Hematologic engraftment and immune reconstitution posttransplantation with anti-B1 purged autologous bone marrow.

Hematologic engraftment and immune reconstitution were examined in patients who received cyclophosphamide and total body irradiation therapy followed by infusion of autologous bone marrow purged with anti-B1 monoclonal antibody (MoAb) and complement as therapy for non-Hodgkin's lymphoma. Hematologic engraftment was prompt with return of greater than or equal to 0.5 X 10(3)/microL granulocytes and greater than or equal to 2 X 10(4)/microL platelets at a median of 26 and 29 days posttransplant, respectively. Immunologic reconstitution, in contrast, was prolonged. Normal numbers of circulating B cells were consistently noted by five months posttransplant, whereas return of normal immunoglobulin levels in some patients did not occur for one year. Normal numbers of T cells were evident within the first month posttransplant, but a reversed T4:T8 ratio persisted in some patients up to three years. In vitro responses of either B cells to triggers of activation or of T cells to mitogens and antigens were not normal for at least three months posttransplant. Natural killer (NK) cells predominated early after transplant and may demonstrate cytotoxicity against tumor cells. Our studies demonstrate that transplantation with anti-B1 purged autologous bone marrow results in complete hematologic and delayed immunologic engraftment. No significant acute or chronic clinical toxicities have been observed.

Transfusion-acquired human immunodeficiency virus infection among immunocompromised persons.

Transmission of the human immunodeficiency virus (HIV) was studied in a group of patients with cancer who received transfusion of blood components harvested from a single, asymptomatic, seropositive donor. Of ten living recipients, nine had antibodies to the virus in fresh or cryopreserved sera at a median of 384 days (range, 237 to 686) after transfusion. In three patients, an enzyme-linked immunosorbent assay was negative at the same time that Western blot and radioimmunoprecipitation techniques showed seropositivity. Cultures for HIV obtained at a median of 615 days (range, 322 to 714) after transfusion were positive in seven of nine seropositive recipients. Six seropositive recipients have developed immunologic and clinical sequelae of HIV infection at a median of 286 days (range, 56 to 745) after transfusion. The sera of the two patients without clinical sequelae neutralized HIV in an in-vitro assay, whereas the seven other seropositive patients lacked such neutralizing antibodies. Our study characterizes the clinical, serologic, virologic, and immunologic manifestations of HIV infection in immunocompromised persons.

Transfusion-related sepsis after prolonged platelet storage.

The antecubital fossa venipuncture site in frequent blood donors can become scarred or "dimpled" and colonized with surface and deep bacteria that are not sterilized by standard iodophor preparation techniques. These microorganisms can be introduced into blood or platelets at the time of donation. Recent advances that permit the prolonged storage of platelets at room temperature before transfusion allow proliferation of these contaminating bacteria, particularly gram-positive microorganisms. Documented are three episodes of platelet contamination with gram-positive organisms and four cases of sepsis in recipients of these platelets, which were obtained through the "dimpled" site of a single donor and stored for at least 80 hours at 22 degrees C before transfusion. In contrast, platelets harvested from this donor's "dimpled" site and stored for not more than 50 hours were transfused to 25 patients without complication. Therefore, the extended storage of platelets at 22 degrees C prior to transfusion demands strict awareness of any possible sources of extrinsic contamination, since gram-positive bacteria can proliferate under these conditions and result in infectious complications in recipients.

A quick and efficient way to pool platelets.

An easy and efficient method for pooling multiple platelet concentrates is presented. By adaption of a laboratory vacuum system, the process of pooling platelet units was significantly shortened without platelet loss. In our laboratory time study, the use of this pooling system resulted in time savings of 27.5 percent and 35.9 percent during pooling of four-unit and six-unit platelet packs, respectively. Platelet loss by the vacuum method was not distinguishable from that of the hand method (p = 0.4 by two-sample t test).

Blood-group-A-like substance in a preparation of pneumococcal vaccine.

A platelet transfusion from a blood group O donor, immunized 1 month before with Pneumovax, caused a hemolytic reaction in a blood group A recipient. Forty-five of 59 group O donors (76%) and all of nine group B donors immunized with Pneumovax had a fourfold or higher anti-A response. Half of the anti-A antibody in high titered donors was in the IgG fraction. Pneumovax contained approximately 30 micrograms of an A-like substance per dose; polyvalent pneumococcal vaccines prepared by two other manufactures contained very low and probably subimmunogenic concentrations. Several culture media prepared from animal tissues contained as antigen of similar physical, immunologic, and chemical properties, and were the most likely source of the contaminant. Manufacturing procedures have since been revised to eliminate A-like substances.

Pulmonary complications during granulocyte transfusions: incidence and clinical features.

The use of granulocyte transfusions in profoundly neutropenic patients has increased markedly in recent years. Whenever a pulmonary infiltrate develops during the course of these transfusions, the question arises as to what role the transfusions are playing and whether the transfusions should be discontinued to prevent pulmonary deterioration. We have analyzed our recent experience of 593 granulocyte transfusions in 93 patients. 18 patients (19%) developed respiratory compromise or pulmonary infiltrates at some time during the course of granulocyte transfusion. 6 of the 18 cases were reactions to the granulocytes while the remainder were due to fluid overload or other causes. The risk of pulmonary complications did not correlate with the development of cytotoxic leukocyte antibodies, length of transfusion, or concomitant use of Amphotericin. They appeared to be more common in patients with active sepsis. Acute life-threatening pulmonary reactions were rare. Patients receiving granulocyte transfusions should be monitored carefully for pulmonary infiltrates, but other cases should be sought before the transfusions are discontinued.