Methods for the selection of platelet products for alloimmune-refractory patients.

The ability to efficiently and accurately diagnose the cause(s) of platelet (PLT) refractoriness is paramount in providing effective PLT products for transfusion. Recent advances in methods for detecting and identifying alloantibodies against human leukocyte antigens (HLAs) and human PLT antigens, combined with accurate molecular techniques for HLA typing, have provided a framework for the development of clinical algorithms to support such patients. Alloantibodies may be detected and/or identified by several methods, including complement-dependent cytotoxicity, enzyme-linked immunosorbent assays (ELISA), and microbead-based assays using Luminex or flow cytometry. The primary difference in these assays is the sensitivity of detection and the range of antibody specificities that may be reliably identified. Direct PLT cross-matching to identify compatible PLTs can be accomplished by several methods, including solid-phase red cell adherence, modified antigen capture ELISA, and flow cytometry. A survey of blood centers and laboratories providing transfusion support has identified the heterogeneity of testing options available, areas of concern and need for improvement, and common obstacles in providing appropriate and timely support to immune-refractory PLT patients. Depending on the testing methods and the pool of HLA-typed PLT donors available, there are numerous options for developing suitable algorithms to provide effective support to immune-refractory PLT patients.

New RHCE variant alleles encoding the D- - phenotype.

BACKGROUND: Variant alleles that do not produce RhCE antigens are rare. Consequently, they pose a challenge to transfusion when found in alloimmunized patients and make blood units valuable when found in donors. STUDY DESIGN AND METHODS: Five index cases and their relatives were studied by both serologic and molecular techniques. Genomic DNA was subjected to microarray genotyping, sequencing, exon scanning, and/or copy number determination assays to identify the RHCE allele(s) responsible for their D+ C- c- E- e- (D- -) phenotype. RESULTS: The five apparent D- - phenotypes were confirmed by molecular methods. Three of them contained unreported RHCE-null alleles, namely, RHCE*Ce-D(3-9)-Ce, RHCE*Ce87_93insT, and RHCE*cE221A. CONCLUSION: Molecular analysis of D- - phenotypes allows the identification of new RHCE-null variants. Conversely, detection of described RHCE-null variants facilitates confirmation of D- - phenotypes in patients and donors, helping improve transfusion safety.

Blood groups and transfusions in pigs.

The blood groups of pigs are important to transplantation research because some are also important transplantation antigens and because pigs undergoing organ or hematopoietic transplantation may require transfusion support. There is considerable literature on the subject but much of it is not in transplant related journals. We will review this literature and also give some practical advice on transfusion support.

Performance evaluation of the application of body fluids on the Sysmex XE-2100 series automated hematology analyzer.

Body fluid analysis on the Sysmex XE-2100 series automated hematology analyzer was evaluated at 4 hospitals (Baylor University Medical Center, Dallas, TX; St. John's Mercy, St. Louis, MO; Carle Clinic, Urbana, IL; and ACL Laboratories, West Allis, WI, USA). The total nucleated cell and red blood cell (RBC) counts of 493 samples were obtained with the Sysmex XE-2100 automated hematology analyzer and compared with results obtained by manual chamber counting. Seventy-eight samples were not suitable for evaluation because of the presence of clots, crystals, error messages related to white blood cell (WBC) and RBC parameters, and so on. Pearson correlation coefficients for the WBC parameter were 0.99 for cerebrospinal fluid, 0.95 for serous fluid, 0.99 for synovial fluid, and 0.99 for samples of combined body fluids. Ninety-six samples were used to compare RBC counting methods because these samples had RBC counts greater than 0.01 10 6/mL. The Pearson correlation coefficients for the RBC parameter were 0.96 for cerebrospinal fluid, 0.97 for serous fluid, 0.97 for synovial fluid, and 0.97 for samples of combined body fluids. Carryover, precision, and linearity studies also performed for WBC and RBC counts yielded very good results.