Correspondence DOUGLAS HUESTIS, Editor Tucson,Arizona Methodology Clarified
paper, as published, did not properly underscore the critical evaluation of serologic discordance grading that is still in progress in our laboratory.-Elias Cohen. Ph. D., Associate Chief Cancer Research Scientist. Roswell Park Memorial Institute, Buflalo, N . Y . The foregoing letter was submitted to Mr. Mishler for his comments, which follow:
To the Editor: Some of the methods described in the recent paper by Mishler et a1 (Transfusion 14:352, 1974) require a clarification. The manuscript was submitted for publication by the first author, without my prior review and permission as one of the co-authors. On page 354, paragraph 3, lines 1 and 2 should be corrected to: In an effort to determine the relationship of donor-recipient histocompatibility to the postinfusion leukocyte level, a series of studies was conducted. The microlymphocytotoxicity typing method of Amos et all was employed and the donor versus recipient results were expressed as follows: per cent serologic discordance = (total number of discordant antigens or reactions/total number of sera used) x 100. On page 355, paragraph 1 should be corrected by substituting the word “serologic” wherever the letters “HL-A” appear. On page 355, paragraph 6 should be corrected by deleting the letters “HL-A” and inserting the word serologic before “discordance,” in lines 9 and 14. In addition, I gratefully acknowledge the technical assistance of Shirley G. Gregory, M.A., M.T. (A.S.C.P.), Usha Khurana, and Carol Cox for the tissue typing. The typing of donors and recipients for I I major HL-A antigens was possible through reagent sera provided by Dr. Donald Kayhoe, Immunology Branch, National Institutes of Health, Bethesda, Maryland. Effective utilization of serologic discordance is totally dependent upon the specificity of the reagent sera selected for HL-A and non-HL-A typing of-lymphocytes or other blood cells. The
To the Editor: In response to the letter from Dr. Elias Cohen, the following points should be clarified. Prior to submission of the manuscript to the journal, a draft was sent to Dr,. Donald Higby and to Dr. J. F. Holland for their comments, corrections, etc. Only after their approval was received was the manuscript submitted for consideration for publication. While it is true that the collection of data reported in the paper was done in Dr. Cohen’s laboratories, report and analysis of data pertaining to granulocyte replacement therapyl.2 were done solely by the paper’s first author (JMM). In the article in question, only a brief review of the data on serologic discordance was presented. All points mentioned in Dr. Cohen’s letter have been thoroughly detailed in further written’.2 and oral3 presentations. I hope this will clarify any questions raised by Dr. Cohen. Thank you for the opportunity to respond.-John M . Mishler, M . S c . , Clinical Coordinator. McCaw Laboratories. Glendale. Gal$
Red Blood Cell Transfusions To the Editor:
We were greatly interested in Becker and Aster’s article on red blood cell transfusions
302 Transfusion May-June 1975
Volume 15 Number 3
Volume I5 Numkr 3
303
CORRESPONDENCE
(Transfusion 12:109, 1973). This paper appeared just as we were evaluating our 20-year experience with packed red cell preparations in the hope of achieving further improvement. We agree completely with Becker and Aster that one must first explain to hospital physicians the advantages of red blood cells. Physicians are generally not well informed about this and may consider red blood cells a less valuable byproduct. The negative viewpoint tends to be aggravated by some technical problems encountered in transfusion and related to the higher viscosity of red blood cells: e.g., slow filtration and flow, and the need for a wider caliber needle. Once these obstacles are overcome and the undoubted advantages of red blood cells are appreciated, particularly for anemic patients, red blood cells become more in demand than whole blood. Our transfusion service supplies about 4,000 beds. We have prepared packed red blood cells since 1953. Originally, we were preparing some units as resuspended red blood cells (in the glucose-saccharose-citrate solutions #8 and 2 of the Central Institute of Hematology and Blood Transfusion, Moscow) and some as concentrated red cells in only their residual plasma. Later, after it had been shown that ordinary packed red blood cells survive better in the recipient than those resuspended in glucosesaccharose-citrate (reference available from authors), we stopped supplying the resuspended cells. The production and usage of red blood cells in the years 1960 to 1973 is shown in Table 1. The outdating of red blood cell units ranged from 3 to 8 per cent. Table I shows the frequency of reactions after red blood cell transfusions, which was higher than after whole blood. We attribute this to the fact that we deal exclusively with blood in glass bottles. Most reactions were febrile, less often allergic. We ascribed three reactions to bacterial toxins. Considering that from 1960 to 1973, 99,515 units of red blood cells were transfused, the frequency of reactions is inconsequential and we consider red blood cell transfusions quite safe. Further safety is checked by bacteriologic culture of the plasma removed from each unit and also by cultures from random bottles of red blood cells on each production day. Contaminated units were, of course, discarded. Plasma contamination ranged from 0.34 to 2.08 per cent, and 13 of 5,063
Table 1. Amount of Packed Red Blood Cells Prepared and Transfused, and the Percentage of Reactions in Recipients (1960- 19731
Year
Produced (liters)
Transfused (liters)
Percentage of React ions
1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973
2.207 2,466 1,906 1,837 1,920 1,999 2,362 2,468 1,934 2,062 2,496 3,167 2,601 3.1 46
2,142 2.447 1,661 1,827 1,765 1,964 2,360 2,346 1,857 1,896 2,256 2,999 2,456 3.017
0.4 0.4 0.7 0.6 0.4 0.6 0.4 1 .o 0.6 0.6
1.1 0.1 0.3
Table 2. Milliliters Transfused per Bed per Year in the Teaching Hospital
Department
Whole Blood
Red Blood Cells
Surgery Gynecology-Obstetrics Medicine Pediatrics Other
1,300 890 47 0 270 150
1,200 790 590 30 150
cultures of red blood cell units (0.25%) gave positive cultures. Red blood cells have been found useful in all clinical fields. Table 2 gives our current usage, as represented by the amounts used per bed per year in the teaching hospital in Bratislava. With the exception of pediatrics, where technical difficulties were encountered, more red blood cells were used than whole blood (2/3 to :% of all transfusions). We agree with the idea that 60 to 80 per cent of all transfusions not only can but should consist of packed red blood cells, in the interest of effective hemotherapy. This approaches the concept of “made to order” transfusion.-M. Hrubisko. B. Busova, J . Mayer. Department o/ Hematology and Blood Transfusion, 801 00 Bratislava, Part izanska 4 , Czechoslovakia.
paper, as published, did not properly underscore the critical evaluation of serologic discordance grading that is still in progress in our laboratory.-Elias Cohen. Ph. D., Associate Chief Cancer Research Scientist. Roswell Park Memorial Institute, Buflalo, N . Y . The foregoing letter was submitted to Mr. Mishler for his comments, which follow:
To the Editor: Some of the methods described in the recent paper by Mishler et a1 (Transfusion 14:352, 1974) require a clarification. The manuscript was submitted for publication by the first author, without my prior review and permission as one of the co-authors. On page 354, paragraph 3, lines 1 and 2 should be corrected to: In an effort to determine the relationship of donor-recipient histocompatibility to the postinfusion leukocyte level, a series of studies was conducted. The microlymphocytotoxicity typing method of Amos et all was employed and the donor versus recipient results were expressed as follows: per cent serologic discordance = (total number of discordant antigens or reactions/total number of sera used) x 100. On page 355, paragraph 1 should be corrected by substituting the word “serologic” wherever the letters “HL-A” appear. On page 355, paragraph 6 should be corrected by deleting the letters “HL-A” and inserting the word serologic before “discordance,” in lines 9 and 14. In addition, I gratefully acknowledge the technical assistance of Shirley G. Gregory, M.A., M.T. (A.S.C.P.), Usha Khurana, and Carol Cox for the tissue typing. The typing of donors and recipients for I I major HL-A antigens was possible through reagent sera provided by Dr. Donald Kayhoe, Immunology Branch, National Institutes of Health, Bethesda, Maryland. Effective utilization of serologic discordance is totally dependent upon the specificity of the reagent sera selected for HL-A and non-HL-A typing of-lymphocytes or other blood cells. The
To the Editor: In response to the letter from Dr. Elias Cohen, the following points should be clarified. Prior to submission of the manuscript to the journal, a draft was sent to Dr,. Donald Higby and to Dr. J. F. Holland for their comments, corrections, etc. Only after their approval was received was the manuscript submitted for consideration for publication. While it is true that the collection of data reported in the paper was done in Dr. Cohen’s laboratories, report and analysis of data pertaining to granulocyte replacement therapyl.2 were done solely by the paper’s first author (JMM). In the article in question, only a brief review of the data on serologic discordance was presented. All points mentioned in Dr. Cohen’s letter have been thoroughly detailed in further written’.2 and oral3 presentations. I hope this will clarify any questions raised by Dr. Cohen. Thank you for the opportunity to respond.-John M . Mishler, M . S c . , Clinical Coordinator. McCaw Laboratories. Glendale. Gal$
Red Blood Cell Transfusions To the Editor:
We were greatly interested in Becker and Aster’s article on red blood cell transfusions
302 Transfusion May-June 1975
Volume 15 Number 3
Volume I5 Numkr 3
303
CORRESPONDENCE
(Transfusion 12:109, 1973). This paper appeared just as we were evaluating our 20-year experience with packed red cell preparations in the hope of achieving further improvement. We agree completely with Becker and Aster that one must first explain to hospital physicians the advantages of red blood cells. Physicians are generally not well informed about this and may consider red blood cells a less valuable byproduct. The negative viewpoint tends to be aggravated by some technical problems encountered in transfusion and related to the higher viscosity of red blood cells: e.g., slow filtration and flow, and the need for a wider caliber needle. Once these obstacles are overcome and the undoubted advantages of red blood cells are appreciated, particularly for anemic patients, red blood cells become more in demand than whole blood. Our transfusion service supplies about 4,000 beds. We have prepared packed red blood cells since 1953. Originally, we were preparing some units as resuspended red blood cells (in the glucose-saccharose-citrate solutions #8 and 2 of the Central Institute of Hematology and Blood Transfusion, Moscow) and some as concentrated red cells in only their residual plasma. Later, after it had been shown that ordinary packed red blood cells survive better in the recipient than those resuspended in glucosesaccharose-citrate (reference available from authors), we stopped supplying the resuspended cells. The production and usage of red blood cells in the years 1960 to 1973 is shown in Table 1. The outdating of red blood cell units ranged from 3 to 8 per cent. Table I shows the frequency of reactions after red blood cell transfusions, which was higher than after whole blood. We attribute this to the fact that we deal exclusively with blood in glass bottles. Most reactions were febrile, less often allergic. We ascribed three reactions to bacterial toxins. Considering that from 1960 to 1973, 99,515 units of red blood cells were transfused, the frequency of reactions is inconsequential and we consider red blood cell transfusions quite safe. Further safety is checked by bacteriologic culture of the plasma removed from each unit and also by cultures from random bottles of red blood cells on each production day. Contaminated units were, of course, discarded. Plasma contamination ranged from 0.34 to 2.08 per cent, and 13 of 5,063
Table 1. Amount of Packed Red Blood Cells Prepared and Transfused, and the Percentage of Reactions in Recipients (1960- 19731
Year
Produced (liters)
Transfused (liters)
Percentage of React ions
1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973
2.207 2,466 1,906 1,837 1,920 1,999 2,362 2,468 1,934 2,062 2,496 3,167 2,601 3.1 46
2,142 2.447 1,661 1,827 1,765 1,964 2,360 2,346 1,857 1,896 2,256 2,999 2,456 3.017
0.4 0.4 0.7 0.6 0.4 0.6 0.4 1 .o 0.6 0.6
1.1 0.1 0.3
Table 2. Milliliters Transfused per Bed per Year in the Teaching Hospital
Department
Whole Blood
Red Blood Cells
Surgery Gynecology-Obstetrics Medicine Pediatrics Other
1,300 890 47 0 270 150
1,200 790 590 30 150
cultures of red blood cell units (0.25%) gave positive cultures. Red blood cells have been found useful in all clinical fields. Table 2 gives our current usage, as represented by the amounts used per bed per year in the teaching hospital in Bratislava. With the exception of pediatrics, where technical difficulties were encountered, more red blood cells were used than whole blood (2/3 to :% of all transfusions). We agree with the idea that 60 to 80 per cent of all transfusions not only can but should consist of packed red blood cells, in the interest of effective hemotherapy. This approaches the concept of “made to order” transfusion.-M. Hrubisko. B. Busova, J . Mayer. Department o/ Hematology and Blood Transfusion, 801 00 Bratislava, Part izanska 4 , Czechoslovakia.
