Vox sanguinis
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Case Reports
Post-transfusion purpura: initiation by leukocyte-poor red cells in a polytransfused woman.
An elderly, multiparous, multiply transfused woman developed post-transfusion purpura (PTP) after the transfusion of 2 units of leukocyte-poor red cells and was successfully treated by plasmapheresis and corticosteroids. Her pre-PTP transfusion history was characterized by frequent, multiple transfusions of platelet antigen-containing blood products 12 to 5.5 years prior to the onset of disease and, apart from the initiating transfusion, only frozen red cells in the 5.5 years immediately preceding the onset of thrombocytopenia. Leukocyte-poor red cells thus appear capable of initiating PTP. Use of a few units of frozen red cells may result in a shorter than normal refractory period, after which time PTP may occur upon exposure to sufficient platelet antigen.
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Historical Article
Modified packed red cells and the development of the circle pack.
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Platelet studies were done in healthy male volunteers and in thrombocytopenic patients. Some of the platelets used in the study were isolated by mechanical apheresis using either the Haemonetics blood processor 30, the IBM blood processor 2997 or the Fenwal CS-3000 blood processor before freezing. Other platelets were isolated from individual units of whole blood and pooled before freezing. ⋯ In the thrombocytopenic patients, in vivo recovery values were 50% of those from fresh platelets. The transfusion of previously frozen washed platelets reduced clinical bleeding in the thrombocytopenic patients with bleeding. There was no evidence of quality deterioration in platelets after storage at -80 degrees C for at least 2 years, as determined from in vivo recovery and in vivo survival values, nor was there any adverse effect as a result of shipment of the frozen platelets in dry ice in polystyrene foam containers from one facility to another.
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Case Reports
The Hey antigen and antibody. A second family study and the first example of an IgG anti-Hey.
A three generation family with 16 members shows that the Hey red blood cell antigen is not in the Rh, P or Kidd systems. The mother of the proband was found to have an IgG component in her anti-Hey, probably the result of alloimmunization by her two Hey-positive children. the wife of the proband who had 1 Hey-positive child, and 4 recipients of a single unit of Hey-positive blood did not have detectable anti-Hey. The presence of the IgG component of the mother's anti-Hey raises the possibility that both hemolytic disease of the newborn (HDN) and hemolytic transfusion reactions (HTR) could occur due to anti-Hey.
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A 24-hours service was organized to study changes in the hemostatic system in surgical patients undergoing massive transfusion for excessive bleeding during operation or in the early postoperative period. Hemostasis tests gave normal results in only 12(7%) of the 172 patients, while in the remaining 160(93%) one or more tests gave abnormal results. The platelet count was the most frequently abnormal, followed by the prothrombin time and plasma fibrinogen. ⋯ These measures also failed to decrease the requirements for whole blood and/or packed red cells. Therefore, indiscriminate administration in the massively transfused postoperative patient of blood components based on preestablished schemes appears to be unjustified. An approach based on hemostasis screening, identification of the underlying disorder, directed therapeutic intervention and laboratory monitoring is likely to be more effective.