Graft-versus-host reaction following blood product transfusion

The observation of graft-versus-host (GVH) reaction after platelet transfusion in a patient with Hodgkin's disease led us to analyze 38 reported cases in the literature, to outline prognostic factors and to characterize patients at risk. Overall mortality was 68 percent. It was higher among children (76 percent) than among adults (62 percent), and among patients with Hodgkin's disease and immune deficiency syndromes (88 percent) than among those with leukemias (23 percent, p < 0.005). Following blood transfusions from normal donors, mortality was higher (88 percent) than after transfusions from donors with chronic myelocytic leukemia (25 percent, p < 0.05). Minimal lymphocyte doses necessary to cause GVH reaction are in excess of 10⁷/kg. Adults seem more resistant to homografts than do children, and the host's cellular immune status is of major prognostic importance. Lymphocytes from donors with chronic myelocytic leukemia may be deficient, and after a threshold dose, the number of lymphocytes transfused does not correlate with clinical outcome. Effective prophylactic measures do exist for this complication but satisfactory therapy does not.     

Enhanced angiogenesis following allogeneic blood transfusion

Blood transfusions are associated with recurrence of solid cancers. Angiogenesis is essential for cancer growth. Our aim was to determine for the first time in a prospective cohort study the effect of prestorage allogeneic leucodepleted SAGM (saline, adenine, glucose, mannitol) red cell transfusion on angiogenic factor levels and in vitro angiogenesis. Forty pretransfusion adult hospital inpatients were selected consecutively. Serum vascular endothelial growth factor (VEGF) and endostatin were measured in each patient before and after prestorage allogeneic leucodepleted SAGM red cell transfusion. All samples were exposed to an in vitro endothelial cell proliferation assay and 10 sample groups were also exposed to an in vitro whole angiogenesis assay. The median number of units transfused was 2 (minimum-maximum, 2-4). Twenty-nine (73%) patients had a rise in VEGF, with an overall increase of 118 pg/ml (quartiles -5, 306; P < 0.01). Twenty-eight (70%) patients had a decrease in endostatin, with an overall reduction of 1.2 ng/ml (quartiles 4.0, 0.0; P = 0.017). There was an overall 33% increase in endothelial cell proliferation (P < 0.01) and a 9.4% increase in in vitro whole assay angiogenesis (P < 0.01). Prestorage allogeneic leucodepleted SAGM red cell transfusions are associated with a favourable angiogenic factor imbalance and an elevation in in vitro angiogenesis.     

RhE相同表型输血与不同表型输血疗效对比观察

目的:比较RhE相同表型输血与不同表型输血的临床效果。方法:选择患者80例,在严密观察患者生命体征的情况下,输注红细胞悬液2个单位,观察2组输血前后血红蛋白(Hb)、血细胞比容(HCT)变化及发生的输血不良反应。结果:输血后相同表型组Hb和HCT均显著高于输血前和不同表型组(P0.05),不同表型组输血前后Hb和HCT,差异均无统计学意义(P0.05),相同表型组输血后仅出现2例发热患者,而不同表型组输血后则以出现血红蛋白尿和腰背痛为主,且两者均显著多于相同表型组(P0.05)。结论:针对存在输血史、妊娠史的患者,应该建议供血机构进行RhE血型鉴定和配型,以便更好的提高输血的有效性和安全性。     

Enhanced angiogenesis following allogeneic blood transfusion1

Blood transfusions are associated with recurrence of solid cancers. Angiogenesis is essential for cancer growth. Our aim was to determine for the first time in a prospective cohort study the effect of prestorage allogeneic leucodepleted SAGM (saline, adenine, glucose, mannitol) red cell transfusion on angiogenic factor levels and in vitro angiogenesis. Forty pretransfusion adult hospital inpatients were selected consecutively. Serum vascular endothelial growth factor (VEGF) and endostatin were measured in each patient before and after prestorage allogeneic leucodepleted SAGM red cell transfusion. All samples were exposed to an in vitro endothelial cell proliferation assay and 10 sample groups were also exposed to an in vitro whole angiogenesis assay. The median number of units transfused was 2 (minimum–maximum, 2–4). Twenty‐nine (73%) patients had a rise in VEGF, with an overall increase of 118 pg/ml (quartiles ?5, 306; P < 0.01). Twenty‐eight (70%) patients had a decrease in endostatin, with an overall reduction of 1.2 ng/ml (quartiles 4.0, 0.0; P = 0.017). There was an overall 33% increase in endothelial cell proliferation (P < 0.01) and a 9.4% increase in in vitro whole assay angiogenesis (P < 0.01). Prestorage allogeneic leucodepleted SAGM red cell transfusions are associated with a favourable angiogenic factor imbalance and an elevation in in vitro angiogenesis.     

The neuropathologic phenotype of experimental ovine BSE is maintained after blood transfusion

Iatrogenic transmission by blood transfusion has been described in cases of human variant Creutzfeldt-Jakob disease (vCJD), experimental ovine bovine spongiform encephalopathy (BSE), and natural sheep scrapie, demonstrating that blood in these prion diseases is infectious. However, the possible effect of the transfusion, derived from differences in the inoculum (blood) and the route of infection (intravenous), on the pathologic phenotype of the disease in the recipients is not known. This study describes the neuropathologic phenotype of PrP(d) accumulation in sheep succumbing to neurologic disease after blood transfusion from donors experimentally infected with BSE; these were either clinically or subclinically affected at the time of donation. We demonstrate that blood can become infectious at early stages of ovine BSE infection and that the PrP(d) immunohistochemical phenotype is maintained after transfusion. This suggests that a change in the pathologic phenotype of vCJD would not be expected as a result of exposure to infected blood.     

A prospective study of the incidence of delayed haemolytic transfusion reactions following peri-operative blood transfusion

Delayed haemolytic transfusion reactions (DHTRs) are a recognized sequel of blood transfusion. The true incidence and importance of this complication have been difficult to estimate due to the lack of any prospective studies. We have carried out such a study by testing 530 patients who were transfused during cardiac surgery. 2% of the patients had new red cell alloantibodies detectable 1 week following transfusion. Despite this finding, and the fact that at the time the study was performed pre-transfusion antibody screening of recipients was not routine practice, no DHTRs were diagnosed on clinical or laboratory criteria. These results indicate that the reported incidences, based on retrospective recognition of DHTRs, are not a serious underestimate of the frequency of the complication.     

Acute HIV illness following blood transfusion in three African children

Three children are described in whom pre-transfusion samples were HIV-seronegative and post-transfusional samples, obtained within 1 week after transfusion, were HIV-seropositive. Two of them developed a transient fever within 1 week of receiving the blood transfusion, and a transient generalized skin eruption which lasted for about 2 weeks. All three developed persistent generalized lymphadenopathy. One child developed a lumbar herpes zoster 7 months after transfusion. IgM Western blots demonstrated the presence of antibodies to protein bands p17, p24 and p55 in all three children. These three case reports suggest that children who receive a seropositive blood transfusion are at high risk for developing acute manifestations of HIV infection.     

Two cases of graft-versus-host disease following transfusion of nonirradiated blood products

Summary Two patients, suffering from AML and AMMoL respectively, experienced acute GVHD after transfusion of nonirradiated blood products. One of the patients, who surprisingly showed normal granulocyte counts during the acute phase of GVHD, survived and is disease-free eight months after initial diagnosis was made.Vorgetragen auf der Sitzung Aktuelle Mitteilungen der 26. Jahrestagung der Deutschen und Österreichischen Gesellschaft für Hämatologie und Onkologie im Oktober 1981 in München     

Splenic platelet-sequestration following routine blood transfusion is reduced by filtered/washed blood products

The mean fall in the platelet count following 23 routine transfusions of 3-5 units packed cells for anaemia was 32.5%. This was significantly reduced to 12.5% in 15 similar transfusions through a 40 microns microaggregate filter (P less than 0.01) and to 4.6% following five transfusions through a polyester fibre filter (P less than 0.005). In 10 transfusions with frozen or polyester fibre filtered, washed red cells, the decrease in platelet count was 4.2% (P less than 0.001). A study of 111In-oxine labelled autologous platelets in nine patients indicated that the fall in platelet count was due to increased splenic sequestration. Since thrombocytopenia following routine transfusion is reduced by procedures which filter the packed cells, the decrease in platelets is probably caused by their adherence to infused microaggregate debris causing their premature removal from the circulation. Patients with preexisting thrombocytopenia who receive red cell transfusions for anaemia, should therefore receive blood products depleted of microaggregate debris in order to avoid exacerbation of thrombocytopenia and haemorrhagic complications.