Memorial Blood Centers

BackgroundThe year 2020 presented the transfusion community with unprecedented events and challenges, including the ongoing SARS‐CoV‐2 (COVID‐19) pandemic, and more recently by civil unrest, following the death of George Floyd in late May of 2020. As a level 1 trauma center located in Minneapolis, Minnesota, Hennepin Healthcare (HCMC) offers a unique perspective into the changes in massive transfusion protocol (MTP) activations and usage during this tumultuous period. This may provide insight for addressing similar future events.Study design and methodsMTP logs from March 2020 to August 2020 were compared to logs from March to August 2019. The data were de‐identified, and MTP activations and component usage were categorized by activation reason. These categories were compared across the 2‐year period to examine the impact of COVID‐19, including stay‐at‐home orders, and civil unrest.ResultsFor the examined 6 months of the year 2020, there were a total of 140 MTP activations, compared to 143 in 2019. There were more activations for violent trauma (VT) in 2020 than 2019 (44 vs. 32). This increase in activations for VT was offset by a decrease in non‐trauma activations (54 vs. 66). There was a significant increase in the number of components used in VT activations.DiscussionDuring 2020, the initial mild decrease in MTP activations was followed by a dramatic increase in the number of activations and component usage for VT in June and July of that year.

US blood centers can screen female plateletpheresis donors with a history of one or more pregnancies for both Class I and Class II anti-HLA antibodies using one of two platforms. One is a flow-based assay that yields a quantitative result and the other an enzyme-linked immunosorbent assay (ELISA) that yields either a positive or a negative result (above or below cutoff). The results of HLA antibody screening tests were analyzed by donor ABO group. Results from large and small American blood collection centers using both platforms were analyzed. Positivity rates were compared by chi-square test and the results stratified by parity using the Mann-Whitney test. No differences in parity were noted among donors of different ABO groups, but a significantly higher rate of HLA antibody positivity was observed among group O donors for the ELISA (31% of group O donors vs. 21% of non-group O donors, p < 0.0001). The higher rate of positivity was primarily due to Class I reactivity. This difference in antibody frequency was not observed at centers using the flow-based assay. Centers using the ELISA may have a higher rate of permanent deferral from plateletpheresis donation among group O female donors. Although the reasons for the higher rate of reactivity on Class I ELISA testing are unknown, this could result from test system characteristics or differences in group O donor antibody strength or specificity.

Sweet syndrome is characterized by painful, erythematous cutaneous lesions containing neutrophilic infiltrates. Although more commonly seen in adults, Sweet syndrome has also been recognized in several pediatric cases. Two previous cases of pediatric Sweet syndrome and 1 adult case have been described in chronic granulomatous disease (CGD) patients. We report the case of an infant with known CGD who was presented with methicillin-sensitive Staphylococcus aureus lymphadenitis and subsequently developed Sweet syndrome. CGD patients are prone to several disorders of inflammation. This case illustrates that Sweet syndrome may be part of the spectrum of inflammatory conditions to which CGD patients are predisposed.

The availability of molecular beacon-based, real time polymerase chain reaction (PCR) and a semi-automated sample extraction procedure have made it possible for us to retrospectively examine HCV replication kinetics in HCV naive chimpanzees infected during the past 20 years. We compared these in 17 animals that developed chronic infection, and in 21 that developed self-limited infection. No differences were found in infecting dose, or replication kinetics in the acute phase between these two types of infection. An unanticipated finding was the fact that 10 of 17 animals developing chronic infection partially controlled virus replication for 48 +/- 48 weeks after typical acute phase viraemia, and prior to development of chronic infection. Twenty-nine out of 30 (29/30) sera, which were negative by quantitative PCR during the downregulated period, were, however, positive by the more sensitive Genprobe isothermal transcription-mediated amplification (TMA) assay. Thus, downregulation was not complete. Ten animals showing self-limited infection showed complete resolution of viraemia by TMA assay. Quasispecies analysis revealed that in all, except one case, the virus reappearing after downregulation was essentially identical to that of the originally infecting virus.

Human immunodeficiency virus type-1 (HIV-1) genetic diversity is one of the remarkable characteristics of these viruses, and the mechanisms involved in the selective forces driving HIV-1 evolution are of great interest. Samples from hosts infected with multiple distinct strains represent a valuable in vivo resource to investigate the role of recombination in the natural evolution of HIV-1. This work describes a detailed study regarding the evolution of the envelope gene (env) (C2-V5 region) in a dually infected child who received blood transfusions simultaneously from two distinct HIV-1 infected donors. In this study, we were able to directly compare the data obtained from the dually infected recipient with data obtained from two other singly HIV-1 infected children who had received blood transfusion from each of the two donors. Sequences from the singly infected children clustered into two distinct groups, each related to the respective donor-derived sequence by phylogenetic analysis, and hence were consistent with the epidemiological data. In the case of the dually infected child, a high degree of recombination between the two donor-derived sequences was observed at the C2-V3 region, whereas in the V4-V5 region selection of only one derived donor sequence was seen. Measurement of nonsynonymous versus synonymous substitution rates at each region revealed that negative selection was the main evolutionary force acting on the viral population of the dually infected child, regardless of the genetic mechanism by which each region evolved. Based on direct comparison with data obtained for the two singly infected children we propose that the higher amount of viral diversity observed in HIV-1 multi-infection events, as in the case of the dually infected patient, might contribute to maximizing selective advantage and possibly minimizing immune response. We conclude that recombination shaped by selective forces may increase the adaptive potential of HIV-1.