Quality is a matter of mind: proposed quality improvement through the implementation of best practice.

In the past two decades, blood component, production and transfusion therapy have undergone considerable changes in terms of preparation of purer and safer products. This has led to a real improvement in their clinical effectiveness and prevention of untoward effects. With new developments in "tailor made" products it becomes imperative to establish a system of Quality Management in blood transfusion, similar to those of pharmaceutical manufacturers of blood products.

Current methods for the preparation of platelet concentrates: laboratory and clinical aspects.

Modern blood transfusion services are striving to attain the highest standards through continual quality improvement and ensure that a formalised quality system is in place in the organisation for time management and waste reduction. With respect to the production of platelet concentrates (PCs), semi-automated and automated procedures are now available which are convenient and allow the processing of multiple packs simultaneously or the production of multiple doses of PCs with low leucocyte content. Nevertheless, PCs are highly heterogeneous on the basis of cellular content and storage stability.

The quality of clinical FFP, cryoprecipitate and cryosupernatant derived from single donor apheresis procedures and random donations collected in a BAT system: assessment of the activity states of FVIII, contact activation, microvesicle content and cytokines.

In establishing the best practice and/or evaluating any new process or procedures it is essential that apart from the compliance to specification, provided by the Guidelines (i.e. AABB or UK-BTS/ NIBSC), the changes that might occur in the activation states, and other regulatory mechanisms should be considered.

Effect of pH and buffering condition on dMPV of three types of platelet concentrates.

Normal platelets display a log normal size distribution pattern when analysed by an automated cell counter. Considerable changes in the platelet size distribution occurs during collection, processing and storage. This is easily monitored by the variation seen in the cellular indices or size distribution patterns.

Cytokines in platelet concentrates: a comparison of apheresis platelet (haemonetics) and filtered and unfiltered pooled buffy-coat derived platelet concentrates.

Variable degrees of platelet activation, shape changes, microvesiculation and fragmentation may occur during collection, processing and storage of platelet concentrates (PCs), contributing to different rate of platelet storage lesion. Leukocytes contribute to both the frequency of transfusion reactions and the acceleration of the rate of platelet storage lesion hence leukocyte removal of platelet concentrates has been introduced to overcome these problems. However transfusion reaction can still occur with the use of leuko-reduced products and it is not fully elucidated that the rate of storage lesion is equivalent for filtered and unfiltered counter parts.

New horizons in blood transfusion medicine: present status and future trends.

In the past two decades, we have witnessed enormous advances in all areas of transfusion medicine, from simple and practical aspects of blood component collection and processing to the development of "designer products" and the use of recombinant products or other alternatives. Considerable efforts were directed, in particular, towards transfusion support for specific categories of patients, such as neonates and those undergoing transplant procedures, where patients' clinical states ultimately influence the choice of product(s) and where emphasis should be placed on both the optimisation of clinical effectiveness and safety, as well as minimising the adverse/untoward effects of transfusion. The objective of this Forum Discussion is to provide an overview of what is currently on the horizon and then describe the potential changes that are expected on the new horizon, within the next decade.

Yersinia enterocolitica transmission from a red cell unit 34 days old.

In 1993 the North London Blood Transfusion Centre received its first report of Yersinia enterocolitica transmission from a unit of red cells supplied to a local hospital. The recipient was a 23-year-old male who was neutropenic following a third cycle of chemotherapy for treatment of acute myeloblastic leukaemia (FAB type M6) and received a 34-day-old red cell unit. During transfusion the patient developed septicaemia and endotoxin-mediated shock.

HCV counselling in haemophilia care.

The many areas of uncertainty about HCV make counselling patients with haemophilia and HCV a challenge. In this review a brief summary is made of the current understanding of the natural history of hepatitis C infection, the modes of transmission, diagnostic techniques, and treatment options available. This forms a necessary background to counselling patients and their contacts.

Do monocyte ADCC assays accurately predict the severity of hemolytic disease of the newborn caused by antibodies to high-frequency antigens?

Monocyte ADCC assays are helpful indicators of the severity of hemolytic disease of the newborn (HDN) due to anti-D. It would be particularly useful if the assays also accurately predicted the ability of antibodies to high-frequency antigens (HFA) to cause HDN. To investigate this possibility, 14 antenatal sera containing antibodies to HFA were tested and the results correlated with the severity of HDN.

A prospective study of the incidence of red cell allo-immunisation following transfusion.

To establish the incidence and timing of red cell allo-immunisation following transfusion, pretransfusion and serial post-transfusion samples were screened for allo-antibodies in a total of 452 patients who had undergone elective surgery. Antibody screening was performed by 2-stage papain, manual polybrene and indirect antiglobulin techniques (IAT). Red cell allo-antibodies were found in 42 patients and 38 of these (8.

Detection of red cell antibodies: current and future techniques.

The techniques used routinely in blood group serology for detection of antigen:antibody reactions rely on haemagglutination caused by the ability of antibodies, or antibody:antibody complexes to cross-link with individual cells. The anti-human globulin technique has become the most important test for detecting significant red cell antibodies; however, the classical tube test has been refined to improve speed and sensitivity with the introduction of microtube (column) agglutination and solid-phase methods. Historically, clinical laboratories in the UK have used albumin and/or enzyme methods to support the antiglobulin technique but the cost of these, the insensitivity of albumin techniques, and the doubtful clinical relevance of antibodies detected only by enzyme methods have led to a re-assessment of their value.

Organisation of blood transfusion services.

Worldwide, the availability of blood product support for patients varies considerably, not only in quantity and in standards but also with regard to safety from infections, and specifications for components. Similarly, the organisation responsible for providing blood varies from one country to another. This article discusses the organisation of transfusion services in the UK, describing how the blood supply is provided and looks briefly at the structure of the organisations involved.

Transfusion-associated graft-versus-host disease: current concepts and future trends.

Since the initial reports, in the early 1960s, of Transfusion-Associated Graft-versus-Host Disease (TA-GVHD) in infants with congenital immunodeficiency and individuals with various haematological malignancies, our knowledge of this rare but uniformly fatal consequence of transfusion has improved. Today, it is possible to define with greater certainty patients who are most at risk; the blood components capable of causing TA-GVHD; and the methods for preventing TA-GVHD. In the absence of effective treatment for TA-GVHD, attention is currently focused on potential preventative measures, in particular using u.