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Background: This report describes the first year of a government-sponsored program that uses daily reports from 29 sentinel sites to monitor the capacity of the US blood supply to meet demand., Study Design and Methods: From August 15, 2001, to August 14, 2002, 29 sentinel sites provided daily reports of the number of units of RBCs in inventory, transfused, exported, and outdated by ABO and Rh, and platelets by random or apheresis donor. Days supply of each component category was calculated as the number of units in inventory reported on a day divided by the sum of units transfused, exported, and outdated on that day. Sites also provided daily responses to questions about threatened or actual shortages., Results: The median of the days supply of RBCs at the 26 hospital transfusion services was 7.2 days. However, median days supply varied substantially by site and by day of the week. A+, O+, and O- units accounted for 30, 35, and 12 percent of total inventory and were maintained at a median supply of 7.4, 6.4, and 9.5 days, respectively. Reports of threatened RBC shortages peaked in early January 2002 and again in early July 2002. The July 2002 peak was about twice the January 2002 peak. Inventories at community-based centers were similar to those at hospital transfusion services. Hospitals maintained only a 1-day supply of platelets. Eight percent of random and 4 percent of apheresis platelets were outdated. There were 20 reports that surgery had to be postponed or canceled because platelets were unavailable., Conclusions: Inventories of RBCs maintained at the participating sites were sufficient, with only one brief exception, to meet local demand during the first year of this monitoring program. The weekly rate of threatened shortage reports was more sensitive than days inventory as a predictor of actual shortages of RBCs. Unlike RBCs, platelet days supply, reports of threatened or actual platelet shortages, and platelet outdate rates did not vary seasonally.

Impairment of platelet function commonly occurs after cardiopulmonary bypass, and may result in substantial bleeding. Because desmopressin acetate (a synthetic analogue of vasopressin) shortens bleeding time in a variety of platelet disorders, a controlled clinical trial of intravenous desmopressin was performed in 39 patients with excessive mediastinal bleeding (greater than 100 ml/h) and a prolonged template bleeding time (greater than 10 minutes) more than 2 hours after termination of cardiopulmonary bypass. Twenty-three desmopressin recipients and 16 control patients (no desmopressin) were similar in surgical procedure, pump time, platelet count, template bleeding time and amount of bleeding before therapy (p = NS). Compared with the control group, the patients receiving desmopressin (20 micrograms; mean 0.3 micrograms/kg) utilized fewer blood products (29 +/- 19 versus 15 +/- 13 units/patient; p less than 0.05), especially platelets (12 +/- 9 versus 4 +/- 7 units/patient; p = 0.004), while achieving a similarly effective reduction in mediastinal bleeding (4.8- and 4.3-fold, p = 0.001 for both). Severe platelet dysfunction was partially corrected within 1 hour after desmopressin infusion, during which interval no blood products were administered: the template bleeding time shortened (from 17 to 12.5 minutes, p less than 0.05), whereas the platelet count remained unchanged (at 96 +/- 35 and 105 +/- 31 X 10(3)/mm3, p = NS). The plasma levels of two factor VIII components increased: procoagulant activity (VIII:C) from 0.97 +/- 0.43 to 1.52 +/- 0.74 units/ml (p less than 0.05) and von Willebrand factor (VIII:vWF) from 1.28 to 1.78 units/ml (p less than 0.05); these increases correlated with the shortening of the bleeding time (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical studies have suggested that granulocyte transfusions may be of value in the treatment of septic neonatal patients who present with severe granulocytopenia. We have developed a protocol for the preparation of granulocyte concentrates from freshly collected units of whole blood, using an automated blood cell processor. The red cells were washed with saline. Then, the buffy coats were collected from the washed red cells and studied for their suitability as granulocyte concentrates for neonatal transfusion. The mean number of granulocytes per concentrate was 1.6 X 10(9) in a mean volume of 25 ml. Studies of granulocyte function, including viability, random mobility, chemotaxis, phagocytosis and nitro-blue tetrazolium reduction, demonstrated that the granulocytes were functionally unimpaired following preparation of the concentrates. These studies suggest that concentrates of functional granulocytes, suitable for transfusion to neonatal patients, can be prepared from fresh units of whole blood, using a cell processor. This procedure is more cost-effective than leukapheresis and allows for delivery of granulocytes for transfusion in a more timely fashion.

We attempted to control the platelet count of a patient with primary thrombocytosis utilizing long-term plateletpheresis therapy. The patient previously could not be controlled with chemotherapy, because of rapid development of leukopenia. Although intensive pheresis at the rate of four to five procedures per week produced rapid lowering of the patient's platelet count, continued therapy at the rate of two to three procedures a week failed to maintain these counts, and platelets gradually rose to pretreatment levels. We conclude that while plateletpheresis can produce acute lowering of elevated platelet counts, the rate of platelet production in primary thrombocytosis may be too rapid to allow for long-term control by pheresis alone, utilizing an acceptable treatment schedule of one of three procedures per week.

Background and Objectives Cytomegalovirus (CMV) is a significant pathogen transmissible through blood transfusion that can have devastating effects on immunocompromised patients. Current transfusion practice provides two choices for transfusion of cellular blood components that reduce the risk of transfusion-transmitted CMV (TT-CMV): blood components collected from CMV seronegative donors and leucocyte-reduced (LR) blood components. Materials and Methods A web-based survey was designed and administered to AABB physician members in April 2007 to collect information regarding current blood banking and clinical practices for prevention of TT-CMV in the United States. Results Individuals representing 183 different institutions completed the entire survey (an institutional response rate of 32.5%). Sixty-five percent of respondents indicated that their institution considered that CMV-seronegative and LR products are equally effective in preventing TT-CMV. When analyzed by institutional type, academic institutions and community hospitals were more likely to subscribe to the premise that LR blood components are equally effective at preventing TT-CMV, than were community blood centres and government institutions. However, reported practices for specific patient populations did not match this view of equivalence between CMV-seronegative and LR products with many patient populations preferentially receiving CMV-seronegative components. Fetal and neonatal populations were more likely than other patient populations to receive CMV-seronegative products to reduce the risk of TT-CMV. Conclusion There is wide variability in transfusion practices to reduce the risk of TT-CMV. Lack of a consensus approach may reflect the conflicting data that exist in the literature as well as adherence to longstanding practice. [ABSTRACT FROM AUTHOR]

Background: Universal Leukocyte Reduction (ULR) of blood components can minimize the incidence of many untoward reactions to blood transfusion. However, the cost of this process will be substantial. It has been suggested that the cost might be Offset by a reduction in the incidence of postoperative infection, thereby shortening the length of hospital stay (LOS), thus reducing the total cost of hospital care for transfused patients (pts). Reports of reduced LOS have relied on purely retrospective analyses, without proper control for other confounding factors. Since we instituted a policy of ULR at our 870 bed hospital for a period of 2 years (1992-3), we have the unique opportunity to examine LOS prior to, during and after discontinuing ULR. This capability provides a control for confounding factors that might affect LOS over time. Methods: Transfused patients undergoing coronary artery bypass graft surgery (CABG) were divided into 3 groups: Group 1=1991 (prior to ULR); Group 2=1992-3 (during ULR); and Group 3=1994 (following ULR). Three groups of controls were non-transfused CABG pts during these same time periods (Groups 4, 5 and 6). We examined hospital records to determine LOS, cost of hospital care, and incidence of postoperative infection. Analysis of variance was performed to compare the means among the three groups of pts and controls. Results: A total of 1217 pts received transfusion (Group 1=416, Group 2=404, Group 3=317). Controls were 508 pts (Group 4=152, Group 5=182, Group 6=174). Mean LOS for the transfused groups was 19, 17 and 14 days, respectively (p=0.001). For controls it was 12, 11 and 9 days, respectively (p=0.001). Mean cost of hospital care for transfused pts was: Group 1=$103,000, Group 2=$123,000, Group 3=$121,000 (p=0.001). For controls: Group 4=$66,000, Group 5=$72,000, Group 6=$78,000 (p=0.004). Mean incidence of any postoperative infection was: Group 1=11%, Group 2=13%, Group 3=7% (p=0.04). For controls: Group 4=7%, Group 5=7%, Group 6=2% (p=0.06). Discussion: Although there was a statistically significant reduction in LOS for transfused pts over the study periods, there was no evidence that the 1992-3 time period showed anything other than being an intermediate in the general time trend for decreasing LOS and increasing cost of hospital care. Furthermore, these trends paralleled those of non-transfused control pts. Finally, rates of postoperative infection showed no decline during the ULR years. Conclusion: ULR has been shown to reduce many of the complications of blood transfusion, but our data suggest that the cost may not be offset by reduced LOS and cost of hospital care. [ABSTRACT FROM AUTHOR]

Presents a case report on transfusion-associated graft-versus-host disease (TA-GVHD) in an immunocompetent recipient of unirradiated directed donor blood. Occurrence of TA-GVHD; Cause of TA-GVHD; Medical condition of the patient; Requirement for a definitive demonstration of TA-GVHD.