We evaluated the efficacy of two skin disinfectants (10% povidone iodine vs. 0.5% chlorhexidine gluconate) at the donor phlebotomy site against three different species of bacteria (Bacillus cereus, coagulase-negative staphylococci, Propionibacterium acnes). The growth of Bacillus cereus in apheresis-derived platelet concentrates was very rapid with a doubling time of 6 hours, and reached 107CFU/ml within 72 hours. When RC-MAP prepared from whole blood inoculated with Bacillus cereus was stored at 4°C, growth of Bacillus cereus was stopped for 21 days. However, when storage temperature was increased to 22°C on Days 7 or 21, rapid proliferation occurred as was observed in apheresis-derived platelets experiments. Bacterial proliferation was also observed in buffy coat and platelet-poor plasma prepared from whole blood. No difference was seen between 10% povidone iodine and 0.5% chlorhexidine gluconate in the efficacy of disinfectants against coagulase-negative staphylococci and Propionibacterium acnes. However, disinfection of Bacillus cereus was achieved with 10% povidone iodine only. Bacillus cereus showed proliferation in all blood components. These results suggest that donor skin disinfectant should be done using 10% povidone iodine in any blood collection.
Blood type without the Gregory (Gya) antigen, a high frequency antigen, is extremely rare. A woman showing Gy (a-) received anti-Gya antibody during pregnancy. Two infants born to the woman developed hemolytic disease. There has been no previous report of hemolytic disease in infants born to mothers with anti-Gya antibody. In the present case, the results of a positive direct anti-globulin test on cord blood cells differed from those reported previously. Furthermore, there have been no previous reports describing the IgG subclass in Gy (a-) subjects (IgG1, and IgG4 in the present case). During perinatal care of a pregnant woman with anti-Gya antibody, it is important to provide compatible blood; the present case suggests that transfusion management in these women should consider the possibility of hemolytic disease occurring in the newborn.
A 46-year-old female patient who developed acute myelogenous leukemia in October, 1995, required red blood cell transfusion from day 9 and continuous platelet transfusion from day 13 after the beginning of antileukemic chemotherapy. When total transfused platelets reached 130 units, platelet transfusion refractoriness (PTR) occurred. A high anti-HPA-5a antibody titer (×4, 096) was detected using the MPHA method when 300 units were transfused. The antibody titer declined thereafter, but the antibody and PTR lasted throughout the clinical course, whereas anti-HLA antibody was not detected. There were no physical signs that caused the persistent PTR. HPA-matched platelet transfusion was tried once around the terminal stage of the disease, but efficacy was not confirmed because of the presence of severe infection and bleeding tendency. These findings therefore suggest this to be a unique case in that anti-HPA-5a antibody alone caused platelet transfusion refractoriness.