaggregate content and flow rates of packed red blood cells

Platelet rich red cells (PRRC) and platelet poor red cells (PPRC) are both prepared in the course of red cell production. PRRC tend to have a higher hematocrit (82 +/− 7) than PPRC (77 +/− 5), (p less than .001). There are more microaggregates present in PRRC (2.48 +/− 1.41 gm) than in PPRC (1.46 +/− 0.61 gm), (p less than .001). The infusion rate for PRRC was 4.0 × 1.8 ml/minute, and this was significantly smaller than for PPRC which was 9.7 +/− 1.7 m/minute, (p less than .001). This compares to a rate for whole blood of 32.8 ml/minute. The difference in flow rate of the two types of red blood cells is in part due to a difference in viscosity, but more inportantly due to a difference in microaggregate content. Flow rate is normalized for both types of packed cells by the addition of 100 to 150 ml of saline, while infusion time is normalized by the addition of only 50 to 100 ml of saline to the packed cell units.     

The manual preparation of leukocyte-poor red cells for transfusion by a new filter

Standard and buffy-coat-depleted red cell concentrates were filtered through a new cellulose acetate filter with a manual procedure. No residual leukocytes could be detected in 19 of the 21 filtered units. Extracellular hemoglobin after red cell filtration and concentration never exceeded 10 mg per unit. No transfusion reaction occurred in 10 recipients with potent lymphocytotoxic antibodies in their serum and histories of febrile transfusion reactions. This filter allows the preparation of leukocyte-poor red cell units with a safe, simple, and effective manual procedure.     

Acute pulmonary edema associated with transfusion of packed red blood cells

We experienced a patient who suffered noncardiogenic acute pulmonary edema after transfusion of packed red blood cells which contained antigranulocyte antibodies. The data suggested that complement activation and the release of polymorphonuclear protease were involved in the pathogenesis of the complication in the present patient. Furthermore, blood coagulative system was also activated after the transfusion. The underlying mechanisms of the complication are discussed.     

新型冰冻红细胞洗涤机洗涤效果的研究

目的研制一种全自动、封闭式,体积小、重量轻,洗涤程序设计简单的新型冰冻红细胞洗涤机。方法全血采自健康献血者,ACD抗凝,离心获浓缩红细胞,加入甘油到终浓度为40%,-80℃保存。42℃条件下冻融红细胞,利用自行设计的透析式新型冰冻红细胞洗涤机,使用3种自动化洗涤程序洗涤红细胞,直至可输注。结果洗涤后红细胞形态正常,3种程序洗涤后红细胞的回收率(%)分别为69.73±8.36,85.09±6.03和88.43±4.72;红细胞血红蛋白的回收率(%)分别为45.30±2.66,70.80±3.76和81.26±5.55;洗后上清液中游离血红蛋白的含量(g/L)为0.20±0.08,0.14±0.03和0.25±0.13,采用单因素k水平方法对数据进行统计学分析,得出了最佳洗涤程序。结论该新型冰冻红细胞洗涤机采用优化的洗涤程序,洗涤后的冰冻红细胞达到了国家的质量标准。     

Removal of white cells from red cells by transfusion through a new filter

The effectiveness of a new filter (RC100) for the preparation of white cell-depleted red cells (RBCs) at the bedside was evaluated in vitro and in vivo using three RBC products: standard RBC concentrate (CPDA units), RBCs suspended in saline-adenine-glucose-mannitol additive solution after the removal of plasma (SAGM units), and RBCs suspended in SAGM after the removal of plasma and buffy coat (SAGM-BC units). Median RBC recovery was at least 92 percent when 2 units were administered through one filter; median values for residual white cells and platelets were less than or equal to 20 × 10(6) and less than or equal to 2.5 × 10(9) per 2 units, respectively. The in vivo study was carried out in 80 multiply transfused patients with thalassemia, 35 of whom had experienced frequent nonhemolytic transfusion reactions when given standard or buffy coat-free RBCs. During the 6-month study, each patient was given two transfusions of each type of RBC product One febrile nonhemolytic transfusion reaction occurred in each of two patients receiving SAGM-BC units, but in no other case. If the flow rate is not reduced, the median transfusion time is 35 minutes per CPDA unit and 15 minutes per SAGM and SAGM-BC unit. It is concluded that the transfusion of RBCs through the RC100 is a simple and effective procedure to administer white cell-depleted RBCs prepared at the bedside.     

Potassium load in CPD-preserved whole blood and two types of packed red blood cells

The potassium load of transfused blood must be minimized. We have compared the total plasma potassium content of units of CPD-preserved stored whole blood (SWB), stored packed cells (SPC), and packed cells prepared from stored whole blood (WB-PC). Plasma potassium concentrations, unit weights, and hematocrits of 20 units of SWB, 27 units of SPC, and 20 units of WB-PC of various ages were measured. During the 21-day storage period, total plasma potassium content per unit increased in units of SPC at the same rate as in units of SWB, because plasma potassium concentration increased in SPC at three times the rate of SWB. The values for total plasma potassium per unit at 14 and 21 days in mEq/unit were: SWB, 4.4, 5.8; SPC 3.1, 4.4; and WB-PC 1.9, 2.5. Thus, SPC units may contain substantial amounts of plasma potassium when stored for two to three weeks. However, removal of most of the remaining supernatant plasma from SPC units just prior to administration provides a readily available supply of low potassium blood while allowing maximum conservation of scarce blood resources.     

Indicators of erythrocyte damage after microwave warming of packed red blood cells

BACKGROUND: Localized overheating of packed red blood cells (PRBCs) after microwave warming with consequent damage to erythrocytes has been reported. We therefore compared possible cellular markers of erythrocyte damage, as measured by flow cytometry, with laboratory indicators of hemolysis to evaluate the effects of microwave warming on PRBCs. METHODS: PRBC samples were warmed to room temperature or to 37, 42, 47, 52, or 57 degrees C in a water bath. Flow cytometry was performed after fluorescein labeling using antibodies to spectrin, Ca(2+)-ATPase, and Na(+)-K(+)-ATPase. The forward-to-sideward scatter (FSC/SSC) ratio and antibody binding were evaluated. Plasma free hemoglobin (FHb) and alpha-hydroxybutyrate dehydrogenase (HBDH) were measured immediately after heating and after 48 h. In addition, all measurements were made before and after the heating of PRBCs to 35 degrees C by a microwave blood warmer. RESULTS: Analysis of 15000 erythrocytes showed a decrease in the FSC/SSC ratio and antibody binding above 47 degrees C [at 37 degrees C, median (SD) of 94.2 (7.4) with 0.07 (0.05)% fluorescein-positive; at 52 degrees C, median (SD) of 177.0 (19.0) with 18.5 (6.4)% positively gated; P <0.001]. FHb [room temperature, 0.3 (0.2) g/L] was increased 2-fold at 37 and 42 degrees C, 4-fold at 47 degrees C, and 25-fold at 52 degrees C. HBDH increased in parallel. Hemolysis markers showed an additional twofold increase 48 h after heating to 42 and 47 degrees C. Microwave heating to 35 degrees C did not produce significant changes of any marker. CONCLUSIONS: All markers of cellular damage were altered after heating to >47 degrees C, and a substantial part of hemolysis was delayed. The methodology can be used for future testing of other blood warming devices.     

Effect of packed red blood cells transfusion on plasma fibronectin during liver resection

Our study aimed at evaluating the effect of blood transfusion - allogeneic or autologous - on plasma levels of fibronectin during liver resections. Thirty-five patients scheduled for liver resection were randomly allocated to receive autologous (group autologous blood transfusion (ABT), n= 19) or allogeneic (homologous) (homologous blood transfusion (HBT), n= 16) packed red blood cell to maintain serum haemoglobin concentration above 9 g. Serum levels of fibronectin were measured before induction of anaesthesia, at the end of operation and at first, third and sixth postoperative day. Perioperative morbidity and survival rate were also recorded. Serum fibronectin levels were significantly higher (P < 0.05) in the autologous group than in the allogeneic, at the first (134 +/- 49 microg mL(-1) vs. 89 +/- 31 microg mL(-1)) and third (178 +/- 51 microg mL(-1) vs. 96 +/- 41 microg mL(-1)) postoperative day. No differences in survival and complication rate between the two groups were observed. Concentrations of serum fibronectin seem to be adversely affected by allogeneic blood transfusion during liver resection surgery, although this does not seem to affect patients' morbidity and mortality.     

白细胞滤除对保存期内红细胞流变性和形态的影响

目的 探讨白细胞滤除对保存期红细胞流变性及形态的影响.方法 选择30名健康献血者的血液制备成红细胞悬液,随机分为实验组(n=30):使用去白细胞输血过滤器去除红细胞悬液中的白细胞(简称滤白组);对照组(n=30):未滤白的红细胞悬液;2组一起常规保存.取采血后d0、d7、d14、d21、d28、d35的血标本作白细胞(WBC)和红细胞计数(RBC)、红细胞压积、血液高剪切力、低剪切力及细胞形态学检测.结果 过滤前后红细胞悬液内的WBC为(6.80±0.85)(× 109/L) vs (3.12±0.26)(×106/L) (P ＜0.01);保存d21时低、高切粘度分别为:对照组(11.28±1.88)1/s、(2.85±0.29)200/s,滤白组(12.36±1.57)1/s、(2.93±0.22) 200/s,较保存1～2周明显上升(P＜0.05),但组间比较未见明显著变化(P＞0.05);瑞氏染色结果显示2组细胞形态也有不同变化,滤白组红细胞形态保存较好.结论 白细胞滤除能有效减少白细胞崩解产物或分泌因子对红细胞形态的影响.     

一种新型试剂红细胞保养液的制备和应用

目的　研制用于微量板法等血清学试验的一种通用的试剂红细胞保养液。方法　采用试管法、微量板法、纸片法等作红细胞血型血清学试验 ,观察所研制的新保养液配制的试剂红细胞在试验中应用效果和保存期间的变化。结果　该保养液可于 4℃保存试剂红细胞 3个月 ,它在ABO反定型试验中敏感性高、特异性强、无抗原抗体免疫反应导致的溶血和弱凝集现象。结论　该保养液所配制的红细胞贮存时间长 ,可用于微量板等方法的ABO反定型等试验 ,适合手工和自动化仪器检测