Reducing blood donor exposures in low birth weight infants by the use of older, unwashed packed red blood cells.

We performed a prospective, randomized masked trial to determine whether the use of dedicated units of packed red blood cells equipped with seven satellite bags would reduce donor exposures in infants with birth weights < 1500 gm. We also examined the use of unwashed and older red blood cells. Red blood cells given to the study group were used without washing and until their expiration date (35 to 42 days). Changes in blood pH, potassium, ionized calcium, and hemoglobin were determined with each transfusion and compared with data collected from a control group that received washed, younger red blood cells. There was a 64% reduction in donor exposures in the study group. Changes in infants' blood pH and calcium levels with transfusion were the same in the two groups. There was a clinically unimportant difference in potassium levels. A greater rise in hemoglobin values occurred when washed cells were used. There was no correlation between changes in the blood levels measured and the age of unwashed cells infused. We conclude that the use of red blood cells from satellite bag-equipped dedicated units decreases donor exposures, and that the practices of using only younger red blood cells and of saline washing of red blood cells before infusion, are unwarranted.

Congenital rubella syndrome: ophthalmic manifestations and associated systemic disorders.

Congenital rubella syndrome has a wide variety of severe ophthalmic and systemic complications. A worldwide rubella epidemic from 1963 to 1965 affected thousands of infants. This is a 20 year follow up study of patients with congenital rubella syndrome analysing the prevalence of ophthalmic disorders, associated systemic problems, and correlations among these defects. The authors statistically analysed 125 cases of congenital rubella seen in the Mayo clinic ophthalmology department over a 32 year interval. Most patients were young adults. Ocular disease was the most commonly noted disorder (78%), followed by sensorineural hearing deficits (66%), psychomotor retardation (62%), cardiac abnormalities (58%), and mental retardation (42%). Multiorgan disease was typical (88%). Ocular disease and hearing loss were frequently associated (53% had both) but not significantly correlated. A similar association existed between ocular and cardiac disease. Cataracts and microphthalmia were significantly correlated with poor visual acuity (each p < 0.0001). Glaucoma was significantly correlated with cataracts (p = 0.0002) and microphthalmia (p = 0.0024) but not poor visual acuity. Four patients with microphthalmia developed late onset glaucoma. No significant association was found between gestational age at time of maternal infection and the incidence of individual ocular conditions. However, several cardiac disorders were significantly associated with gestational age. Although new cases of congenital rubella are rare, surviving victims continue to challenge the ophthalmic and medical communities with a wide range of ocular and systemic disorders.