Prevention of transfusion-acquired cytomegalovirus infections in newborn infants.

Transfusion-acquired cytomegalovirus infections occurred in 13.5% of 74 infants of seronegative mothers who were exposed to one or more blood donors who had a CMV indirect hemagglutination titer of 1:8 or higher. None of 90 infants of seronegative mothers exposed only to donors with CMV IHA titers of less than 1:8 became infected. Ten of 41 (24%) infants of seronegative mothers who received more than 50 ml of packed red blood cells and who were exposed to at least one seropositive donor became infected. None of 23 infants of seronegative mothers who received this amount of blood but who were exposed only to seronegative donors became infected. Fatal or serious symptoms developed in 50% of the infected infants of seronegative mothers and in none of the 32 infected infants of seropositive mothers. Acquired CMV infections occurred in 15% of infants of seropositive mothers who were exposed to the red blood cells of seropositive donors and in 17.6% of infants of seropositive mothers exposed only to seronegative donors. Use of seronegative donors reduced the prevalence of excretion of CMV among hospitalized infants who were 4 weeks of age or older from 12.5 to 1.8% and eliminated acquired CMV infections in infants of seronegative mothers.

New transfusion program for an intensive care nursery.

We have established a new transfusion program for an intensive care nursery which is based on crossmatching several infants to the same unit of type O Rh0(D) negative packed red blood cells, dividing the unit into quadpacks, and allowing multiple entry into each quadpack over a 24-hour period in the nursery. With this procedure, each donor unit can be used to provide multiple transfusions to four infants over a four-day period. Follow-up of transfusion recipients revealed that 20% had evidence of previous or ongoing CMB infection at 10 months of age, a prevalence comparable to that for transfused infants in other studies. We found no evidence for transmission of HB infection and a low risk of allosensitization to red cell and lymphocyte antigens.

A new low incidence red blood cell antigen, Pe.

A new low incidence red cell antigen (Pe), and its identifying IgG antibody are described. The antigen is destroyed by enzymes and is absent from serum, urine, saliva, and platelets. The Pe gene frequency is estimated to be less than 0.0003, and the Pe locus does not appear to be linked to Rh or Fy, nor carried by the X or Y chromosomes. The clinical significance of this antibody remains to be determined.

Nonhemolytic IgG anti-IT.

Nonhemolytic, IgG, anti-IT autoantibodies were found in the sera of three Caucasian patients, none of whom had Hodgkin's disease. Each antibody reacted by indirect antiglobulin test. Two of the three also reacted in albumin at 37 C, and one of these was moderately enhanced by papain. As judged by transfusion responses, reticulocyte counts, hematocrit stability, and one hour 51Cr red blood cell survivals, none of the antibodies were considered to be hemolytic. When tested with anti-IgG serum, cells from all three had a positive direct antiglobulin test. Anti-IT antibody was eluted from their cells. Ii status of the patients' cells differed from normal in each case. These data suggest greater variation in the disease association, serologic reactivity, and clinical significance, of anti-IT than has been evident from previous studies.

Modified microtiter tray method for blood typing.

A simple technique for red blood cell typing is described utilizing V-bottom microtiter trays with cell suspensions of 0.2%. This technique is many times more sensitive than tube or slide methods and can be used for direct agglutination, antiglobulin tests and mixed field agglutination.

Clinical value of washed-platelet concentrates in patients with non-hemolytic transfusion reactions.

In patients with severe allergic reactions to plasma proteins it is possible to observe such reactions to even the small quantity of plasma contained in platelet concentrates. A platelet washing solution was designed, and platelet concentrates for four such patients were washed before infusion. Transfusion reactions were completely eliminated by the washing procedure. Platelet recovery was equivalent to that of unwashed platelets, and hemostatic effectiveness of the infused platelet concentrates was evidenced by abrupt cessation of bleeding episodes, including purpura and hematuria. Platelet washing represents a valuable, rapid and simple approach to the problem patient with thrombocytopenia and severe reactions to plasma proteins.

Evaluation of a walking-donor blood transfusion program in an intensive care nursery.

A prospective study was carried out to identify the immediate and long-range advantages and disadvantages of a walking-donor transfusion program for an intensive care newborn nursery. The effect of heparin on coagulation of blood was evaluated and found to be minimal. There was no evidence of transmission of HBSAg. The prevalence of CMV infection at the time of follow-up was higher in infants who had received blood from donors seropositive for CMV than in infants who had been transfused from seronegative donors. In our experience, a walking-donor program has been a safe and effective method for the provision of small transfusions of blood to sick neonates.