Prestorage universal WBC reduction of RBC units does not affect the incidence of transfusion reactions.

BACKGROUND: Febrile nonhemolytic transfusion reaction (FNHTR) has been identified as a pivotal reason for prestorage universal WBC reduction. A regional blood center implemented universal prestorage WBC reduction for RBCs on January 1, 2000. Whether prestorage universal WBC reduction of RBC units will affect FNHTR is not known. STUDY DESIGN AND METHODS: All reports of RBC transfusion reactions at Barnes-Jewish Hospital submitted for evaluation to the blood bank, before and after the implementation of WBC reduction of RBCs, were retrospectively evaluated. RESULTS: For the 36,303 allogeneic RBC transfusions administered in 1999, 85 reactions (0.23%) were reported. These reactions were classified as FNHTR in 43 cases, allergic in 13, delayed hemolytic in 19, and miscellaneous in 10. For the 31,543 non-WBC-reduced RBC transfusions performed in 1999, 78 reactions (0.25%) were reported. These reactions were classified as FNHTR in 39 cases, allergic in 13, delayed hemolytic in 19, and miscellaneous in 7. In the first half of 2000, 32 reactions (0.20%) were reported for 16,093 prestorage WBC-reduced RBC transfusions (p = 0.41). There were 13 FNHTRs and 10 allergic, 7 delayed hemolytic, and 2 miscellaneous reactions. The use of prestorage WBC-reduced RBCs did not significantly affect the rate of reactions classified as allergic (0.04% in 1999; 0.06% in 2000; p = 0.43) or as FNHTR (0.12% in 1999; 0.08% in 2000; p = 0.33). For all patients, universal WBC reduction in 2000 did not reduce the rate of FNHTR from the rate seen with selective bedside WBC reduction, the practice used in 1999 (0.12% in 1999; 0.08% in 2000; p = 0.36). CONCLUSION: No significant difference was found in the incidence of transfusion reactions in patients receiving prestorage WBC-reduced RBCs and non-WBC-reduced RBCs. In addition, no difference was found in transfusion reaction rates when periods of prestorage universal WBC reduction were compared to those of selective WBC reduction.

A comprehensive career ladder for the clinical laboratory.

Retention and promotion of current staff are highly desirable goals for today's clinical laboratory because recruitment and replacement are costly. In the face of balancing these costs with competition for technologists and limited upward mobility within the laboratory, a comprehensive career ladder that expands employee job horizons and gives depth to their jobs is a powerful tool for staff retention and, at the same time, increases the organization's productivity and recruitment potential.

Alloimmunization in patients with warm autoantibodies. A retrospective study employing three donor alloabsorptions to aid in antibody detection.

We examined the value of performing alloabsorptions to detect clinically significant alloantibodies in patients with warm autoantibodies who must receive crossmatch-incompatible blood. One hundred and twenty-five (125) patients were evaluated using alloabsorption with red cells (RBCs) from three donors: R1R1, R2R2, and rr, whose phenotypes other than Rh were selected to exclude 98 percent of clinically significant alloantibodies. This technic was selected rather than autoabsorption due to insufficient quantities of patient cells available and to the possible presence of transfused cells in some instances. Patients were divided into three risk categories: I--no prior pregnancy or transfusion; II--history of pregnancy and/or one to five transfusions; and III--greater than five transfusions. No significant alloantibodies were found in 32 category I patients. Of 74 category II patients, 13 (17.5%) had significant alloantibodies detectable after absorption. Six of 19 (31.5%) category III patients had alloantibodies. The majority showed Rh specificity: anti-E (13), -C (6), -c (2), -D (1). Anti-K was found in five samples. Forty-two (42%) percent of the alloantibodies were undetectable prior to the alloabsorptions. We conclude that category II and particularly category III patients are at significant risk of allosensitization and should be evaluated by an absorption procedure prior to the transfusion of crossmatch-incompatible red cells.

Isolation and serological characterization of a monoclonal antibody recognizing the N blood group antigen.

A mouse hybridoma has been isolated which secretes a hemagglutinating monoclonal antibody (MoAb) recognizing the N and 'N' blood group antigens. This conclusion is based upon the following observations. First, all red cells expressing either N or one of the alleles of Ss (ie, 'N' were strongly agglutinated by the MoAb diluted fourfold. The only cells not reactive were of the M+N-S-s-(U-) and M+N-S-s-(U+) phenotype and cells (J.R. and A.G.) expressing Lepore-type hybrids of the MN and Ss sialoglycoproteins, which do not express N or 'N'. Secondly, red cells of the N+S-s-(U-) phenotype were rendered unreactive to MoAb following treatment of the cells with trypsin, which is known to destroy N antigen activity. Conversely, cells expressing S and/or s maintained their reactivity with MoAb following trypsin treatment, which does not cleave 'N' from the Ss sialoglycoprotein. When spent culture medium containing MoAb was diluted and tested against a panel of red cells, the antibody titer fell into two distinct categories depending upon the MNSs phenotype of the target. Red cells expressing either homozygous or heterozygous N-sialoglycoprotein (N-SGP) were agglutinated by 128-fold diluted MoAb. In contrast, a 16-fold dilution of MoAb was the endpoint for agglutination of cells lacking N-SGP, but expressing S and/or s.