Washed red blood cells

Primary immunodeficiency diseases

Published in Gabriel Virella, Medical Immunology, 2019

John W. Sleasman, Gabriel Virella

Blood IgA and IgG levels are developmentally regulated, and levels increase with age so the diagnosis of IgA or IgG subclass deficiency requires comparison to age-matched healthy controls. Newborn infants are completely deficient in IgA, and adult levels are not reached until puberty. Selective IgA deficiency is defined by IgA levels <10 mg/dL after age 4 years with normal for age levels of IgG and IgM. There is no effective replacement therapy for selective IgA deficiency, and Ig replacement therapy is not indicated as intravenous IgG does not contain IgA. IgA-deficient patients who require blood transfusions should be given washed red blood cells, and alternatives for plasma infusions should be used. Patients should be educated about their increased risk of reactions to blood products.

Concepts of Replacement Therapy: Blood Components, Blood Derivatives, and Medications

Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019

Francis R. Rodwig

Another common response to transfusion is an allergic reaction, with rash and/or hives and itching, usually without fever. This recipient immune response is directed against soluble proteins in the donor plasma. If urticaria is the only symptom noted, the transfusion can be temporarily discontinued while an antihistamine (e.g., diphenhydramine, 25–50 mg, either orally or intravenously) is administered. If the symptoms are resolved quickly, the transfusion can be restarted. Pretreatment with an oral antihistamine can usually prevent such reactions in susceptible patients. Washed red blood cells may be needed in patients who are refractory to these measures. Anaphylactic reactions can occur, with the classic symptoms of a severe allergic reaction, including apprehension, laryngeal and facial edema with respiratory compromise, nausea, vomiting, loss of consciousness, and shock. This reaction is most often seen in patients with a congenital IgA deficiency, but may be seen in other conditions (31). Aggressive treatment of the anaphylaxis is needed, which includes stopping the transfusion, establishing or maintaining intravenous access, and the use of epinephrine. Airway protection and the use of corticosteriods may be needed. Preventative measures should include the use of blood products with the plasma removed, or blood or components from IgA-deficient donors.

Published in Ronald M. Atlas, James W. Snyder, Handbook Of Media for Clinical Microbiology, 2006

Ronald M. Atlas, James W. Snyder

Preparation of Medium: Add components, except blood, to distilled/deionized water and bring volume to 1.0L. Mix thoroughly. Adjust pH to 8.0. Place in a steam bath for 30 min. Do not autoclave. Cool to 45°-50°C. Add 50.0mL of washed red blood cells. Mix thoroughly. Pour into sterile Petri dishes. Dry plates before using.

Quantification of cotinine in dried blood spots as a biomarker of exposure to tobacco smoke

Published in Biomarkers, 2018

Daniel Ladror, Bruce Pitt, William Funk

Comparisons between cotinine levels in plasma/serum and DBS samples must be made with caution. While very strong correlations were observed between match plasma samples and reconstituted DBS samples, reconstituted DBS samples were prepared using washed red blood cells that were collected from a nonsmoker. As a result, red blood cells that were present in these samples would not be expected to contribute to the cotinine levels in these reconstituted DBS samples. However, in DBS samples collected directly via finger or heel prick, the measured levels of cotinine will be influenced by cotinine in and/or bound to red blood cells. For example, cotinine has been previously been observed to bind to sulfhydryl groups on the surface of the red blood cell membrane (Asgary et al.2005). While we found that in blood samples spiked with cotinine the ratio of cotinine between plasma and whole blood stabilized after approximately one hour, the cotinine plasma to whole blood ratio was greater for samples with lower total cotinine levels (6.22 ng/mL) than higher total cotinine levels (64.8 ng/mL), with ratios of 1.43 and 1.22, respectively. These results indicate that partitioning of cotinine into the red blood cells and/or binding of cotinine to the red blood cell membranes is influenced by the overall cotinine concentrations in blood. While further studies are required to confirm these results, these findings suggest that whole blood (e.g. DBS samples) may provide a better estimate of tobacco smoke exposure than plasma/serum, because whole blood captures total blood cotinine levels, and therefore would not be influenced by the effects of differential partitioning of cotinine across blood fractions at different blood cotinine levels.