Purpose: Critically ill neonates are frequently transfused with packed red cells. Some of these transfused neonates also need chromosome analysis. There is a long-standing tradition in pediatrics of not performing chromosome analysis after transfusion. We wished to determine whether transfusion with packed red cells affect the cytogenetic results in neonates. Method: The medical records of all neonates at the Medical College of Georgia who had had chromosome analysis between June 1995 and June 1998 were reviewed. Ten neonates had received transfusion prior to cytogenetic testing. Of these 10 infants, two had been transfused two or more times. Routine cytogenetic analysis of 20 metaphases at 550-band level had been performed on all 10 patients. Heteromorphic markers were compared in 10 randomly selected metaphases for any discrepancy. To determine whether there were theoretical reasons to delay chromosome analysis in transfused neonates, samples of irradiated, and/or filtered, and nonfiltered blood were obtained from the blood bank and analyzed for the presence of lymphocytes. Results: Prior transfusion did not affect karyotype results. A nonmosaic abnormal karyotype was found in 3 of the 10 patients.A fourth patient's karyotype was 45,X/47,XXX. This mosaicism was constitutive and consistent as demonstrated by a follow-up chromosome analysis. All other abnormal karyotypes were consistent with the dysmorphic phenotype. Randomly selected metaphases did not show any differences in the identifiable heteromorphic markers in all 10 patients. Although there was a 50% chance of patients receiving blood from a donor of opposite sex, there were no instances in which cells with a karyotype of the opposite sex were found in the patients' blood. The irradiated and filtered cultured donor blood samples did not show any metaphases. However, metaphases were seen in the cultures from nonfiltered and nonirradiated donor blood. Conclusions: Based on these results one does not need to delay karyotyping babies who have had blood transfusions. Packed red cell transfusion in newborns does not compromise the accuracy of chromosome analysis in our study even with multiple transfusions. Genetics in Medicine, 2001:3(4):314 -317.
Twenty-nine patients received high-dose chemotherapy and autologous stem cell transplantation from June 1997 to December 1998. The number of CD34+ cells reinfused was 2.4 x 10(6) to 69.0 x 10(6)/kg. Twelve patients developed a fever in the immediate postengraftment period. One patient had a documented infection that could account for the fever; a second patient had a rash and biopsy proven acute graft-versus-host disease (GvHD) that responded to steroids. In the other 10 patients (30%) there was no identifiable cause of the fever. One of these patients received 4.2 x 10(6) CD34+ cells/kg. The other nine received 22.0 x 10(6) to 69.0 x 10(6) CD34+ cells/kg. In our series of 29 patients, 9 of the 11 (82%) patients who received > 20 x 10(6) CD34+ cells/kg developed fever in the postengraftment period. There was a significant association between the number of CD34+ cells (<20 vs. >20 x 10(6)) and occurrence of fever (odds ratio = 76.5; p = 0.00005). Even though they engrafted promptly (7 to 9 days), the fever required evaluation for infection, blood cultures, antibiotic treatment, and observation. This required additional hospitalization of 1 to 7 days. These data suggest that a high number of CD34+ cells is frequently associated with post-engraftment fever and prolongation of the hospital stay. Should there be an upper limit in the number of reinfused CD34+ cells is a question that has to be addressed and possibly studied.
An antibody to a low-incidence antigen was identified in the serum of a nontransfused male patient. The antibody was subsequently identified as anti-Wra and was only detectable at the antihuman globulin (AHG) phase of the crossmatch. Instances of severe hemolytic transfusion reactions have been reported following the transfusion of red blood cells containing low-incidence antigens in patients with antibodies directed toward these antigens (e.g., anti- Wra, -Cob, -Jsa, etc.). Elimination of the AHG phase of the crossmatch can result in either risks or benefits. Since patients seen at this facility primarily have been multitransfused or are multiparous females, the AHG phase of the crossmatch has been maintained. Immunohematology 1997;13:20–22.
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Four methods were investigated to determine their suitability as platelet compatibility procedures: leukoagglutination, lymphocytotoxicity, platelet suspension immunofluorescence and platelet enzyme-linked immunosorbant assay. None of the tests were found to reliably predict the 24-hour-posttransfusion platelet increment in 8 refractory thrombocytopenic patients judged refractory to random donor platelet therapy.
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