Transfusion of frozen thawed blood stored at -20 degrees C to -25 degrees C.

OBJECTIVE: To determine the clinical efficacy of transfusion of frozen-thawed (FT) red cells using a 5-bag system for freezing (at -20 degrees C to -25 degrees C), storage and reconstitution. DESIGN: A prospective, controlled, non-randomised clinical trial was undertaken with two groups of orthopaedic surgical patients. Nine patients received FT homologous blood and a control group of 10 patients received homologous blood stored in liquid form at 4 degrees C. Five transfusion-dependent patients with medical conditions were also studied. OUTCOME: Thirty-three FT units were transfused without incident to 14 patients. In addition to clinical assessment, haematological and biochemical parameters were monitored after transfusion. There were no clinical side effects and laboratory data were consistent with those after recent surgery or for pre-existing medical conditions and subsequent blood transfusion. On the practical side certain technical difficulties were encountered which improved with experience. CONCLUSIONS: One of the major advantages of the system is the 35-day shelf-life at 4 degrees C after reconstitution. This system has potential for pre-deposit autologous collection, especially where large volume replacement may be required.

High-grade non-Hodgkin's lymphoma complicating polypoid nodular lymphoid hyperplasia and multiple lymphomatous polyposis of the intestine.

Three patients with multiple lymphoid polyps of the small intestine--two with nodular lymphoid hyperplasia and one with multiple lymphomatous polyposis--developed high-grade B-cell lymphomas. A literature search has revealed only 10 previous cases of nodular lymphoid hyperplasia complicated by lymphoma and none of an association between multiple lymphomatous polyposis and high-grade lymphoma.

Haemolysis induced by intravenously-administered immunoglobulin.

Two concurrent cases of haemolysis that was induced by intravenously-administered gamma-globulin are reported. Haemolysis, predominantly as a result of passively-acquired anti-A antibodies, occurred twice in one patient; anti-D antibodies also were incriminated in the first haemolytic episode. Passively-acquired anti-D antibodies that were found in the same batch of gamma-globulin contributed to the haemolytic episode in the second patient. These adverse reactions could have been prevented if a minor crossmatch procedure had been performed before the commencement of intravenous gamma-globulin therapy. It is considered important that manufacturers of intravenously-administered gamma-globulin preparations decide safe titres of these alloantibodies, and that suitable volumes be dispatched with each batch to enable a minor crossmatch procedure to be performed.

Ultraviolet radiometry of clinical sources with a miniature multijunction thermopile.

Three versions of the Dexter 2M miniature multijunction thermopile were evaluated for the radiometry of clinical ultraviolet radiation (UVR) sources. The acceptance angle had been increased in two of these devices, and one also contained an additional ceramic heat sink under its receiver element. Measurements were made of their absolute sensitivity and linearity, and their response to various UVR sources was compared to that of Hilger Schwarz FT17 and FT32 vacuum compensated thermopiles. Both of the acceptance angle modifications yielded an angular response less than that of the wide-angle FT32 thermopile. The additional ceramic heat sink diminished, but did not eliminate, the initial surge in the 2M thermopile output voltage following exposure. Under constant irradiance, the 2M output voltage was stable after the initial surge had decayed, even without the additional heat sink. It was concluded that irradiance measurements should be made after the output voltage had stabilised. Any version of the 2M thermopile could be used for relative day-to-day monitoring of all UVR sources, and the version with the widest acceptance angle could be used for the absolute radiometry of certain extended sources.

Autologous blood transfusion for elective surgery.

Between September 1983 and June 1985, 336 patients were assessed by the Autologous Blood Transfusion Service; 267 men, mean age, 65 (range, 16-75) years, and 40 women, mean age, 63 (range, 40-70) years, participated in the programme (29 patients were excluded as unsuitable). Orthopaedic and vascular surgery accounted for 80% of the cases. Complications were minor even in this elderly group. Surgical and transfusion details for a one-month period were studied retrospectively. Of the surgical cases that required crossmatched blood, 50% were for "emergency" and "burn" surgery, and 50% for elective surgery. Forty-five per cent of this latter group were unsuitable as autologous donors, 21% had participated in the autologous blood transfusion programme, and an additional 34% were deemed to be suitable donors. The realistic upper limits of our autologous blood transfusion programme were determined as being 55% of elective cases that require crossmatched blood. To be efficient an autologous blood transfusion service must be incorporated into an existing homologous blood transfusion service and must complement, rather than replace, homologous blood transfusion.