Autologous blood donation: hemodynamics in a high-risk patient population.

Transfusion practices have changed dramatically in recent years as a result of the acquired immune deficiency syndrome crisis. The use of preoperative donation of autologous blood units has gained popularity. Healthy individuals tolerate phlebotomy well, experiencing a 2- to 5-percent incidence of vasovagal reactions.

Computerization of plateletpheresis quality control records with a commercially available spreadsheet program.

Many apheresis units lack the resources to acquire customized computer software for record keeping. We have adapted a commercially available "spreadsheet" program (Lotus 1-2-3) to aid in quality control activities for plateletpheresis. Data are entered in a grid pattern wherein each donation occupies one row and successive columns contain numerical data derived from the donation.

Alloimmunization to RhD by platelet transfusions in autologous bone marrow transplant recipients.

Platelet transfusions from RhD-positive (D-positive) donors are often given to RhD-negative (D-negative) cancer patients. The low observed rate of alloimmunization has been attributed to disease and therapy-related immunosuppression. We have studied the occurrence of alloimmunization in 16 D-negative patients who did not have detectable anti-D prior to autologous bone marrow transplantation for malignant disease.

Treatment of von Willebrand's disease and hypofibrinogenemia with single donor cryoprecipitate from plasma exchange donation.

Conventional replacement therapy for hypofibrinogenemia and von Willebrand's disease requires multiple donor exposures and a correspondingly high risk of blood-borne infection. We describe the collection and successful use of cryoprecipitate derived from a single donor by plasma exchange donation to support such patients through major hemostatic stresses. The father of an epileptic patient with von Willebrand's disease produced cryoprecipitate containing 23,546 units of von Willebrand factor (vWF) in nine desmopressin-stimulated donations; this provided total factor replacement for neurosurgery to remove a seizure focus.

Simultaneous collection of platelets and cryoprecipitate by plasma-exchange donation.

To increase cost efficiency, the simultaneous collection of platelets during plasma-exchange donation of cryoprecipitate was investigated. Sixteen desmopressin (DDAVP)-stimulated donors underwent 90 simultaneous donations. Permanent donor plasma loss for each donation averaged 150 ml in cryoprecipitate and 151 ml in platelet concentrates.

Long-term frequent plasma exchange donation of cryoprecipitate.

Plasma exchange donation accomplishes the selective donation of cryoprecipitate. It facilitates the repeated donation of large quantities of factor VIII by individual donors and reduces donor exposure for recipients. A highly motivated donor is described who has undergone 103 donations between May 1983 and March 1987, producing 359,460 IU of factor VIII and supplying all the factor VIII needed since August 1983 by his severely affected hemophiliac son, now age 14.

A high-potency, single-donor cryoprecipitate of known factor VIII content dispensed in vials.

Current factor VIII products expose recipients to many donors and hence to a high risk of acquiring blood-borne infections. Plasma-exchange donation of cryoprecipitate can reduce donor exposure by repeatedly obtaining large yields of factor VIII from individual donors. In this study, donor factor VIII levels were stimulated with desmopressin before donation.

Hematologic emergencies.

Hematologic emergencies require thorough but prompt evaluation of the patient, availability of relatively routine laboratory tests, and immediate decisions. This article discusses the emergencies associated with red blood cell disorders, white blood cell disorders, hemostatic disorders, and transfusion reactions.

Analysis of serum free light chains by crossed immunoelectrophoresis: comparison with urinary light chains in light chain disease.

We investigated the relationship between serum free light chain levels measured by crossed immunoelectrophoresis in ten patients with light chain disease and traditional 24-hour urinary light chains in the same patients. The crossed immunoelectrophoresis test requires only a venipuncture for specimen acquisition, can be completed within 24 hours, and has a reproducibility (+/- 14%) comparable with that of other immunoprecipitin techniques. Twenty-eight serum-urine pairs, representing 18 discrete intervals, were analyzed.

'Hypocryoglobulins'. Enhanced cryoprecipitation from hypotonic serum in patients with vasculitis.

Three patients with cutaneous vasculitis and one patient with digital gangrene had a negative or equivocal test for cryoglobulins but a positive result in a modified assay for cryoproteins ( hypocryoglobulins [ HGs ]) in which serum is rendered hypotonic by dilution with an equal volume of distilled water before incubation in the cold. Each cryoprecipitate contained a mixture of immunoglobulins, and in two instances, a monoclonal component was demonstrated. Rheumatoid factor activity was found in two precipitates.

Complement metabolism during membrane plasma separation.

Because it has been found that some plasma separator membranes can activate complement in serum, this study focuses on the behavior of complement during actual membrane plasmapheresis. Complement metabolism in subjects undergoing membrane plasma separation with three different prototypic devices was studied. Complement activation was judged by crossed immunoelectrophoretic analysis of C3 in plasma.

Serum-free light chain analysis by crossed immunoelectrophoresis: correlation with plasmapheresis in light chain disease nephropathy.

The technique of crossed immunoelectrophoresis (X-IEP) has been used to quantify free monoclonal light chains (LC) directly in the serum of patients with light chain disease, without preliminary gel or membrane filtration of serum to separate whole immunoglobulin. LC concentration is proportional to the area under an immunoprecipitin peak formed by LC in the patient's serum and an anti-LC antibody of appropriate specificity. Light chains of beta electrophoretic mobility can be processed in the standard X-IEP technique at pH 8.

Complement activation by plasma separator membranes.

Because of their structural similarity to dialysis membranes, six plasma separator membranes were evaluated for the ability to activate complement, as judged by immunoconversion of the third component of complement in crossed immunoelectrophoresis. A polysulfone and two cellulose acetate membranes were relatively strong alternative pathway activators. Polypropylene, poly[vinylidine fluoride] and polyvinyl-chloride derivative membranes were weak activators in some sera.

The impact of adenine and inventory utilization decisions on blood inventory management.

The use of citrate-phosphate-dextrose-adenine as an anticoagulant for whole blood increases the storage period permitted for whole blood and red cells from 21 to 35 days. A simulation model was used to analyze the possible consequences for outdates and shortages of the addition of adenine. The model accepts as input (1) the maximum age (21 or 35 days), (2) parameters describing the demand and supply distributions, and (3) parameters describing inventory control (crossmatch recycle period, transfusion fraction, deviation from optimal target inventory levels).

Partial plasma protein replacement in therapeutic plasma exchange.

We wished to determine whether subtotal replacement of protein in plasma removed at plasma exchange would be adequate to prevent hypovolemia and hypoproteinemia. Seven well nourished outpatients with chronic progressive multiple sclerosis underwent 60 plasma exchanges in which two liters of plasma were replaced with 750 ml saline followed by 1250 ml of a 5% albumin solution (62.5% albumin replacement).

Haemolytic transfusion reaction due to ABO incompatible plasma in a platelet concentrate.

A patients of blood type A1 developed brisk, but transient haemolysis after receiving a platelet transfusion derived from 4 group 0 donors. Anti-A was detected on his red cells and in his plasma. 2 of the platelet donor were found to have very high titers (1:10240) of anti-A and positive haemolysin tests.

Effects of centrifugation leukapheresis with hydroxyethyl starch on the complement system of granulocyte donors.

In granulocyte donors during centrifugation leukapheresis (CL), total hemolytic complement, Clq, C3, factor B, and properdin decreased, but only to the extent expected from hemodilution. Crossed immunoelectrophoresis showed no C3 conversion in plasma obtained from the leukapheresis appeared during CL or in donor plasma immediately after CL. When serum was incubated with hydroxyethyl starch, total hemolytic complement did not decrease and C3 conversion was not detected by crossed immunoelectrophoresis.

Factor VIII collection by pheresis.

A new blood donation procedure for obtaining selectively the proteins in cryoprecipitate consists of sequential automated plasma exchanges, in which the donor's fresh plasma is replaced with the autologous cryoprecipitated supernatant from the previous exchange donation. Fresh plasma is processed into cryoprecipitate and supernatant, both of which are frozen and stored. Six donors have undergone a total of twenty-six exchange donations of 1.

Plasmapheresis with return of cryoglobulin-depleted autologous plasma (cryoglobulinpheresis) in cryoglobulinemia.

Three patients with cryoglobulinemia have been treated with automated plasma exchange procedures in which the replacement fluid was autologous plasma, obtained at a previous plasmapheresis and incubated in the cold to precipitate abnormal protein. All three responded with a reduction in cryoglobulin level and an improvement in clinical manifestations of cryoglobulinemia. The cost of treatment was less than that of conventional plasmapheresis, even though the quality of the replacement fluid was superior.