Guideline development for prevention of transfusion-associated graft-versus-host disease: reduction of indications for irradiated blood components after prestorage leukodepletion of blood components.

Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare, commonly fatal complication of transfusion preventable by irradiation of blood units. The revision of the Dutch transfusion guideline addressed the question whether irradiation is still necessary if blood components are prestorage leukodepleted. We searched for published cases of TA-GVHD following transfusion of prestorage leukodepleted blood and through contacting haemovigilance systems. Six presumed cases were found, dating from 1998 to 2013. Four out of six patients had received one or more non-irradiated units despite recognised indications for irradiated blood components. In the countries providing information, over 50 million prestorage leukodepleted, non-irradiated, non-pathogen-reduced cellular components were transfused in a 10-year period. Potential benefits of lifting indications for irradiation were considered. These include reduced irradiation costs (€ 1.5 million annually in the Netherlands) and less donor exposure for neonates. Findings were presented in an invitational expert meeting. Recommendations linked to human leukocyte antigen similarity between donor and recipient or intra-uterine transfusion were left unchanged. Indications linked to long-lasting deep T-cell suppression were defined with durations of 6 or 12 months after end of treatment (e.g. autologous or allogeneic stem cell transplantation). Need for continued alertness to TA-GVHD and haemovigilance reporting of erroneous non-irradiated transfusions was emphasised.

Comparison of 6 automated assays for total and free prostate-specific antigen with special reference to their reactivity toward the WHO 96/670 reference preparation.

BACKGROUND: Prostate-specific antigen (PSA) assays have historically produced different results. Our aim was to investigate the comparability of assay results of selected commercially available assay methods designed to measure total, free, or complexed PSA (tPSA, fPSA, and cPSA). METHODS: We measured tPSA, fPSA, and cPSA in 70 samples and in the WHO PSA 96/670 reference preparation with 6 assays (Beckman-Coulter Access, Abbott ARCHITECT and AxSYM, Bayer Advia Centaur, DPC IMMULITE 2000, and Roche Modular Analytics E170). We also calculated the fPSA/tPSA ratio. RESULTS: The mean deviations from the expected tPSA and fPSA values for the WHO 96/670 reference preparation were 0.37 (range, 0.01-1.32) and 0.19 (range, 0.05-0.49) microg/L, respectively. When plotted against the expected WHO 96/670 reference preparation value, regression slopes varied from 0.99 to 1.22 and r2 from 0.9996 to 1.000. When total PSA was measured in mixtures of sera with high and low tPSA concentrations, the mean (SD) slope of regression of different assays against an in-house method was 1.04 (0.09). In these specimens, the fPSA/tPSA ratio was 0.11-0.14 with different methods. The tPSA and fPSA values in patient samples measured in different assays and plotted against ARCHITECT gave regression slopes from 0.88 to 0.97. The results of the studied assays for tPSA in serum samples agreed within 15%, from each other, and all results for the WHO 96/670 reference preparation were within 6.8% (confidence interval, 1.7%-15.2%) of the expected value. The results for fPSA were more diverse. CONCLUSIONS: Differences among PSA assays appear to have decreased since introduction of the WHO 96/670 reference preparation, but further efforts are needed to harmonize fPSA assays.