Audit on the usage of plasma derived/recombinant coagulation factor concentrates at a German university hospital.

BACKGROUND: There is a lack of data on the usage of plasma derived/recombinant coagulation factor concentrates (PD/RCFC) regarding diagnostic categories. An audit of PD/RCFC and blood component usage at a tertiary care teaching hospital in northern Bavaria was conducted. STUDY DESIGN AND METHODS: All blood components and PD/RCFC transfused at a university hospital (Erlangen, Germany) during the year 2006 were analysed. Transfused blood products were listed by major diagnostic categories (MDC) formed from principal diagnoses of recipients according to the International Classification of Diseases, tenth revision and German modification. RESULTS: Blood component usage has markedly increased since last surveyed in 1994 through 1996. The diagnostic categories responsible for most transfusions have not changed since. Antithrombin is the PD/RCFC used most, whereas most money for PD/RCFC was spent on FVIII concentrates. Polytrauma patients need most fibrinogen, whereas most of FXIII is needed in patients with malignancies. Patients with prolonged artificial ventilation receive PCC most often. Altogether, three MDCs (Pre, 17, 05) accounted for 80·5% of costs created by PD/RCFC transfusion. CONCLUSION: This study provides for the first time combined data on blood component and PD/RCFC usage in a German university hospital. It shows that the MDCs responsible for most of the costs in transfusion therapy with blood components and with PD/RCFC are few, and are the same. At the same time, blood bank information software should be further improved in order to be able to identify new trends in hemotherapy in more detail.

[Manufacture of autologous serum eye drops for out-patient therapy : cooperation between ophthalmic clinic and transfusion medicine department]. / Herstellung von Eigenserumaugentropfen zur ambulanten Therapie : Kooperation von Augenklinik und transfusionsmedizinischer Abteilung.

BACKGROUND: Autologous serum eye drops are an important therapy option in severe ocular surface disorders and the therapeutic effectiveness has been demonstrated in many clinical studies. The production and use of autologous serum eye drops is strictly controlled by legal regulations in Germany: Both the German Medicines Act (AMG) and the Blood Transfusion Act regulate production, distribution and application, unless it is carried out by one person under controlled conditions in a hospital setting. MATERIAL AND METHODS: In cooperation with the ophthalmic clinic and the department of transfusion medicine, a standard operating procedure (SOP) was developed and a license for production and delivery of autologous serum eye drops was obtained from the appropriate local authorities. The experiences of the first two years of practice were analyzed. RESULTS: By an interfaculty cooperation, the possibility of legal and feasible out-patient treatment with autologous eye drops has been established at the University Hospital Erlangen. From 07/2005 to 07/2007, there ware 240 prescriptions for autologous serum eye drops. Unexpectedly, a relatively high rate (3.3%) of patients with primarily unknown viral or bacterial infectious diseases were found, which were diagnosed during the screening. These patients had to be excluded from autologous serum eye drop therapy. CONCLUSION: The treatment with autologous serum eye drops in an out-patient setting is possible, when the infrastructure for manufacture and delivery is provided in accordance with existing regulations.

The in vitro quality of washed, prestorage leucocyte-depleted red blood cell concentrates.

BACKGROUND AND OBJECTIVES: No data are currently available on the quality of washed prestorage leucocyte-depleted red blood cell concentrates (RCCs). MATERIALS AND METHODS: Five groups of RCCs stored in additive solution (SAG-M) were washed. The groups differed in the age of RCCs (2-5 days or 11-15 days), the temperature during the washing procedure and a 6-h storage period (4 degrees C or room temperature) and the washing solution (saline, SAG-M or 5% albumin). We measured ATP, 2,3-diphosphoglycerate (2,3-DPG), haemolysis, blood cell count, Na(+), K(+), pH, pO(2), pCO(2) and lactate, before and after the washing procedure and hourly during the 6-h postwash storage period. RESULTS: The erythrocyte ATP content increased by 2-13%, relative to the baseline value, during the washing procedure. The 2,3-DPG level decreased by 15-35% in 2-6-day-old RCCs and by 30-40% in 11-15-day-old RCCs (relative to baseline values) during the washing procedure. In RCCs that were washed and stored at room temperature, and in 2-week-old RCCs, a further decrease in 2,3-DPG of up to 40%, relative to the baseline value, was observed during the 6-h postwash time-period. CONCLUSIONS: Washing of RCCs stored in SAG-M results in a considerable, significant loss of erythrocyte 2,3-DPG, especially in older RCCs. This loss increases in during a 6-h storage period postwash, even at 4 degrees C. This loss of erythrocyte quality might well outweigh the benefits of washed SAG-M RCCs during massive transfusion in neonates.

Morbidity of harvesting of bone grafts from the iliac crest for preprosthetic augmentation procedures: a prospective study.

It has been the aim of the present prospective clinical study to assess the morbidity following the harvest of bone from the anterior and posterior ilium in elective preprosthetic augmentations. Fifty consecutive healthy patients (30 female, 20 male, mean age 52.5+/-9.3 years, range 31 years to 65 years) underwent augmentations of implant sites by iliac crest bone grafts. The bone harvest was carried out in 25 cases from the anterior and in 25 cases from the posterior ilium. The superficial sensory function of the skin was determined quantitatively preoperatively, 7 and 30 days after surgery with the 'Pain and Thermal Sensitivity' Test (PATH Test). On the same occasions subjective pain on a visual analogue scale (VAS) and gait disturbances were documented. In the PATH Test, for the innervation areas of the lateral femoral cutaneous nerve (LFCN) and the superior and middle cluneal nerves (SMCN) a significant impairment of the superficial sensory function could be found after 1 week and a significant tendency towards recovery after 1 month (warm stimulus(FCNpreop) 37.9+/-3.0 degrees C, warm stimulus(LFCNday7): 38.6+/-3.2 degrees C, warm stimulus(LFCNday30): 37.9+/-2.9 degrees C, P(LFCNwarmpreop/day7)=0.023,P(LFCNwarmpreop/day30) =0.886, warm stimulus(SMCNpreop): 36.1+/-2.4 degrees C, warm stimulus(SMCNday7): 36.6+/-2.3 degrees C, warm stimulus(SMCNday30): 36.3+/-4.0 degrees C,P(SMCNwarmpreop/day7) <0.0005,P(SMCNwarmpreop/day30) =0.086). Gait disturbances were seen in seven patients after anterior and in three patients after posterior bone harvest 7 days after surgery (P(gaitdisturbanceanterior/posterior)=0.123). After 1 month none of the patients of both groups showed gait disturbances any longer. The maximum subjective pain level was found on the second postoperative day in both groups. It was significantly higher for the anterior approach (VAS(anteriorday2) 7.0+/-1.5, VAS(posteriorday2) 5.5+/-1.8,P(VASanterior/posteriorday2) =0.004). At day 7 and at day 30, the pain levels did no longer differ significantly (VAS(anteriorday7) 3.7+/-1.4, VAS(posteriorday7) 3.2+/-1.6,P(VASanterior/posteriorday7) =0.165, VAS(anteriorday30) 1.4+/-0.7, VAS(posteriorday30) 1.4+/-0.8,P(VASanterior/posteriorday30) =0.724). Because of the lower morbidity of bone harvest from the posterior ilium in the early postoperative phase compared to the anterior approach it seems that it should be preferred in elective augmentation procedures.

The variability of compensatory erythropoiesis in repeated autologous blood donation.

BACKGROUND: Compensatory RBC production during repeated preoperative autologous blood donation (PABD) shows marked interindividual variability. This study was performed to reveal variables that might be useful to predict the amount of the erythropoietic response to PABD in an individual patient who was not iron deficient. STUDY DESIGN AND METHODS: In a retrospective study, 104 adult patients, 48 women and 56 men (mean age, 59.9 years; range, 18-82 years) who donated 3 units (450 mL) of autologous blood at weekly intervals for major surgery were investigated. Blood counts, ferritin, and net preoperative RBC production (net RBC production) were determined in all patients, and soluble transferrin receptor and endogenous levels of EPO, SCF, and IL-1beta were measured in 63 patients. Multiple linear regression analysis was used to determine whether the variance of net RBC production was attributable to baseline values of these variables. RESULTS: Net RBC production was not different in patients who received oral iron and patients who did not (384 +/- 222 mL vs. 356 +/- 158 mL). In both groups, the same two variables consistently showed a significant relationship to net RBC production: the length of the period between the third donation and the last visit was positively related (p = 0.00001 vs. p = 0.0002) and the Hct at baseline was negatively related (p = 0.0002 vs. p = 0.02) with net RBC production. The proportion of variance in net RBC production that was attributable to these two variables was 48.1 percent (r(2) = 0.481) and 34.9 percent (r(2) = 0.349), respectively. CONCLUSION: RBC production after PABD increases with increasing interval from last donation to surgery. This suggests that the interval from last donation to surgery should be maximized. This can be achieved by organizational measures in combination with the preparation of RBC concentrates in additive solution with a maximum shelf life.

Effect of gamma radiation on the in vitro aggregability of WBC-reduced apheresis platelets.

BACKGROUND: The effect of gamma radiation on single-donor apheresis platelet concentrates (SDPs) has been elucidated only incompletely. The only existing report on the function of SDPs stored in the irradiated state found a deterioration in the in vitro aggregability at the end of shelf life in SDPs divided before irradiation with 1500 cGy. STUDY DESIGN AND METHODS: The in vitro properties of platelets were examined in four series of irradiated and control platelets, each obtained from the same 15 donors. Irradiation with 3000 cGy was performed on Days 0, 3, and 5. Cellular content, aggregability by ADP alone or ADP and epinephrine, spontaneous and induced CD62 expression, beta-thromboglobulin release, glucose consumption, lactate production, and pH were measured immediately after preparation and on Days 3 and 5 after donation. RESULTS: Comparable in vitro properties were measured in irradiated and control platelets, whether irradiation was performed on Day 3 or Day 5. However, in platelets irradiated on Day 0, we found a significantly better in vitro aggregability by 20 microM: ADP immediately after irradiation and by 10 microM: ADP and 2 microM: epinephrine at the end of shelf life than was found in the other groups (Day 5 results: Day 0 irradiation: 75 +/- 32%; Day 3 irradiation: 45 +/- 45%; Day 5 irradiation: 47 +/- 41%; control: 40 +/- 24%; p<0.05). CONCLUSION: Gamma radiation had no adverse effect on platelet quality in extremely WBC-reduced SDPs. On the contrary, a slight, but significantly better in vitro aggregability was found in SDPs irradiated before storage than in platelets irradiated later during storage and in unirradiated platelets. This increased in vitro aggregability persisted until the end of shelf life.

Collection of MNCs with two cell separators for adoptive immunotherapy in patients with stage IV melanoma.

BACKGROUND: MNCs for adoptive immunotherapy may be collected by leukocytapheresis with a cell separator. STUDY DESIGN AND METHODS: Six healthy cytapheresis donors donated two MNC concentrates on a cell separator (AS.TEC 204, Fresenius): one on the standard MNC program and one on a modified MNC program with reduced centrifuge velocity that leads to a lower platelet contamination. Seventeen patients with malignant melanoma donated 26 MNC concentrates: 5 on the AS.TEC 204 MNC program, 9 on the modified AS.TEC 204 MNC program, and 12 on another modified MNC program (Spectra, COBE). RESULTS: In the course of cultivation of MNCs to dendritic cells (DCs), the donor MNC concentrates with the lower platelet contamination (475 +/- 85 x 10(9)/L) had a significantly higher relative DC yield (low platelet contamination: 3.9 +/- 1.6% of the plated cells; high platelet contamination: 2.5 +/- 1.8% of the plated cells; p = 0.019) than the concentrates with the higher platelet contamination (2364 +/- 448 x 10(9)/L). No significant difference was found in the yields of MNCs and CD14+ cells in the three protocols used for the collection of MNCs from patients with melanoma. The components obtained by the standard AS.TEC 204 MNC program had a significantly higher platelet contamination (1768 +/- 994 x 10(9)/L) than the components obtained by the modified AS.TEC MNC program (360 +/- 98 x 10(9)/L; p<0.05) and the modified Spectra MNC program (636 +/- 266 x 10(9)/L); p<0.05). Because of the low number of investigated components, no significant difference in the DC yield of the three protocols could be detected (mean DC yield after cultivation: 746 +/- 429 x 10(6)). CONCLUSION: A high platelet contamination of MNC concentrates intended for adoptive immunotherapy can lead to a significant impairment of the DC yield after cultivation. Both the modified AS.TEC 204 and the modified Spectra MNC programs are well suited for collecting MNC concentrates with high MNC yields and low platelet contamination from patients with malignant melanoma.

Determination of eicosanoid and cytokine production in salvaged blood, stored red blood cell concentrates, and whole blood.

STUDY OBJECTIVE: To determine the production of the eicosanoids prostaglandin 2 (PGE2) and thromboxane 2 (TxB2) and the cytokines interleukin 1 beta (IL-1-beta) and interleukin 6 (IL-6) in whole blood (WB), unfiltered red blood cell (RBC), and filtered RBC concentrates, and salvaged blood. DESIGN: Prospective study. SETTING: University hospital of Erlangen. PATIENTS: 32 healthy volunteers and 14 ASA physical status I, II, and III radical prostatectomy patients (mean age 65 yrs). INTERVENTIONS: Sixteen WB units and 16 RBC units (divided into 16 filtered and unfiltered units each) were taken from 32 volunteers. Fourteen salvaged RBC units were obtained from the 14 radical prostatectomy patients. Sixteen WB units were stored for 35 days. From the 16 WB donations, RBC concentrates (PAGGS-M) were prepared. The RBC concentrates were halved, one half had its leukocytes removed at day 0; both halves were stored for 49 days. Salvaged blood (n = 14) was stored up to 2 hours during surgery and then retransfused. MEASUREMENTS AND MAIN RESULTS: Immediately at the start of the study, in all blood units (WB, RBC filtered, and RBC unfiltered units) at days 0 and 21, and at the end of the storage period (WB: 35 days, RBC concentrates: 49 days) and in the salvaged RBC units, the following parameters were measured: PGE2, TxB2, IL-1-beta, IL-6, hematocrit, platelet number, leukocytes, blood volume, and hemoglobin. During storage, different levels of PGE2, TxB2, IL-1-beta, IL-6 for WB, filtered RBC concentrates, and unfiltered RBCs were found. The higher levels of PGE2, TxB2, IL-1-beta, and IL-6 were found in the WB and RBC salvaged units than the filtered RBCs or unfiltered RBC units. There was no statistically significant difference between WB and salvaged RBCs. Higher levels of leukocytes and platelets were found in WB units and salvaged RBCs as compared to filtered or unfiltered RBCs. CONCLUSIONS: The eicosanoid and cytokine levels in the salvaged, filtered RBC, unfiltered RBC, and WB units stayed within physiological limits, suggesting that these levels do not contribute to the risk of nonhemolytic, immunomodulated transfusion reactions, even in massive transfusions.

The influence of automated plateletpheresis on systemic levels of hematopoietic growth factors.

BACKGROUND: Megakaryocytopoiesis and platelet production are regulated by several hematopoietic growth factors. The present study focuses on the effects of automated plateletpheresis on systemic levels of different hematopoietic growth factors. STUDY DESIGN AND METHODS: Platelet count, mean platelet volume, and serum levels of thrombopoietin, erythropoietin, interleukin-1beta, interleukin-6, and stem cell factor in 21 healthy donors were measured before platelet collection, after the first half of the apheresis procedure, at the end of apheresis, and on Days 1, 2, and 7 thereafter. RESULTS: Thrombopoietin levels (initial level: 49.5 +/- 25.5 pg/mL) showed a significant increase between measurements taken at the end of apheresis and Day 1 (56.9 +/- 26.7 pg/mL; p = 0.01). There was a highly significant decrease in stem cell factor levels during apheresis (p<0.0005), reaching preapheresis values (1679 +/- 210 pg/mL) on Day 1. A highly significant increase in erythropoietin levels (initial level: 7.5 +/- 4.0 U/L) was seen after apheresis (p<0.0005 on Days 1 and 2). The level remained significantly elevated until Day 7 (p = 0.004). Interleukin-1beta and interleukin-6 levels (before donation: 1.4 +/- 1.8 pg/mL and 1.1 +/- 0.7 pg/mL, respectively) did not change during the observation period. Thrombopoietin levels correlated consistently and inversely with stem cell factor levels after apheresis (Day 1, r = -0.46, p = 0.035; Day 2, r = -0.50, p = 0.02; Day 7, r = -0.50, p = 0.02). CONCLUSION: The data show a coordinated response of the hematopoietic system to platelet loss. It is suggested that the decrease in serum stem cell factor levels during apheresis reflects the consumption of stem cell factor by early hematopoietic progenitors that expand to initiate early megakaryocytopoiesis. The temporary increase in thrombopoietin is the result of platelet loss and serves as a stimulus for subsequent thrombopoiesis. The pronounced elevation of erythropoietin after apheresis suggests a role for this primarily erythropoietic cytokine in thrombopoiesis, too.

Oral or intravenous iron as an adjuvant to autologous blood donation in elective surgery: a randomized, controlled study.

BACKGROUND: This study was performed to evaluate the capacity of oral and intravenous (i.v.) iron administration during autologous blood donation (ABD) to improve the efficacy of ABD and to prevent the need for allogeneic blood transfusion in patients without iron deficiency who are undergoing major elective surgery for which a minimum of 3 autologous units have been ordered. STUDY DESIGN AND METHODS: One hundred twenty-three patients were enrolled in an open-labeled, randomized, controlled trial and assigned to three treatment groups: patients in Group 1 received 3 x 100 mg of Fe2+ per day given orally for 5 weeks before operation; patients in Group 2 received 200 mg of Fe3+ given intravenously after each donation combined with initial i.v. iron supplementation in patients with hemoglobin under 15 g per dL; and patients in Group 3 were in the control group that received no iron medication. A modest ABD program involving weekly phlebotomy and threshold hemoglobin values for donation of 11.5 g per dL in women and 12.0 g per dL in men was performed. RESULTS: Ninety patients, 15 women and 15 men in each of the three groups, completed the study. The mean net red cell production during ABD was no higher (p>0.2) in the iron-treated groups (Group 1: 473 +/- 178 mL; Group 2: 436 +/- 170 mL; Group 3 (controls): 397 +/- 174 mL). The mean number of autologous units donated per patient did not differ (p>0.7) among the groups (Group 1: 3.1 +/- 0.6; Group 2: 2.9 +/- 0.7; Group 3: 3.0 +/- 0.7). The proportion of patients who needed allogeneic blood transfusion showed no significant (p>0.4) advantage for iron treatment, (Group 1: 7%; Group 2: 20%; Group 3: 10%). CONCLUSION: In non-iron-deficient patients undergoing modest ABD without erythropoietin therapy, neither oral nor i.v. application of iron during the preoperative period enhances the success of preoperative ABD.

Cytokine generation in whole blood, leukocyte-depleted and temporarily warmed red blood cell concentrates.

BACKGROUND AND OBJECTIVES: It has been suggested that inflammatory cytokines such as Interleukin (IL)-1beta, IL-6, tumor necrosis factor-alpha (TNF-alpha) and IL-8 might be responsible for a large number of non-antibody-mediated adverse reactions to the transfusion of blood components, especially of platelet concentrates (PCs). The aim of this study was to compare the levels of proinflammatory cytokines in different blood components containing red cells such as buffy-coat-free packed red cells (RBCs), filtered RBCs and whole blood (WB) during storage under several conditions. MATERIALS AND METHODS: WB (CPD-A1, n = 16) was stored for 35 days at 2-6 degrees C; samples were taken on days 0, 21 and 35. Buffy-coat-poor RBCs in additive solution PAGGS-M (n = 16) were divided into halves, one half was leukocyte (WBC)-depleted by filtration on day 0, both halves were stored for 49 days at 2-6 degrees C (samples: days 0, 21, 49). Furthermore, buffy-coat-poor, unfiltered SAG-M RBCs (n = 16) were halved immediately after production and stored at 2-6 degrees C until day 42 (samples: days 0, 21, 42). One half remained at room temperature for 24 h on day 3. Cytokine levels were determined with commercial enzyme-linked immunosorbent assays. RESULTS: Levels of IL-1beta and TNF-alpha rose during storage of WB and RBCs. IL-6 could be detected markedly above the detection threshold in WB only. At the end of storage, we detected IL-8 in 1 of 16 units of WB tested, in 10 of 16 standard PAGGS-M RBCs and in 15 of 16 temporarily warmed SAG-M RBCs. Prestorage filtration of RBCs prevented the accumulation of IL-1beta and TNF-alpha. Temporarily warming of RBCs for 24 h did not cause any substantial increase in cytokine levels other than IL-8. RBCs stored in different additive solutions (PAGGS-M versus SAG-M) showed similar cytokine concentrations during storage. The cytokine content of WB was very similar to that of buffy-coat-poor RBCs. CONCLUSION: Cytokine levels measured in WB and buffy-coat-poor RBCs result in levels which are unlikely to cause febrile reactions even in the case of massive transfusion. We conclude that, according to present knowledge, there is no reason for prestorage filtration of buffy-coat-poor RBCs or WB to avoid febrile transfusion reactions due to cytokine accumulation during storage.

A survey of blood utilization in children and adolescents in a German university hospital.

There are no detailed data on blood use with regard to diagnoses of recipients during infancy, childhood and adolescence. Available information on this issue is incomplete and no longer current. We conducted a survey of blood component use in children and adolescents in an acute-care university hospital in the greater area of Nuremberg between June 1994 and September 1996. Packed red blood cells (RBCs), fresh-frozen plasmas (FFPs) and platelet (PLT) components were evaluated for the recipients discharge diagnoses. Source study files were extracted from the hospital transfusion service and the medical records department. Transfused units were listed by broad diagnostic categories and leading diagnostic groups formed from principal diagnoses of the recipients according to the International Classification of Diseases, 9th edn (ICD-9). 34.3% of 2869 RBC cell units, 35.0% of 1095 FFP units and 5.0% of 1028 PLT components were used in patients with congenital diseases, mainly cardiac defects. The disease category neoplastic diseases was next most frequently associated with blood transfusion diagnosed in recipients of 23.9% of all RBCs, 15.6% of all FFP units and in 66.4% of all PLT units. Malignant diseases and benign haematological diseases (diagnostic categories II and IV) accounted for 68.9% of all costs of blood component transfusion. These findings demonstrate the increased importance of platelet transfusion for the organization of local and regional blood donation programmes and for cost analysis exercises. The study shows that detailed information on local blood use may be obtained quickly using available data collections of transfusion services and medical record departments.

Evaluation of a platelet apheresis technique for the preparation of leukocyte-reduced platelet concentrates.

OBJECTIVES: Reduction of the white blood cell (WBC) contamination in platelet concentrates (PC) protects patients from the immunological and infectious side effects of platelet transfusion caused by WBC. This can be done either by filtration of the PC or by improved apheresis techniques that yield WBC-poor preparations. METHODS: To evaluate an improved technique for platelet collection, we carried out 201 separations in 89 healthy cytapheresis donors using the new COBE Spectra leukoreduction system (LRS) and compared the results with those of standard dual-needle separations obtained with the same cell separator. RESULTS: A small but statistically significant difference was found in platelet collection efficiency in comparison with the standard non-LRS software procedures (LRS: 52.6 vs. 56.3% for the reference). However, median WBC contamination was only 0.01 x 10(6) WBC per LRS product. This significant (p < 0.0005) improvement corresponds to a 10-fold reduction of WBC as compared with the standard dual-needle technique. CONCLUSIONS: The COBE Spectra LRS system produced PCs with a platelet collection efficiency nearly equal to previous techniques and with a residual WBC content satisfying even the most stringent criteria for WBC-depleted blood components. As this purity is achieved without important platelet loss, conventional fiber filtration no longer seems necessary in this kind of PC.

A survey of blood component use in a German university hospital.

BACKGROUND: There are no recent studies on transfusion practice and blood use with regard to diagnoses of European recipients. We conducted a survey of blood component use, including packed red cells, fresh-frozen plasma, and platelets, in an acute-care university hospital in the Greater Nürnberg area. STUDY DESIGN AND METHODS: A survey was carried out of blood component transfusion at a university hospital (Erlangen, Germany) between June 1994 and May 1996. Transfused units were listed by broad diagnostic categories formed from principal diagnoses of the recipients according to the International Classification of Diseases, Ninth Revision. RESULTS: Among 100,497 discharged patients, 6,590 patients who received transfusion (6.6%) are represented in this survey. Of 28,440 red cell units and 8,592 fresh-frozen plasma units, 72.4 percent and 66.9 percent, respectively, were used in patients with neoplastic diseases, circulatory system diseases, or disorders of the digestive system. Of 2704 platelet units, 78.1 percent were transfused to patients with neoplastic or gastrointestinal diseases or diseases of blood-forming organs. These four diagnostic categories accounted for 77.7 percent of all costs of transfusion therapy. Males received 60.1 percent of all blood components transfused, and patients less than 65 years old received 68.0 percent. CONCLUSION: This survey provides information on blood component usage in a German university hospital. It demonstrates the concentration of today's blood utilization among a few diagnostic categories. The study shows that detailed information on local blood use may be obtained quickly by using data available from transfusion services and medical record departments. This information is relevant for quality management of transfusion practice, cost analyses and for planning local and regional blood donation programs.

Stem cell separation in paediatric patients.

We performed 28 separations in 11 children weighing from 14 to 72 kg (median: 27 kg) using either the Cobe Spectra or the Fresenius AS 104 cell separator. For children under 20 kg, human albumin solution was used for the last 200 mL of the priming procedure instead of NaCl. Blood flow was reduced to 30-50 mL min-1 depending on the children's size and weight to prevent citrate reactions. Within 149-337 min we processed three times the patients' total blood volume and collected 309.7 x 10(6) (102.9-1140.0) mononuclear cells (MNC) and 2.01 x 10(6) (1.90-6.50) CD34+ cells per kg body weight. These results were comparable to the results we previously obtained in adults. We conclude from these initial results that peripherae blood stem cells (PBSC) separations, with both devices, can be adapted successfully to the needs of paediatric patients.

Separation of peripheral blood derived stem cells in children.

We performed 28 separations in 10 children from 14 to 44 kg (median: 24 kg) using either the Cobe Spectra or the Fresenius AS 104 cell separator. For children below 20 kg, human albumin solution was used for the last 200 ml of the priming procedure instead of NaCl. Blood flow was reduced to 30 - 50 ml/min depending on the childrens' size and weight to prevent citrate reactions. Within 149 - 337 minutes we processed 3 x the patients' total blood volume and collected 326.9 x 10(6) (76.5-1, 140.0) MNC and 2.03 x 10(6) (0.14-10.12) CD34+ cells per kg body weight. These results were comparable to the results we previously obtained in adults. We conclude from these initial results that PBSC separations with both devices can be adapted successfully to the needs for paediatric patients.

[Iron homeostasis in preoperative autologous blood donation]. / Der Eisenhaushalt bei der präoperativen Eigenblutspende.

OBJECTIVE: The role of iron metabolism, the value and the limits of oral as well as intravenous iron substitution in preoperative autologous blood donation are discussed according to the literature. DATA SOURCES AND SELECTION CRITERIA: The critical review of the German and English literature is based on a Medline backsearch covering the last 20 years. RESULTS: The success of preoperative autologous blood donation substantially depends on the volume of whole-body iron and on the amount of storage iron which is available at the beginning of the donation phase. Since iron losses due to repeated blood donations within a few weeks cannot be replaced sufficiently by food, medical iron substitution seems to be appropriate. Nevertheless, hitherto neither oral nor intravenous iron substitution could be demonstrated as useful instruments for an improvement of erythropoietic response in non iron deficient patients after autologous blood donation. Merely, intravenous iron used in combination with recombinant erythropoietin seems to be an effective support for erythropoiesis during predeposit. CONCLUSIONS: At the moment intravenous iron medication in autologous blood donation should be restricted to well-established exceptional cases. The use of intravenous iron combined with erythropoietin seems to be justified to avoid ineffective erythropoieses and to achieve a dose reduction of recombinant erythropoietin. Since there are nearly no risks and a possible efficacy cannot be totally excluded, oral iron supplementation may be applied to patients who tolerate it well. Real iron deficiency has to be treated with iron application. Further clinical studies have to be done for a final validation of the efficacy of iron substitution in non iron deficient preoperative autologous blood donors.

[18 months experience with a new single needle cytapheresis system (Fresenius AS 104 SN)]. / 18 Monate Erfahrung mit einem neuen Single-needle-Zytapheresesystem (Fresenius AS 104 SN).

BACKGROUND: Since October 1991 the third-generation cell separator Fresenius AS 104 offers a single-needle (SN) option for thrombocytapheresis. Here we present our first 18-month experience with this new single-needle system. MATERIALS AND METHODS: We performed 395 thrombocytaphereses in 225 donors. The influence of blood flow, cycle volume, and interface position on efficacy and leukocyte contamination was evaluated. RESULTS: 395 thrombocytaphereses were performed with an average thrombocyte yield of 3.00 +/- 0.69 x 10(11) platelets and a leukocyte contamination of 1.66 +/- 3.1 x 10(8) per concentrate. Blood flow rates of 50 ml/min (vs. 60 ml/min) and an interface position of 6:2 (vs. 7:1) resulted in a lower leukocyte contamination, but without statistical significance. CONCLUSION: The SN program of the AS 104 provides high thrombocyte yields and less leukocyte contamination than other SN systems, but 77% of the concentrates still contain more than 0.5 x 10(8) leukocytes.