Transfusion
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Case Reports
Virus-inactivated factor VIII concentrate prevents postoperative bleeding in a patient with von Willebrand's disease.
A patient with von Willebrand's disease underwent cholecystectomy after replacement therapy with a factor VIII concentrate that had been sterilized by treatment with tri(n-butyl)phosphate and Tween 80. The patient received 53 units of factor VIII per kg of body weight prior to operation. ⋯ This replacement regimen prevented excessive bleeding during surgery and supported normal hemostasis during the postoperative period. Analysis of the multimeric pattern and the functional assay of von Willebrand factor in factor VIII concentrates indicated that the procedures utilized for virus inactivation had no significant deleterious effect upon the quality of von Willebrand factor molecules.
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The authors studied retrospectively the formation of clinically significant red cell (RBC) alloantibodies in 958 HLA-typed, multiply transfused patients receiving kidney (603 patients) or liver (263 patients) transplants or plateletpheresis transfusions (92 patients). RBC alloantibodies were found in 91 (9.5%) of these patients and multiple antibodies in 35 (3.7%). Rh (D, C, c, and E) antibodies accounted for 49 percent of the total and Kell antibodies for 31 percent. ⋯ Renal transplant patients with RBC alloantibodies were somewhat more broadly HLA-alloimmunized than were those without RBC alloantibodies. Patient gender did not affect these results. The authors concluded that the immune response to RBC alloantigens is independent of HLA type but is associated with an increased level of HLA antibody formation.