Influence of gamma irradiation and storage on apheresis platelets.

BACKGROUND AND PURPOSE: Gamma irradiation of platelet concentrates to prevent graft-versus-host disease may inactivate contaminated lymphocytes and subsequently inhibit the synthesis of cytokines in the apheresis platelets during storage. We investigated the influence of irradiation and storage on apheresis platelets collected with the COBE Spectra or Fenwal CS-3000 Plus systems. METHODS: Eleven units of apheresis platelets were collected with a COBE Spectra cell separator and another 11 units with a Fenwal CS-3000 Plus system. Each unit of apheresis platelets was divided into two equal parts: one was irradiated with 3000 cGy directly after blood donation, and the other served as a control. Cell counts, platelet activation marker CD62 antigen, blood gas values, and supernatant concentrations of K+, Na+, lactate, glucose, interleukin-1 beta (IL-1 beta), IL-8, and tumor necrosis factor-alpha (TNF-alpha) were determined in paired samples on the day of collection (day 0) and after 5 days of storage (day 5). RESULTS: No significant differences in white cell counts or TNF-alpha concentrations were noted between the irradiated and control platelets on day 0 or day 5, whereas the mean proportion of platelets expressing CD62P (22.65% vs 25%, p = 0.014) and the mean IL-1 beta (45.55 pg/mL vs 52.75 pg/mL, p = 0.004) and IL-8 concentrations (10.68 pg/mL vs 13.07 pg/mL, p = 0.015) were significantly lower in irradiated than control platelets on day 5. The 5-day storage significantly increased the mean proportion of platelets expressing CD62P (25.00% vs 15.02%, p = 0.008), mean PO2 (116.34 mm Hg vs 98.07 mm Hg, p = 0.002), and mean concentrations of K+ (3.30 mmol/L vs 3.06 mmol/L, p < 0.001), lactate (15.12 mmol/L vs 3.23 mmol/L, p < 0.001), IL-1 beta (52.75 pg/mL vs 29.73 pg/mL, p = 0.001), and IL-8 (13.07 pg/mL vs 3.62 pg/mL, p < 0.001). Five-day storage also significantly decreased white cell count (0.18 x 10(8) vs 0.74 x 10(8), p < 0.001), PCO2 (19.38 mm Hg vs 50.51 mm Hg, p < 0.001), and concentrations of HCO3- (10.36 mmol/L vs 21.34 mmol/L, p < 0.001) and glucose (193.37 mg/dL vs 309.18 mg/dL, p < 0.001). Platelet counts and concentrations of IL-1 beta, IL-8, and TNF-alpha on day 0 did not differ significantly between control apheresis platelets collected with the Fenwal CS-3000 Plus and those collected with COBE Spectra. The mean white cell count (1.29 x 10(8) vs 0.19 x 10(8), p = 0.002) and the proportion of platelets expressing CD62P (24.71% vs 7.09%, p < 0.001) on day 0, however, were significantly higher in the platelets collected with the Fenwal CS3000-Plus than in those collected with the COBE Spectra. CONCLUSIONS: Gamma irradiation of apheresis platelets inhibits the expression of platelet CD62P and the secretion of IL-1 beta and IL-8 after 5 days' storage.

[Hemolytic disease of the newborn caused by maternal anti-Di(a): a case report in Taiwan].

The first case of hemolytic disease of the newborn (HDN) possibly caused by anti-Di(a) in a Chinese infant in Taiwan is reported. The mother had two pregnancies before but no history of blood transfusion. Her first male infant was normal, but her second full-term male one developed mild jaundice soon after birth, and the total bilirubin level was 12.1 mg/dL, 18.3 mg/dL, 23.6 mg/dL at 24 hours, 48 hours, and 72 hours of age, respectively. Total bilirubin was 9.1 mg/dL on the eighth day after receiving phototherapy and compatible blood exchange transfusion. The infant recovered uneventfully. The immunohematological study revealed that the mother was group AB, Rh (D)+; Di(a - b+), the father was group O, Rh (D)+; Di(a + b+), the infant boy and his 2-year-old brother were group B, Rh(D)+; Di(a + b+). The direct antiglobulin test (DAT) on the infant red cells was positive (4+ with polyspecific AHG; 4+ with anti-IgG). The maternal serum and infant's eluate from red blood cells showed negative reactions in routine antibody detection tests, but they contained alloantibody reacting against the Di(a+) cells by the manual polybrene test (MP) and indirect antiglobulin test (IAT) in AHG phase. The anti-Di(a) titers in the mother's serum was MP 1:256 and AHG 1:256, and in the infant's eluate was MP 1:128 and AHC 1:64 against Di(a + b+) cells. Based on the above results we conclude that the jaundice in this newborn baby was caused by maternal anti-Di(a) which was most likely induced by previous pregnancy. In conclusion, Diego blood group is a system of high value in anthropology because it accounts for the Mongoloid origin of American Indians, Japanese and Chinese. Anti-Di(a) may cause HDN, as in our case of HDN due to maternal anti-Di(a) in a Chinese infant. But in Europe and America, where practically all people are Di(a - b+) phenotypes, the system seems of no interest in parental studies as well as in blood transfusions. Owing to the Di(a) antigen is of higher incidence in Chinese population, we suggest that the Diego system should be involved in routine compatibility testing or antibody identification problems in parental studies and in blood transfusions in Taiwan.

Cytokine release in febrile non-haemolytic red cell transfusion reactions.

BACKGROUND AND OBJECTIVES: The aim of this study was to elucidate the role and identity of cytokines involved in febrile non-haemolytic red cell transfusion reactions (FNHTRs). MATERIALS AND METHODS: Eighty-one patients experiencing transfusion reactions after receiving packed red blood cells (RBCs) were divided into three groups, as follows, based on the reaction experienced: FNHTRs (n = 60); chills without fever (n = 8); and allergic reaction with urticaria (n = 13). The concentrations of interleukin (IL)-1beta, IL-6, IL-8 and tumour necrosis factor (TNF)-alpha were measured in the packed transfused unit and patients' plasma by using enzyme immunoassays. Wilcoxon's matched-pairs signed test was used to compare the difference in cytokine levels in patients' plasma before and after transfusion. The Kruskal-Wallis test was used first, followed by the Mann-Whitney test, to compare the pretransfusion cytokine levels in patients' plasma between groups and to compare the cytokine levels in packed RBCs transfused to each group of patients. RESULTS: The age of the implicated packed RBC was 11.5 +/- 5.7 days. Significant increases were observed in IL-6 (P < 0.001) and IL-8 (P < 0.001) patients' plasma levels, but not in IL-1beta or TNF-alpha levels, in those patients exhibiting FNHTR. No changes were observed in the patients' plasma samples of the other groups. Cytokine levels in the RBC concentrate supernatants were not appreciably elevated. CONCLUSIONS: Transfusion of packed RBCs may significantly increase intravascular levels of IL-6 and IL-8 in patients with FNHTRs.