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  • 1.
    Almroth, Gabriel
    et al.
    Linköping University, Department of Medical and Health Sciences, Nephrology. Linköping University, Faculty of Health Sciences.
    Berlin, Gösta
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Andersson, Bengt
    Sahlgrens University Hospital.
    Hahn-Zoric, Mirjana
    Sahlgrens University Hospital.
    Long-term treatment results and the immunoglobulin G subclass distribution patterns of proteinase-3-antineutrophil cytoplasm antibody (ANCA) and myeloperoxidase-ANCA in ANCA-associated vasculitis2009In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 43, no 2, p. 160-170Article in journal (Refereed)
    Abstract [en]

    Objective: Small vessel vasculitis associated with antibodies to neutrophil cytoplasm antigens has been denominated antineutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV).

    Material and methods: Ninety-eight patients with various forms of AAV with renal involvement were studied retrospectively with regard to treatment, side-effects and outcome. The immunoglobulin G (IgG) subclass distribution patterns in serum were determined in 51 patients with nephelometry and those of anti-proteinase-3 (PR3) and anti-myeloperoxidase (MPO) in 44 patients by enzyme-linked immunosorbent assay.

    Results: Fifty-nine patients with a mean age of 63 years were given treatment with intermittent intravenous regimens of cyclophosphamide and continuous corticosteroids, whereas 39 patients with a mean age of 58 years were given continuous oral treatment. Malignancy, mainly due to skin tumours, was more common in AAV than in the general population. The total IgG subclass distribution pattern was asymmetric. The response to PR3 was of IgG1, IgG3 and IgG4 isotypes, while IgG1 and IgG3 predominated in the response to MPO.

    Conclusion: The aberrant IgG subclass distribution pattern detected in the autoantibodies may be of importance in the pathogenesis of AAV.

  • 2.
    Backteman, K
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Immunology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Ledent, E
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Berlin, Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Ernerudh, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Immunology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    A rapid and reliable flow cytometric routine method for counting leucocytes in leucocyte-depleted platelet concentrates2002In: Vox Sanguinis, ISSN 0042-9007, E-ISSN 1423-0410, Vol. 83, no 1, p. 29-34Article in journal (Refereed)
    Abstract [en]

    Background and Objectives: To ensure a proper quality control it is important to use a reliable method to count low numbers of leucocytes in leucocyte-reduced platelet concentrates (PCs). Materials and Methods: A modified flow cytometric method for counting low numbers of leucocytes, based on a reference population contained in tubes with an exact number of fluorescent beads and staining with propidium iodide was used. To increase the number of events, the original sample volume was increased. Results: There was a good correlation in the number of leucocytes (r = 0.99) between the modified flow cytometric method and microscopy of samples from unfiltered and expected numbers from serially diluted PCs. Samples from leucocyte-reduced PCs obtained by apheresis or filtered buffy coats showed no correlation between results from the modified flow cytometric method and microscopy (Nageotte). Conclusion: Counting by microscopy gave a lower number of leucocytes than the modified flow cytometric method when counting a low number of cells. However, analysis of the serially diluted PCs proved that the modified flow cytometric method was reliable and rapid, making it suitable for clinical routine use.

  • 3.
    Berlin, Gösta
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Challoner, KE
    Woodson, RD
    Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Low-O2 affinity erythrocytes improve performance of ischemic myocardium2002In: Journal of applied physiology, ISSN 8750-7587, E-ISSN 1522-1601, Vol. 92, no 3, p. 1267-1276Article in journal (Refereed)
    Abstract [en]

    O2 transport and O2 diffusion interact in providing O2 to tissue, but the extent to which diffusion may be critical in the heart is unclear. If O2 diffusion limits mitochondrial oxygenation, a change in blood O2 affinity at constant total O2 transport should alter cardiac O2 consumption (VO2) and function. To test this hypothesis, we perfused isolated isovolumically working rabbit hearts with erythrocytes at physiological blood-gas values and P50 (PO2 required to half-saturate hemoglobin) values at Ph of 7.4 of 17 ▒ 1 Torr (2,3-bisphosphoglycerate depletion) and 33 ▒ 5 Torr (inositol hexaphosphate incorporation). When perfused at 40 and 20% of normal coronary flow, mean VO2 decreased from the control value by 37 and 46% (P < 0.001), and function, expressed as cardiac work, decreased by 38 and 52%, respectively (P < 0.001). Perfusion at higher P50 during low-flow ischemia improved VO2 by 20% (P < 0.001) and function by 36% (P < 0.02). There was also modest improvement at basal flow (P < 0.02 and P < 0.002, respectively). The improvement in VO2 and function due to the P50 increase demonstrates the importance of O2 diffusion in this cardiac ischemia model.

  • 4.
    Berlin, Gösta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Cherif, Honar
    Akademiska sjukhuset - Hematologiska kliniken Uppsala, Sweden Akademiska sjukhuset - Hematologiska kliniken Uppsala, Sweden.
    Knutson, Folke
    Akademiska sjukhuset - Klinisk immunologi och transfusionsmedicin Uppsala, Sweden Akademiska sjukhuset - Klinisk immunologi och transfusionsmedicin Uppsala, Sweden.
    Mattsson, Jonas
    Karolinska Universitetssjukhuset - Centrum för allogen stamcellstransplantation Stockholm, Sweden .
    Axdorph Nygell, Ulla
    Karolinska Universitetssjukhuset - Klinisk immunologi och transfusionsmedicin Stockholm, Sweden .
    Granulocyttransfusion bör övervägas vid neutropeni och allvarlig infektion [Granulocyte transfusion – when and how should it be used?]2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, article id EXUUArticle, review/survey (Refereed)
    Abstract [en]

    There are no randomized controlled trials proving the clinical benefit of granulocyte transfusions. However, clinical experience and a number of case studies suggest that granulocyte transfusions may be life-saving in certain situations. In our opinion granulocyte transfusions should be considered for patients with profound neutropenia and severe, life-threatening infection not responding to antibiotic or antifungal therapy. Since the clinical effect seems to be dose-dependent, the granulocyte concentrate should contain a large number of cells, which usually means that the donor should be mobilized with steroids and G-CSF. Regular blood donors as well as relatives to the patient can be used for granulocyte donations with apheresis technique after information of the process. Granulocyte transfusion should be given daily as long as the indication remains. The clinical efficacy of the transfusions should be evaluated daily.

  • 5.
    Berlin, Gösta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Cherif, Honar
    Akademiska sjukhuset - Hematologiska kliniken Uppsala, Sweden Akademiska sjukhuset - Hematologiska kliniken Uppsala, Sweden.
    Knutson, Folke
    Akademiska sjukhuset - Klinisk immunologi och transfusionsmedicin Uppsala, Sweden Akademiska sjukhuset - Klinisk immunologi och transfusionsmedicin Uppsala, Sweden.
    Mattsson, Jonas
    Karolinska Universitetssjukhuset - Centrum för allogen stamcellstransplantation Stockholm, Sweden Karolinska Universitetssjukhuset - Centrum för allogen stamcellstransplantation Stockholm, Sweden.
    Axdorph Nygell, Ulla
    Karolinska Universitetssjukhuset - Klinisk immunologi och transfusionsmedicin Stockholm, Sweden Karolinska Universitetssjukhuset - Klinisk immunologi och transfusionsmedicin Stockholm, Sweden.
    Replik gällande granulocyttransfusion: Rekommendationerna är väl underbyggda2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115Article in journal (Refereed)
  • 6.
    Berlin, Gösta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Transfusion Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Östergötland satsar på klinisk forskning2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 3, p. 81-84Article in journal (Other academic)
    Abstract [sv]

    Flera rapporter har visat att svensk klinisk forskning under senare år har tappat mark i förhållande till omvärlden.Inom Östergötland har landstinget och den medicinska fakulteten vid Linköpings universitet (Hälsouniversitet) tagit gemensamma initiativ för att ge bättre förutsättningar för klinisk forskning kombinerat med sjukvårdsarbete.

    Åtgärdsplanen »FoU i befattningsutvecklingen« slår fast sjukvårdens uppdrag och roll inom klinisk forskning.

    Årliga FoU-bokslut görs för sjukvårdsenheterna.

    Projektet »Från student till docent« syftar till att rekrytera studenter från de olika utbildningarna i vård och medicin till forskning redan under studietiden och därefter ge möjligheter att bedriva forskarutbildning och fortsatt forskning kombinerat med klinisk karriär.

    Tidsbegränsade forskningsbefattningar inom sjukvården har inrättats för medarbetare med legitimationsyrken.

    Infrastrukturen kring klinisk forskning med olika typer av kompetensstöd för den enskilda forskaren har stärkts.

  • 7.
    Ernerudh, Jan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Immunology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Berlin, Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Ekerfelt, Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Immunology.
    The use of cell products for treatment of autoimmune neuroinflammatory diseases2002In: Current Medicinal Chemistry, ISSN 0929-8673, E-ISSN 1875-533X, Vol. 9, no 16, p. 1497-1505Article in journal (Refereed)
    Abstract [en]

    Cell products are live cells that are given to patients in order to replace or modify the function of missing or dysfunctional cells. Progress in technology and in the understanding of pathobiology may lead to the use of cell products in many areas. This review outlines the use of cell products in the treatment of autoimmune diseases, with focus on neuroinflammatory diseases like multiple sclerosis. Treatment of autoimmune diseases should be selective and specific in order to avoid serious side effects. To achieve this, T lymphocyte regulation has been in focus for several immunomodulatory regimens. One area of great interest is the use of T cell vaccination, when autologous attenuated auto-reactive T cells are given to patients in order to initiate a specific immune response to the pathogenic T cell populations. Phopheresis may be an immunomudulatory treatment related to T cell vaccination. Another promising area involves ex-vivo alteration of the cytokine profile of harmful auto-reactive T cells. This can be achieved by genetic manipulation or by certain cytokine stimulations. A subsequent adoptive cell transfer will, by homing mechanisms, lead to at site specific delivery of the cells, which will have a local down-regulatory effect on the inflammatory process. Although unsolved questions regarding doses, timing, optimal preparing conditions and mechanisms still remain, both T cell vaccination and adoptive transfer of ex-vivo manipulated cytokine secreting cells have proven successful for treatment of neuroinflammation in experimental models. T cell vaccination was shown to be feasible in patients with multiple sclerosis, however, otherwise the experience in humans so far is limited.

  • 8.
    Ernerudh, Jan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Immunology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Ludvigsson, Johnny
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Berlin, Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Samuelsson, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Effect of photopheresis on lymphocyte population in children with newly diagnosed type 1 diabetes2004In: Clinical and Diagnostic Laboratory Immunology, ISSN 1071-412X, Vol. 11, no 5, p. 856-861Article in journal (Refereed)
    Abstract [en]

    In recent years photopheresis has been claimed to be an effective form of immunomodulation. It has also been shown to have an effect on the disease process at the onset of type 1 diabetes. In a double-blind, placebo-controlled randomized study, we analyzed if the effect of photopheresis in children with newly diagnosed diabetes is related to changes in the balance of lymhocyte populations. We also analyzed if lymphocyte subsets were related to recent infection, mild or aggressive disease manifestations, heredity, or gender. Nineteen children received active treatment with photopheresis, while 21 children received sham pheresis (placebo group). No influence of a history of previous infection, heredity, or certain clinical parameters on lymphocyte subsets was found. At the onset of type 1 diabetes, girls showed a higher proportion and a larger number of T cells (CD3+) and T-helper cells (CD4+) and a higher proportion of naïve CD4 +CD45RA+ cells. In the placebo group, an increase in the number of subsets with the activated phenotype in both the CD4 (CD29 +) and the CD8 (CD11a+) compartments was noted during the course of the study. These changes did not occur in the photopheresis group. No relation between lymphocyte subsets and clinical outcome was found 1 year after the treatment with photopheresis. In conclusion, we found no major effect of photopheresis on lymphocyte populations in a group of children with newly diagnosed type 1 diabetes. However, in the placebo group the proportions of activated CD4 and CD8 cells increased over time. Since these changes did not occur in the actively treated group, our findings suggest that photopheresis may have some suppressive effects.

  • 9.
    Faresjö, Maria
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics.
    Ernerudh, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Immunology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Berlin, Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Garcia, Jorge
    Ludvigsson, Johnny
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    The immunological effect of photopheresis in children with newly diagnosed type 1 diabetes2005In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 58, no 3, p. 459-466Article in journal (Refereed)
    Abstract [en]

    Photopheresis has been claimed to have immune-modulating effects, but the mechanisms of action are unknown. This study investigated the immune effect of photopheresis in children with type 1 diabetes, with a focus on the balance of Th1- and Th2-like cytokines. Ten children with newly diagnosed type 1 diabetes (10-17 y) were treated with five double treatments of photopheresis and 10 children matched for disease, age, and gender were given placebo tablets and sham pheresis. Expression of IFN-γ and IL-4 mRNA was determined by real-time reverse-transcriptase polymerase chain reaction (RT-PCR) and secretion of IFN-γ, IL-10, and IL-13 in cell-culture supernatants by ELISA after stimulation with glutamic acid decarboxylase (GAD65) (a.a. 247-279), the ABBOS peptide (a.a. 152-169), insulin, phytohemagglutinin (PHA), and keyhole limpet hemocyanin (KLH). Photopheresis changed antigen-stimulated immune balance in line with a Th2-like shift. Thus, the ratio of IFN-γ/IL-4 mRNA expression after in vitro stimulation with a peptide of the autoantigen GAD 65 was reduced after treatment in the photopheresis group. The IFN-γ/IL-4 mRNA expression ratio after in vitro stimulation with insulin was also lower in children treated with photopheresis compared with the placebo group. Photopheresis has an immune-modulating effect in children with type 1 diabetes, causing a Th2-like deviation. Copyright © 2005 International Pediatric Research Foundation, Inc.

  • 10.
    Furubacke, A
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Berlin, Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Anderson, Chris
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Dermatology. Östergötlands Läns Landsting, Centre for Medicine, Department of Dermatology and Venerology in Östergötland.
    Sjöberg, Folke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Lack of significant treatment effect of plasma exchange in the treatment of drug-induced toxic epidermal necrolysis? 1999In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 25, p. 1307-1310Article in journal (Refereed)
  • 11.
    Hammar, Mats
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Asp, Malin
    Linköping University, Department of Medicine and Care.
    Berlin, Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Dahlström, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Eintrei, Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Ekdahl, Anne
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
    Ledin, Torbjörn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Oto-Rhiono-Laryngology and Head & Neck Surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Maller, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    A new program for better clinical supervision of students. A joint project at the Halsouniversitet and county council in Ostergotland2006In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, p. 649-654Article in journal (Other academic)
  • 12.
    Hammar, Mats
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Asp, Malin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care.
    Berlin, Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Dahlström, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Eintrei, Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Anaesthesiology and Surgical Centre, Department of Intensive Care UHL.
    Ekdahl, Anne
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
    Ledin, Torbjörn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Oto-Rhiono-Laryngology and Head & Neck Surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Maller, Rolf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Ny handlingsplan för bättre klinisk handledning av studenter.2006In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, p. 649-654Article in journal (Other academic)
    Abstract [sv]

        

  • 13.
    Knobler, R.
    et al.
    Medical University of Vienna, Austria .
    Berlin, Gösta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Calzavara-Pinton, P.
    University Hospital Spedali Civili, Italy .
    Greinix, H.
    Medical University of Vienna, Austria .
    Jaksch, P.
    Medical University of Vienna, Austria .
    Laroche, L.
    Avicenne Hospital, France .
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Quaglino, P.
    University of Turin, Italy .
    Reinisch, W.
    Medical University of Vienna, Austria .
    Scarisbrick, J.
    University Hospital, England .
    Schwarz, T.
    University Hospital Schleswig Holstein, Germany .
    Wolf, P.
    Medical University of Graz, Austria .
    Arenberger, P.
    Charles University of Prague, Czech Republic .
    Assaf, C.
    HELIOS Klinikum Krefeld, Germany .
    Bagot, M.
    University of Paris 07, France .
    Barr, M.
    University of So Calif, CA USA .
    Bohbot, A.
    University of Strasbourg, France .
    Bruckner-Tuderman, L.
    University of Medical Centre Freiburg, Germany .
    Dreno, B.
    Nantes University Hospital, France .
    Enk, A.
    Heidelberg University, Germany .
    French, L.
    University of Zurich Hospital, Switzerland .
    Gniadecki, R.
    Bispebjerg Hospital, Denmark .
    Gollnick, H.
    Otto Von Guericke University, Germany .
    Hertl, M.
    University Hospital Marburg, Germany .
    Jantschitsch, C.
    Medical University of Vienna, Austria .
    Jung, A.
    Dessau Medical Centre, Germany .
    Just, U.
    Medical University of Vienna, Austria .
    -D. Klemke, C.
    Heidelberg University, Germany .
    Lippert, U.
    Dessau Medical Centre, Germany .
    Luger, T.
    University of Munster, Germany .
    Papadavid, E.
    University of Athens, Greece .
    Pehamberger, H.
    Medical University of Vienna, Austria .
    Ranki, A.
    University of Helsinki, Finland University of Helsinki, Finland .
    Stadler, R.
    Johannes Wesling Medical Centre, Germany .
    Sterry, W.
    Charite, Germany .
    H. Wolf, I.
    Medical University of Graz, Austria .
    Worm, M.
    Charite, Germany .
    Zic, J.
    Vanderbilt University, TN 37212 USA .
    C. Zouboulis, C.
    Dessau Medical Centre, Germany .
    Hillen, U.
    University of Duisburg Essen, Germany .
    Guidelines on the use of extracorporeal photopheresis2014In: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 28, no s1, p. 1-37Article in journal (Refereed)
    Abstract [en]

    BackgroundAfter the first investigational study on the use of extracorporeal photopheresis for the treatment of cutaneous T-cell lymphoma was published in 1983 with its subsequent recognition by the FDA for its refractory forms, the technology has shown significant promise in the treatment of other severe and refractory conditions in a multi-disciplinary setting. Among the major studied conditions are graft versus host disease after allogeneic bone marrow transplantation, systemic sclerosis, solid organ transplant rejection and inflammatory bowel disease. Materials and methodsIn order to provide recognized expert practical guidelines for the use of this technology for all indications the European Dermatology Forum (EDF) proceeded to address these questions in the hands of the recognized experts within and outside the field of dermatology. This was done using the recognized and approved guidelines of EDF for this task. Results and conclusionThese guidelines provide at present the most comprehensive available expert recommendations for the use of extracorporeal photopheresis based on the available published literature and expert consensus opinion.

  • 14.
    Landtblom, Anne-Marie
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    Lindvall, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Neurology . Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    Ledin, Torbjörn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Berlin, Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    A case report of plasmapheresis treatment in a patient with paraneoplastic cerebellar degeneration and high anti-Yo antibody titers2008In: Therapeutic Apheresis and Dialysis, ISSN 1744-9979, Vol. 12, no 1, p. 82-85Article in journal (Refereed)
    Abstract [en]

    A patient with paraneoplastic cerebellar degeneration due to anti-Purkinje cell antibodies (anti-Yo) arising from ovarian carcinoma with metastases was treated with three plasmapheresis (PP) series (a total of 22 PP treatments) over one year and was monitored by repeated otoneurological testing, balance tests and clinical investigations. Blood samples for antibody titers were checked on several occasions. Initially there was a weak clinical response and significantly improved test results regarding the caloric response, as well as a possible effect on visual suppression of the vestibulo-ocular reflex after caloric ear irrigation. After the first series of PP treatment, new metastases were found. A half year later there was a progressive course with increasing general symptoms. Serology tests showed continuously high titers of anti-Yo antibody, although somewhat lower after PP. We thus report a minor and short-lived effect of PP, possibly inhibited by the natural course of metastatic disease. © 2008 International Society for Apheresis.

  • 15.
    Ledent, Elisabeth
    et al.
    Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Transfusion Medicine and Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Berlin, Gösta
    Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Transfusion Medicine and Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Factors influencing white cell removal from red cell concentrates by filtration1996In: Transfusion, ISSN 0041-1132, E-ISSN 1537-2995, Vol. 36, no 8, p. 714-718Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The preparation of blood components by hard centrifugation results in red cell concentrates with a small amount of plasma. The influence of various plasma factors, temperature, and storage time on white cell reduction by filtration was studied. STUDY

    DESIGN AND METHODS: Red cell concentrates were suspended in 100 mL of saline- adenine-glucose-mannitol (SAGMAN) solution or in SAGMAN solution in which 5 or 10 mL had been replaced with an equal amount of fresh plasma, albumin (4%), or heat-inactivated plasma. After overnight storage at 4 degrees C, filtration at a slow flow rate (2 hours) was performed. The effect of temperature was studied by filtration at 4 degrees C and 37 degrees C. To study the influence of storage time, red cell concentrates were stored for 4 to 8 hours or 14 to 20 hours at 4 degrees C and filtered through another model of filter. The number of white cells was counted microscopically or by flow cytometry.

    RESULTS: When 5 or 10 mL of plasma was added, a significantly smaller number of white cells were found after filtration than were found in the SAGMAN control (the median difference between pairs: 23.6 × 10(6) for 5 mL [p = 0.006] and 14.9 × 10(6) for 10 mL [p = 0.003]). The number of white cells was significantly higher with 10 mL of albumin than with 10 mL of plasma (difference, 15.0 × 10(6); p = 0.006). When heat-inactivated plasma was used, the number of white cells was significantly lower than when fresh plasma was used (difference, 0.3 × 10(6); p = 0.009). Filtration at 37 degrees C resulted in a 64-percent reduction in white cells and that at 4 degrees C led to a 99.7-percent reduction (p = 0.006). When the second filter was used, a slight but significantly lower number of white cells was found in the red cell concentrate stored for 14 to 20 hours than in that stored for 4 to 8 hours (difference, 0.03 × 10(6); p < 0.001).

    CONCLUSION: The amount of plasma in the red cell concentrate and the storage time and temperature are important factors in the outcome of white cell reduction by filtration. The effect of plasma does not seem to be due to a general influence of protein or to the activity of complement or fibrinogen.

  • 16.
    Ledent, Elisabeth
    et al.
    Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Transfusion Medicine and Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Berlin, Gösta
    Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Transfusion Medicine and Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Inadequate white cell reduction by bedside filtration of red cell concentrates1994In: Transfusion, ISSN 0041-1132, E-ISSN 1537-2995, Vol. 34, no 9, p. 765-768Article in journal (Refereed)
    Abstract [en]

    Background: White cell filtration of red cell concentrates is often performed at the bedside, in the ward, with the filter inserted in the blood administration line. The aim of this study was to evaluate the efficiency of this filtration method and compare it to filtration in the blood bank.

    Study Design and Methods: One-day-old, buffy coat-reduced, hard-packed red cell concentrates in saline-adenine-glucose-mannitol solution were filtered through different filters designed for bedside or laboratory use. With filters designed for bedside use, filtration of red cells was performed under laboratory conditions at fast flow (10 min) or under bedside conditions at slow flow (2 hours). The remaining white cells were counted microscopically. Filters designed for laboratory use were evaluated at fast flow, and the number of contaminating white cells was counted by flow cytometry.

    Results: With bedside fllters, a significantly higher contamination of white cells was found In the units filtered at slow flow than at fast flow, regardless of the filter used. The number of units with >5 x 106 white cells was 52 (78%) of 67 filtered at slow flow compared to 11 (23%) of 47 at fast flow, all filters taken together. This difference in white cell contamination was mainly due to an increase of polymorphonuclear cells in the red cell concentrates filtered at slow flow. With filters designed for laboratory use, 0 to 2 percent of units (n = 1448) were contaminated with >5 x 106 white cells.

    Conclusion: Bedside filtration for white cell reduction at slow flow is inefficient for 1-day-old, buffy coat-reduced red cell concentrates.

  • 17.
    Ledent, Elisabeth
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Linköping University, Faculty of Health Sciences.
    Semple, John W.
    Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital, Toronto, Canada.
    Berlin, Gösta
    Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Linköping University, Faculty of Health Sciences.
    White Blood Cell Subsets in Buffy Coat-Derived Platelet Concentrates: The Effect of Pre- and Poststorage Filtration2000In: Vox Sanguinis, ISSN 0042-9007, E-ISSN 1423-0410, Vol. 79, no 4, p. 235-241Article in journal (Refereed)
    Abstract [en]

    Background and Objectives: Our objective was to study the effect of storage time on the filtration of platelet concentrates (PCs). We compared the total number of white blood cells (WBC), as well as the distribution of WBC subsets, in units filtered before and after storage.

    Materials and Methods: Buffy coat-derived PCs were filtered either fresh or after 5 days of storage, and total WBC were enumerated by flow cytometry. WBC subsets were analyzed by flow cytometry with three-color fluorescence.

    Results: The total number of white cells before filtration was significantly higher in fresh units compared with stored units, whereas in postfiltration samples the number of white cells was significantly lower in the fresh compared with the stored units. Although absolute numbers were significantly reduced, filtration also induced significant changes in the proportions of subsets in both fresh and stored units; the percentage of T cells was decreased, whereas the percentage of B cells and monocytes was increased after filtration.

    Conclusion: Our results suggest that prestorage WBC filtration of platelet concentrates is superior in reducing the absolute numbers of WBC. However, both pre- and poststorage WBC filtration significantly affect the proportions of WBC in the final product, decreasing the number of T cells while apparently increasing the proportion of MHC class II-positive cell populations.

  • 18.
    Ledent, Elisabeth
    et al.
    Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Transfusion Medicine and Clinical Immunology. Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Wasteson, Åke
    Linköping University, Department of Biomedicine and Surgery, Cell biology. Linköping University, Faculty of Health Sciences.
    Berlin, Gösta
    Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Transfusion Medicine and Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Growth Factor Release during Preparation and Storage of Platelet Concentrates1995In: Vox Sanguinis, ISSN 0042-9007, E-ISSN 1423-0410, Vol. 68, no 4, p. 205-209Article in journal (Refereed)
    Abstract [en]

    The platelet content of platelet-derived growth factor (PDGF), a mitogen stored in the alpha-granules, was studied during preparation and storage of platelet concentrates (PC) and compared to the growth-promoting activity of platelets, β-thromboglobulin (β-TG) and lactate dehydrogenase (LD). We compared PC prepared from platelet-rich plasma (PRP-PC; n= 10) and from buffy coat. Two different pre-preparation storage periods of the buffy coat were used: 4h (BC-PC:4h; n = 10) and 24 h (BC-PC: 24h; n = 5). The platelet content of PDGF and β-TG was measured by a RIA technique and the growth-promoting activity by incorporation of 3H-thymidine in stimulated fibroblasts. The platelet content of PDGF, β-TG and the growth-promoting activity of the platelets decreased in a similar way during preparation and storage of PRP-PC (31 ±2, 35±2 and 33±7%, respectively, at day 5 of storage; mean ± SEM). The release of LD was minor (3.9 ±0.5% at day 5). At day 1 of storage the platelet content of PDGF was significantly better preserved in BC-PC:4h than in BD-PC:24h (88±2 and 81 ±3%, respectively; p = 0.03). Comparing BC-PC:4h and PRP-PC we found a significantly better preservation of PDGF in BC-PC:4h until day 3 of storage (80±2 and 75±1%, respectively at day 3; p = 0.046). In conclusion the preparation of PC according to the PRP method initially induces a higher loss of PDGF, and hence of the growth-promoting activity, than the BC method.

  • 19.
    Ludvigsson, Johnny
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Barn.
    Samuelsson, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Barn.
    Ernerudh, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Immunology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Johansson, C
    Stenhammar, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Barn.
    Berlin, Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Photopheresis at onset of type 1 diabetes: A randomised, double blind, placebo controlled trial2001In: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 85, no 2, p. 149-154Article in journal (Refereed)
    Abstract [en]

    Background - In recent years photopheresis, an extracorporeal form of photochemotherapy using psoralen and ultraviolet A irradiation of leucocytes, has been claimed to be an effective form of immunomodulation. Aim - To evaluate its effect in type 1 diabetes we performed a double blind, controlled study using placebo tablets and sham pheresis in the control group. Methods - A total of 49 children, aged 10-18 years of age at diagnosis of type 1 diabetes were included, 40 fulfilled the study and were followed for three years (19 received active treatment with photopheresis and 21 placebo treatment). Results - The actively treated children secreted significantly more C peptide in urine during follow up than control children. C peptide values in serum showed corresponding differences between the two groups. The insulin dose/kg body weight needed to achieve satisfactory HbA1c values was always lower in the photopheresis group, there was no difference between the groups regarding HbAlc values during follow up. The treatment was well accepted except for nausea (n = 3) and urticaria (n = 1) in the actively treated group. There were no differences regarding weight or height, or episodes of infection between the two groups during follow up. Conclusion - Photopheresis does have an effect in addition to its possible placebo effect, shown as a weak but significant effect on the disease process at the onset of type 1 diabetes, an effect still noted after three years of follow up.

  • 20.
    Meunier, Andreas
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Petersson, A.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Good, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Berlin, Gösta
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Validation of a haemoglobin dilution method for estimation of blood loss2008In: Vox Sanguinis, ISSN 0042-9007, E-ISSN 1423-0410, Vol. 95, no 2, p. 120-124Article in journal (Refereed)
    Abstract [en]

    Background and Objectives: Analysis of haemoglobin (Hb) dilution after bleeding is a simple, inexpensive and non-invasive method to estimate blood loss. Blood volume is estimated, taking sex, weight and height into account. The Hb concentration before and after blood loss is analysed and, from the difference, the blood loss volume can be calculated assuming a normovolemic subject. Although widely used this method has never been validated.

    Material and Methods: The Hb concentration of 21 blood donors was analysed before and up to 4 days after a standard blood donation and in another 18 blood donors the Hb concentration was analysed before and on day 4, 6, 8, 11 and 14 after blood donation. The blood volume of each donor was calculated and the donated blood volume was estimated by weighing. We calculated the blood loss by the Hb dilution method and compared the calculated value with the donated blood volume.

    Results: The mean donated blood volume was 442 ± 10 ml, whereas the mean calculated blood loss was 152 ± 214 ml using the Hb concentration of the first day after donation and 301 ± 145 ml with the Hb concentration of day 6 after blood donation after which no further Hb decrease was observed. The directly measured Hb concentration was always higher than the calculated/expected Hb concentration based on the blood donation volume.

    Conclusions: The Hb dilution method underestimates the true blood loss by more than 30% after a moderate blood loss of approximately 10% of the total blood volume.

  • 21.
    Mortzell, M
    et al.
    Umeå University.
    Berlin, Gösta
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Nilsson, T
    University of Uppsala Hospital.
    Axelsson, C G
    University Hospital, Örebro.
    Efvergren, M
    University Hospital Karolinska.
    Audzijoni, J
    University Hospital, Vilnius.
    Griskevicius, A
    University Hospital, Vilnius.
    Ptak, J
    County Hospital, Czech Republic .
    Blaha, M
    University Hospital, Hradec Kralove.
    Tomsova, H
    University Hospital, Hradec Kralove.
    M Liumbruno, G
    San Giovanni Calibita Fatebenefratelli Hospital.
    Centoni, P
    University Hospital, Livorno.
    Newman, E
    Concord Repatriat General Hospital.
    Eloot, S
    Ghent University Hospital.
    Dhondt, A
    Ghent University Hospital.
    Tomaz, J
    University Hospital, Coimbra.
    Witt, V
    University Hospital, Vienna.
    Rock, G
    University Hospital, Ottawa.
    Stegmayr, B
    Umeå University.
    Analyses of data of patients with Thrombotic Microangiopathy in the WAA registry2011In: Transfusion and apheresis science, ISSN 1473-0502, E-ISSN 1878-1683, Vol. 45, no 2, p. 125-131Article in journal (Refereed)
    Abstract [en]

    Thrombotic Microangiopathy (TMA) is a histopathological feature of various diseases including thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. less thanbrgreater than less thanbrgreater thanThe aim of this study was to investigate the outcome and prognostic variables of TMA-patients. less thanbrgreater than less thanbrgreater thanMaterials and methods: Data were consecutively retrieved from the WAA-apheresis registry (www.waa-registry.org) during 2003-2009. Included were all 120 patients (1237 procedures) who suffered from various forms of TMA, as registered by the ICD-10 code M31.1. Besides registry data, more extensive information was retrieved from the latest 64 patients. Adverse events of the TMA patients were compared to those of the other patients in the registry. less thanbrgreater than less thanbrgreater thanResults: The mean age was 46 years (range 11-85 years, 57% women). In 72% therapeutic apheresis was due to an acute indication while a long-term indication was present in 28%. Plasma exchange was performed by centrifugation and filtration technique (95% and 4%, respectively), and immunoadsorption in 1% of the patients. Only fresh frozen plasma was used as replacement fluid in 69% of procedures. Adverse events were more frequent than in the general apheresis population (10% versus 5%, RR 1.9, CI 1.6-2.3). No death occurred due to apheresis treatment. Three percent of the procedures were interrupted. Bronchospasm and/or anaphylactic shock were present in two patients and one patient suffered from TRALI. At admission 26% were bedridden and needed to be fed. The risk of dying during the treatment period was significantly higher if the patient also suffered from a compromising disease, such as cancer. There was an inverse correlation between the ADAMTS13 level and the antibody titer (r = -0.47, p = 0.034). less thanbrgreater than less thanbrgreater thanConclusions: Patients with TMA have an increased risk for moderate and severe AE compared to the general apheresis population. Many patients were severely ill at admission. The prognosis is worse if the patient also has a severe chronic disease. Even slightly increased ADAMTS13-antibody titers seem to have a negative impact on the ADAMTS13 levels. (C) 2011 Elsevier Ltd. All rights reserved.

  • 22.
    Mortzell, M
    et al.
    Umeå University.
    Berlin, Gösta
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Nilsson, T
    University of Uppsala Hospital.
    Axelsson, C G
    University Hospital, Örebro.
    Efvergren, M
    University Hospital Karolinska.
    Audzijoni, J
    University Hospital, Vilnius.
    Griskevicius, A
    University Hospital, Vilnius.
    Ptak, J
    County Hospital, Frydek Mystek.
    Blaha, M
    University Hospital, Hradec Kralove.
    Tomsova, H
    University Hospital, Hradec Kralove.
    M Liumbruno, G
    San Giovanni Calibita Fatebenefratelli Hospital.
    Centoni, P
    University Hospital, Livorno.
    Newman, E
    Concord Repatriat General Hospital.
    Eloot, S
    Ghent University Hospital.
    Dhondt, A
    Ghent University Hospital.
    Tomaz, J
    University Hospital, Coimbra.
    Witt, V
    University Hospital, Vienna.
    Rock, G
    University Hospital, Ottawa.
    Stegmayr, B
    Umeå University.
    Thrombotic microangiopathy2011In: Transfusion and apheresis science, ISSN 1473-0502, E-ISSN 1878-1683, Vol. 45, no 2, p. 119-123Article in journal (Refereed)
    Abstract [en]

    Thrombotic microangiopathy (TMA) is a histopathological feature of various diseases including thrombotic thrombocytopenic purpura (UP) and hemolytic uremic syndrome (HUS). There are many secondary causes of TMA, many of them could mimic TTP or HUS. This article presents a short overview on TMA. In conclusion TMA is the result of various etiology reasons and pathologic reactions with various clinical entities. It is important to focus on a thorough history including family history when deciding on a diagnosis. Analysis of ADAMTS 13 and ADAMTS 13-antibodies may help to decide continued therapy.

  • 23.
    Mörtzell Henriksson, M.
    et al.
    Nephrol, Umeå, Sweden.
    Newman, E.
    Bone Marrow Transplant and Apheresis, New South Wales, Australia.
    Witt, V.
    St. Anna, Vienna, Austria.
    Derfler, K.
    AKH, Vienna, Austria.
    Leitner, G.
    AKH, Vienna, Austria.
    Eloot, S.
    Gent, Belgium.
    Dhondt, A.
    Gent, Belgium.
    Deeren, D.
    Roeselar, Belgium.
    Rock, G.
    Canada.
    Ptak, J.
    Frydek-Mistek, Czech Republic.
    Blaha, M.
    Hradec Kralove, Czech Republic.
    Lanska, M.
    Hradec Kralove, Czech Republic.
    Gasova, Z.
    Prague, Czech Republic.
    Hrdlickova, R.
    Ostrava, Czech Republic.
    Ramlow, W.
    Rostock, Germany.
    Prophet, H.
    Rostock, Germany.
    Liumbruno, G.
    Livorno, Italy.
    Mori, E.
    Livorno, Italy.
    Griskevicius, A.
    Vilnius, Lithuania.
    Audzijoniene, J.
    Vilnius, Lithuania.
    Vrielink, H.
    Amsterdam, The Netherlands.
    Rombout, S.
    Maastricht, The Netherlands.
    Aandahl, A.
    Oslo, Norway.
    Sikole, A.
    Skopje, Macedonia.
    Tomaz, J.
    Coimbra, Portugal.
    Lalic, K.
    Belgrade, Serbia.
    Mazic, S.
    Zagreb, Croatia.
    Strineholm, V.
    Orebro, Sweden.
    Brink, B.
    Huddinge, Sweden.
    Berlin, Gösta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Dykes, J.
    Lund, Sweden.
    Toss, F.
    BC, Umeå, Sweden.
    Axelsson, C.G.
    BC, Umeå, Sweden.
    Stegmayr, B.
    Nephrol, Umeå, Sweden.
    Nilsson, T.
    Nephrol, Uppsala, Sweden.
    Norda, R.
    BC, Uppsala, Sweden.
    Knutson, F.
    BC, Uppsala, Sweden.
    Ramsauer, B.
    Nephrol., Skövde, Sweden.
    Wahlström,, A.
    Nephrol., Karlstad, Sweden.
    Adverse events in apheresis: An update of the WAA registry data2016In: Transfusion and apheresis science, ISSN 1473-0502, E-ISSN 1878-1683, Vol. 54, no 1, p. 14p. 2-15Article, review/survey (Refereed)
    Abstract [en]

    Apheresis with different procedures and devices are used for a variety of indications that may have different adverse events (AEs). The aim of this study was to clarify the extent and possible reasons of various side effects based on data from a multinational registry. The WAA-apheresis registry data focus on adverse events in a total of 50846 procedures in 7142 patients (42% women). AEs were graded as mild, moderate (need for medication), severe (interruption due to the AE) or death (due to AE). More AEs occurred during the first procedures versus subsequent (8.4 and 5.5%, respectively). AEs were mild in 2.4% (due to access 54%, device 7%, hypotension 15%, tingling 8%), moderate in 3% (tingling 58%, urticaria 15%, hypotension 10%, nausea 3%), and severe in 0.4% of procedures (syncope/hypotension 32%, urticaria 17%, chills/fever 8%, arrhythmia/asystole 4.5%, nausea/vomiting 4%). Hypotension was most common if albumin was used as the replacement fluid, and urticaria when plasma was used. Arrhythmia occurred to similar extents when using plasma or albumin as replacement. In 64% of procedures with bronchospasm, plasma was part of the replacement fluid used. Severe AEs are rare. Although most reactions are mild and moderate, several side effects may be critical for the patient. We present side effects in relation to the procedures and suggest that safety is increased by regular vital sign measurements, cardiac monitoring and by having emergency equipment nearby.

  • 24.
    Norda, Rut
    et al.
    Uppsala University Hospital.
    Axelsson, Claes Goran
    Örebro University Hospital.
    Axdorph, Ulla
    Karolinska University Hospital.
    Berlin, Gösta
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Wikstrom, Bjorn
    Uppsala University Hospital.
    Stegmayr, Bernd
    Uppsala University Hospital.
    Recognition of Intercenter Differences May Help Develop Best Practice2008In: Therapeutic Apheresis and Dialysis, ISSN 1744-9979, Vol. 12, no 5, p. 347-354Article in journal (Refereed)
    Abstract [en]

    The Swedish Apheresis Registry is a National Quality Registry and performing intercenter comparisons can be done as one task. The purpose of this study was to evaluate differences in adverse effects (AE) associated with plasma exchange (PE) for the development of best practice. Six hundred and twenty reports of AE related to a total of 12 461 apheresis procedures performed during 1996-2002 were analyzed, and eight Swedish university hospital centers that reported AE every year were compared. About 70% of all PE in Sweden were performed in centers that also reported AE. During this period, there was no change in the proportion of PE procedures with AE, but there was a decrease in the frequency of prematurely interrupted procedures (2.1% to 1.3%, P=0.003). The mean frequency of moderate and severe AE was 5%. Adverse effects were more common when PE was performed in patients with Guillain-Barrel syndrome (GBS; 10%) or thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS; 8%) than in patients with macroglobulinemia/hyperviscosity syndromes (2%). In the eight centers, there was a four-fold difference in AE between the centers with the highest and the lowest frequency. The frequency of AE in GBS, TTP-HUS and macroglobulinemia/hyperviscosity syndromes differed four-fold, while the frequency of specified symptoms differed more than four-fold. The indications and the choice of substitution fluids could explain some of these differences. The results of the study have initiated changes in practice. The identification of significant intercenter differences in the frequency and symptoms of AE has started improvement in current PE practices.

  • 25. Norda, Rut
    et al.
    Stegmayr, Bernd G
    Berlin, Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Karkus, Jan
    Jonsson, Svante
    Söderström, Tommy
    Knutsson, Folke
    Wikström, Björn
    Berséus, Olle
    Therapeutic apheresis in Sweden: update of epidemiology and adverse events.2003In: Transfusion and apheresis science, ISSN 1473-0502, E-ISSN 1878-1683, Vol. 29, p. 159-166Article in journal (Refereed)
  • 26.
    Palfi, Miodrag
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Berg, Sören
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Ernerudh, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Immunology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Berlin, Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    A randomized controlled trial of transfusion-related acute lung injury: Is plasma from multiparous blood donors dangerous?2001In: Transfusion, ISSN 0041-1132, E-ISSN 1537-2995, Vol. 41, no 3, p. 317-322Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Transfusion-related acute lung injury (TRALI) and other posttransfusion reactions may be caused by granulocyte and/or HLA antibodies, which are often present in blood from multiparous donors. The purpose of this study was to compare the effects of plasma from multiparous donors with those of plasma from donors with no history of transfusion or pregnancy (control plasma) in a prospective, randomized, double-blind, crossover study. STUDY DESIGN AND METHODS: Intensive care patients, judged to need at least 2 units of plasma, were randomly assigned to receive a unit of control plasma and, 4 hours later, a plasma unit from a multiparous donor (=3 live births) or to receive the plasma units in opposite order. The patients were closely monitored, and body temperature, blood pressure, and heart rate were recorded. Blood samples for analysis of blood gases, TNFa, IL-1 receptor antagonist, soluble E selectin, and C3d complement factor were collected at least on four occasions (before and after the transfusion of each unit). RESULTS: Transfusion of plasma from multiparous donors was associated with significantly lower oxygen saturation and higher TNFa concentrations than transfusion of control plasma. The mean arterial pressure increased significantly after the transfusion of control plasma, whereas plasma from multiparous donors had no effect on it. Five posttransfusion reactions were observed in 100 patients, in four cases after the transfusion of plasma from multiparous donors. CONCLUSION: Plasma from multiparous blood donors may impair pulmonary function in intensive care unit patients.

  • 27.
    Palfi, Miodrag
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Hildén, Jan-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Matthiesen, Leif
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Selbing, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Berlin, Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    A case of severe Rh (D) alloimmunization treated by intensive plasma exchange and high-dose intravenous immunoglobulin2006In: Transfusion and apheresis science, ISSN 1473-0502, E-ISSN 1878-1683, Vol. 35, no 2, p. 131-136Article in journal (Refereed)
    Abstract [en]

    Background: In extremely severe Rh (D) alloimmunization, during pregnancy, early diagnosis and treatment is essential to avoid hydrops fetalis. Intrauterine transfusion (IUT) is of utmost importance in the prevention of fetal anemia but it is usually feasible only after 20 weeks of pregnancy. Therefore, additional treatment options in early pregnancy are needed. Study design and methods: A 27-year-old severely D + C immunized woman was admitted at 8 weeks of gestation in her fifth pregnancy with an extremely high concentration of anti-D. Her first pregnancy was uneventful but resulted in D + C alloimmunization. The next two pregnancies were unsuccessful, because of hydrops fetalis resulting in fetal death in pregnancy week 20 and 24, respectively, despite treatment with high-dose intravenous immunoglobulin (IVIG) and IUT treatment. A fourth pregnancy was terminated with legal abortion. The patient was eager and persistent to accomplish a successful pregnancy. Therefore, a combination of treatments consisting of plasma exchange (PE) three times/week and IVIG 100 g/week was started in pregnancy week 12. PE was performed 53 times and totally 159 L of plasma was exchanged. Results: The anti-D concentration was 12 μg/mL (IAT titer 2000) before start of treatment by PE and IVIG in pregnancy week 12. The concentration of anti-D was gradually reduced to approximately 3 μg/mL after only two weeks of treatment and was maintained at that level until pregnancy week 22. In pregnancy week 26 and 27, signs of hydrops were detected by ultrasonography and IUT were performed at each occasion. Sectio was inevitable at pregnancy week 28 + 1 and a male baby was born: Hb 58 g/L (cord sample) and 68 g/L (venous sample), weight 1385 g, Apgar score = 4-5-7, Bilirubin 56-150 mmol/L (4 h). Exchange transfusion was performed on day two and day five. Phototherapy was also implemented for eight days. The newborn's recovery thereafter was uneventful and complete. Conclusion: A combination of PE and IVIG may be an efficient treatment possible to start in early pregnancy in patients with extremely severe Rh (D) alloimmunization, with a history of hydrops fetalis in previous pregnancies. © 2006 Elsevier Ltd. All rights reserved.

  • 28.
    Panzer, S
    et al.
    Medical University of Vienna, Austria .
    Engelbrecht, S
    Alfred Hospital, Australia .
    Cole-Sinclair, M F
    St Vincents Hospital, Australia .
    Wood, E M
    Monash University, Australia .
    Wendel, S
    Hospital Sirio Libanes, Brazil .
    Biagini, S
    Hospital Sirio Libanes, Brazil .
    Zhu, Z
    Institute National Transfus Sanguine, France .
    Lefrere, J-J
    Institute National Transfus Sanguine, France .
    Andreu, G
    Institute National Transfus Sanguine, France .
    Zunino, T
    Institute National Transfus Sanguine, France .
    Cabaud, J-J
    Institute National Transfus Sanguine, France .
    Rouger, P
    Institute National Transfus Sanguine, France .
    Garraud, O
    University of Lyon, France .
    Janetzko, K
    Heidelberg University, Germany .
    Mueller-Steinhardt, M
    Heidelberg University, Germany .
    van der Burg, P
    Sanquin Bloedvoorziening, Netherlands .
    Brand, A
    Leiden University, Netherlands .
    Agarwal, P
    SGPGIMS, India .
    Triyono, T
    University of Gadjah Mada, Indonesia .
    Gharehbaghian, A
    Shahid Beheshti University of Medical Science, Iran .
    Manny, N
    Hadassah Hebrew University of Medical Centre, Israel .
    Zelig, O
    Hadassah Hebrew University of Medical Centre, Israel .
    Takeshita, A
    Hamamatsu University of School Med, Japan .
    Yonemura, Y
    Kumamoto University Hospital, Japan .
    Fujihara, H
    Hamamatsu University, Japan .
    Nollet, K E
    Fukushima Medical University, Japan .
    Ohto, H
    Fukushima Medical University, Japan .
    Han, K-S
    Seoul National University, South Korea .
    Nadarajan, V S
    University of Malaya, Malaysia .
    Berlin, Gösta
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine. Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine.
    Sandler, S G.
    Georgetown University, DC USA .
    Strauss, R G
    University of Iowa Hospital and Clin, IA USA .
    Reesink, H W
    University of Amsterdam, Netherlands .
    Education in transfusion medicine for medical students and doctors2013In: Vox Sanguinis, ISSN 0042-9007, E-ISSN 1423-0410, Vol. 104, no 3, p. 250-272Article in journal (Refereed)
    Abstract [en]

    n/a

  • 29.
    Reesink, H W
    et al.
    University of Amsterdam, Netherlands .
    Lee, J
    Australian Red Cross Blood Serv, Australia .
    Keller, A
    Australian Red Cross Blood Serv, Australia .
    Dennington, P
    Australian Red Cross Blood Serv, Australia .
    Pink, J
    Australian Red Cross Blood Serv, Australia .
    Holdsworth, R
    Australian Red Cross Blood Serv, Australia .
    Schennach, H
    TILAK University of Clin Regional Hospital, Austria .
    Goldman, M
    Canadian Blood Serv, Canada .
    Petraszko, T
    Canadian Blood Serv, Canada .
    Sun, J
    Shanghai Blood Centre, Peoples R China .
    Meng, Y
    Shanghai Blood Centre, Peoples R China .
    Qian, K
    Shanghai Blood Centre, Peoples R China .
    Rehacek, V
    University Hospital, Czech Republic .
    Turek, P
    Thomayer Hospital, Czech Republic .
    Krusius, T
    Finnish Red Cross Blood Serv, Finland .
    Juvonen, E
    Finnish Red Cross Blood Serv, Finland .
    Tiberghien, P
    Etab Francais Sang, France .
    Legrand, D
    Etab Francais Sang, France .
    Semana, G
    Etab Francais Sang Bretagne, France .
    Muller, J Y
    Etab Francais Sang, France .
    Bux, J
    German Red Cross Blood Serv W, Germany .
    Reil, A
    German Red Cross Blood Serv W, Germany .
    Lin, C K
    Hong Kong Red Cross Blood Transfus Serv, Peoples R China .
    Daly, H
    National Blood Centre, Ireland .
    McSweeney, E
    National Blood Centre, Ireland .
    Porretti, L
    Fdn Ca Granda Osped Maggiore Policlin, Italy .
    Greppi, N
    Fdn Ca Granda Osped Maggiore Policlin, Italy .
    Rebulla, P
    Fdn Ca Granda Osped Maggiore Policlin, Italy .
    Okazaki, H
    Blood Serv Headquarters, Japan .
    Sanchez-Guerrero, S A
    National Institute Cancerol, Mexico .
    Baptista-Gonzalez, H A
    Medical Hospital, Mexico .
    Martinez-Murillo, C
    Siglo XXI National Medical Centre Mexican Social Secur, Mexico .
    Guerra-Marquez, A
    La Raza National Medical Centre Mexican Social Secur, Mexico .
    Rodriguez-Moyado, H
    Consejo Mexicano Hematol, Mexico .
    Middelburg, R A
    Sanquin JJ van Rood Centre, Netherlands TRIP, Netherlands .
    Wiersum-Osselton, J C
    Sanquin JJ van Rood Centre, Netherlands TRIP, Netherlands .
    Brand, A
    Sanquin JJ van Rood Centre, Netherlands TRIP, Netherlands .
    van Tilburg, C
    New Zealand Blood Serv, New Zealand .
    Dinesh, D
    New Zealand Blood Serv, New Zealand .
    Dagger, J
    New Zealand Blood Serv, New Zealand .
    Dunn, P
    New Zealand Blood Serv, New Zealand .
    Brojer, E
    Institute Hematol and Transfus Med, Poland .
    Letowska, M
    Institute Hematol and Transfus Med, Poland .
    Maslanka, K
    Institute Hematol and Transfus Med, Poland .
    Lachert, E
    Institute Hematol and Transfus Med, Poland .
    Uhrynowska, M
    Institute Hematol and Transfus Med, Poland .
    Zhiburt, E
    Russian Transfusionist Assoc, Russia .
    Palfi, Miodrag
    Linköping University, Department of Clinical and Experimental Medicine, Transfusion Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Berlin, Gösta
    Linköping University, Department of Clinical and Experimental Medicine, Transfusion Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Frey, B M
    Blood Transfus Serv SRC, Switzerland .
    Puig Rovira, L
    Banc Sang and Teixits Catalonia, Spain .
    Muniz-Diaz, E
    Crus Roja Espanola, Spain .
    Chapman, C
    NHSBT Newcastle Centre, England .
    Green, A
    NHSBT, England .
    Massey, E
    NHSBT, England .
    Win, N
    NHSBT Tooting Centre, England .
    Williamson, L
    NHSBT, England .
    Silliman, C C
    Bonfils Blood Centre, CO 80230 USA .
    Chaffin, D J
    University of Rochester, NY 14642 USA .
    Tomasulo, P
    Blood Syst, AZ USA .
    Land, K J
    Blood Syst, TX USA Blood Syst, CA USA .
    Norris, P J
    Blood Syst, TX USA Blood Syst, CA USA .
    Illoh, O C
    US FDA, MD 20852 USA .
    Davey, R J
    US FDA, MD 20852 USA .
    Benjamin, R J
    Amer Red Cross, MD 20855 USA .
    Eder, A F
    Amer Red Cross, MD 20855 USA .
    McLaughlin, L
    Amer Red Cross, MD 20855 USA .
    Kleinman, S
    University of Vienna, Austria .
    Measures to prevent transfusion-related acute lung injury (TRALI)2012In: Vox Sanguinis, ISSN 0042-9007, E-ISSN 1423-0410, Vol. 103, no 3, p. 231-259Article in journal (Refereed)
    Abstract [en]

    n/a

  • 30.
    Sandgren, Per
    et al.
    Karolinska University Hospital, Sweden; Karolinska Institute, Sweden.
    Berlin, Gösta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Tynngård, Nahreen
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Treatment of platelet concentrates with ultraviolet C light for pathogen reduction increases cytokine accumulation2016In: Transfusion, ISSN 0041-1132, E-ISSN 1537-2995, Vol. 56, no 6, p. 1377-1383Article in journal (Refereed)
    Abstract [en]

    BACKGROUNDPathogen reduction technologies use photoactive substances in combination with ultraviolet (UV) light to inactivate pathogens. A new method uses only UVC light for pathogen reduction. This study assesses the effects of UVC light treatment on cytokine release in platelet (PLT) concentrates (PCs). STUDY DESIGN AND METHODSA PC with 35% plasma and 65% PLT additive solution (SSP+) was prepared from five buffy coats. Three such PCs were pooled and divided into 3 units. One unit was used as a nonirradiated control, the second was a gamma-irradiated control, and the third unit was treated with UVC light technology. Ten units of each type were investigated. Cytokine release was analyzed on Days 1, 5, and 7 of storage. Correlation between cytokines, PLT surface markers, and hemostatic properties was investigated. RESULTSSwirling was well preserved and pH was above the reference limit of 6.4 during storage of PLTs in all groups. Cytokine levels increased during storage in all groups but to a larger degree in PCs treated with UVC light. Only weak correlation was found between cytokines and PLT surface markers (ramp;lt;0.5). However, several cytokines showed strong correlation (ramp;gt;0.6) with the PLTs ability to promote clot retraction. CONCLUSIONUVC treatment resulted in increased release from PLT alpha granules as evident by a higher cytokine release compared to nonirradiated and gamma-irradiated PCs. The clinical relevance of these findings needs to be further evaluated.

  • 31. Scarisbrick, J.J.
    et al.
    Taylor, P.
    Holtick, U.
    Makar, Y.
    Douglas, K.
    Berlin, Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Juvonen, E.
    Marshall, S.
    U.K. consensus statement on the use of extracorporeal photopheresis for treatment of cutaneous T-cell lymphoma and chronic graft-versus-host disease2008In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 158, no 4, p. 659-678Article in journal (Refereed)
    Abstract [en]

    Extracorporeal photopheresis (ECP) has been used for over 30 years in the treatment of erythrodermic cutaneous T-cell lymphoma (CTCL) and over 20 years for chronic graft-versus-host disease (cGVHD). The lack of prospective randomized trials has led to different centres having different patient selection criteria, treatment schedules, monitoring protocols and patient assessment criteria. ECP for CTCL and cGVHD is available only at six specialized centres across the U.K. In the recent Improving Outcomes Guidance the National Institute for Health and Clinical Excellence endorsed the use of ECP for CTCL and because of the complexity of treatment supported its use in specialized centres and also suggested the need for expansion of this service. In 2005 consultants and senior nurses from all U.K. sites and from Scandinavia formed a Photopheresis Expert Group. This group's first aim was to produce a consensus statement on the treatment of CTCL and cGVHD with ECP using evidence-based medicine and best medical practice, in order to standardize ECP eligibility, assessment and treatment strategies across the U.K.

  • 32.
    Schepull, Thorsten
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Norrman, Hanna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics.
    Trinks, Marie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics.
    Berlin, Gösta
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Aspenberg, Per
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Autologous Platelets Have No Effect on the Healing of Human Achilles Tendon Ruptures A Randomized Single-Blind Study2011In: AMERICAN JOURNAL OF SPORTS MEDICINE, ISSN 0363-5465, Vol. 39, no 1, p. 38-47Article in journal (Refereed)
    Abstract [en]

    Background: Animal studies have shown that local application of platelet-rich plasma (PRP) stimulates tendon repair. Preliminary results from a retrospective case series have shown faster return to sports. Hypothesis: Autologous PRP stimulates healing of acute Achilles tendon ruptures. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Thirty patients were recruited consecutively. During surgery, tantalum beads were implanted in the Achilles tendon proximal and distal to the rupture. Before skin suture, randomization was performed, and 16 patients were injected with 10 mL PRP (10 times higher platelet concentration than peripheral blood) whereas 14 were not. With 3-dimensional radiographs (roentgen stereophotogrammetric analysis; RSA), the distance between the beads was measured at 7, 19, and 52 weeks while the patient resisted different dorsal flexion moments over the ankle joint, thereby estimating tendon strain per load. An estimate of elasticity modulus was calculated using callus dimensions from computed tomography. At 1 year, functional outcome was evaluated, including the heel raise index and Achilles Tendon Total Rupture Score. The primary effect variables were elasticity modulus at 7 weeks and heel raise index at 1 year. Results: The mechanical variables showed a large degree of variation between patients that could not be explained by measuring error. No significant group differences in elasticity modulus could be shown. There was no significant difference in heel raise index. The Achilles Tendon Total Rupture Score was lower in the PRP group, suggesting a detrimental effect. There was a correlation between the elasticity modulus at 7 and 19 weeks and the heel raise index at 52 weeks. Conclusion: The results suggest that PRP is not useful for treatment of Achilles tendon ruptures. The variation in elasticity modulus provides biologically relevant information, although it is unclear how early biomechanics is connected to late clinical results.

  • 33.
    Smolowicz, AG
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine.
    Villman, K
    Berlin, Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Tidefelt, U
    Kinetics of peripheral blood stem cell harvests during a single apheresis. 1999In: Transfusion, ISSN 0041-1132, E-ISSN 1537-2995, Vol. 39, p. 403-409Article in journal (Refereed)
  • 34.
    Stegmayr, B. G.
    et al.
    Department of Nephrology, University Hospital of Umeå.
    Almroth, Gabriel
    Linköping University, Department of Medicine and Care, Nephrology. Linköping University, Faculty of Health Sciences.
    Berlin, Gösta
    Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Linköping University, Faculty of Health Sciences.
    Fehrman, I.
    Department of Nephrology, University Hospital of Huddinge.
    Kurkus, J.
    Department of Nephrology, University Hospital of Lund.
    Norda, R.
    Department of Transfusion Medicine, County Hospital of Örebro.
    Olander, R.
    Department of Nephrology, County Hospital of Örebro.
    Sterner, G.
    Department of Vascular and Renal Diseases, University Hospital of Malmö.
    Thysell, H.
    Department of Nephrology, University Hospital of Lund.
    Wikström, B.
    Department of Nephrology, University Hospital of Uppsala.
    Wirén, J. E.
    Department of Anaesthesiology, County Hospital of Jönköping.
    Plasma exchange or immunoadsorption in patients with rapidly progressive crescentic glomerulonephritis: A Swedish multi-center study1999In: International Journal of Artificial Organs, ISSN 0391-3988, E-ISSN 1724-6040, Vol. 22, no 2, p. 81-87Article in journal (Refereed)
    Abstract [en]

    A therapeutic removal of antibodies may be achieved by immunoadsorption (IA) or by plasma exchange (PE). The aim of this prospective randomised study was to compare the efficacy of these different techniques with regard to treatment of patients with rapidly progressive glomerulonephritis (RPG) having at least 50% crescents. Forty-four patients with a RPG were included for treatment either by IA or PE (with albumin as substitution for removed plasma). All patients were additionally treated with immunosuppression. A median of 6 sessions of PEs were performed in 23 patients compared with 6 IAs in 21 patients. Goodpasture's syndrome (GP) was present in 6 patients (PE 3, IA 3). All of them started and ended in dialysis, two died. Among the remaining 38 patients (26 men, 12 women) 87% had antibodies to ANCA. Creatinine clearance for PE versus IA were at a median at start 17.1 and 19.8 ml/min, and at 6 months 49 and 49 ml/min, respectively. At 6 months 7 of 10 patients did not need dialysis (remaining: IA 0/5 and PE 2/5, n.s.). The extent of improvement did not differ between the groups. Three patients died during the observation period of 6 months (IA 2; PE 1, on HD). Although no difference was found between the IA or the PE group this study shows that the protocol used was associated with an improved renal function in most patients (except for Goodpasture's syndrome) whereas 70% of them could leave the dialysis program.

  • 35.
    Stegmayr, B
    et al.
    Umeå, Sweden.
    Ptak, J
    Frydek-Mistek, Czech Republic.
    Nilsson, T
    Uppsala, Sweden.
    Berlin, Gösta
    Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine. Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine.
    Mirea, V
    Örebro, Sweden.
    Axelsson, C G
    Örebro, Sweden.
    Griskevicius, A
    Vilnius, Lithuania.
    Centoni, P
    Livorno, Italy.
    Liumbruno, G
    Livorno, Italy.
    Audzijoniene, J
    Vilnius, Lithuania.
    Mokvist, K
    Uppsala, Sweden.
    Lassen, E
    Umeå, Sweden.
    Knutson, F
    Uppsala, Sweden.
    Norda, R
    Uppsala, Sweden.
    Mörtzell, M
    Umeå, Sweden.
    Prophet, H
    Rostock, Germany.
    Ramlow, W
    Rostock, Germany.
    Blaha, M
    Hradec Kralove, Czech Republic.
    Witt, V
    Vienne, Austria.
    Efvergren, M
    Huddinge, Sweden.
    Tomaz, J
    Coimbra, Portugal.
    Newman, E
    Concord, Australia.
    Eloot, S
    Ghent, Belgium.
    Dhondt, A
    Ghent, Belgium.
    Lalic, K
    Belgrade, Serbia.
    Sikole, A
    Skopje, Macedonia.
    Derfler, K
    Vienna, Austria.
    Hrdlickova, R
    Ostrava, Czech Republic.
    Tomsova, H
    Ostrava, Czech Republic.
    Gasova, Z
    Prague, Czech Republic.
    Bhuiyan-Ludvikova, Z
    Prague, Czech Republic.
    Ramsauer, B
    Skövde, Sweden.
    Vrielink, H
    Amsterdam, The Netherlands.
    Panorama of adverse events during cytapheresis2013In: Transfusion and apheresis science, ISSN 1473-0502, E-ISSN 1878-1683, Vol. 48, no 2, p. 155-156Article in journal (Refereed)
  • 36.
    Stegmayr, B
    et al.
    University Hospital, Umeå.
    Ptak, J
    Czech Republic .
    Wikstrom, B
    University Hospital, Uppsala.
    Berlin, Gösta
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    G Axelsson, C
    University Hospital, Örebro.
    Griskevicius, A
    University Hospital, Vilnius.
    Centoni, P
    Livorno, Italy .
    Liumbruno, G
    Livorno, Italy .
    Molfettini, P
    Livorno, Italy .
    Audzijoniene, J
    University Hospital, Vilnius.
    Mokvist, K
    University Hospital, Umeå.
    Norda, R
    University Hospital, Uppsala.
    Knutson, F
    University Hospital, Uppsala.
    Ramlow, W
    Rostock, Germany .
    Blaha, M
    Witt, V
    Vienna, Austria .
    Evergren, M
    University Hospital, Huddinge.
    Tomaz, J
    Coimbra University Hospital, Portugal.
    World apheresis registry 2003-2007 data2008In: Transfusion and apheresis science, ISSN 1473-0502, E-ISSN 1878-1683, Vol. 39, no 3, p. 247-254Article in journal (Refereed)
    Abstract [en]

    Objectives: Seventy-five centers from many countries have applied for a login code to the WAA apheresis registry. Fifteen centers from 7 countries have been actively entering data at the internet site from 2003 until 2007. We report on data from the registry so far.

    Methods: This is a web-based registry. A link is available from the WAA homepage (www.worldapheresis.org). So far data from 2013 patients (12,448 procedures) have been included. A median of 6 treatments have been performed (range 1140). Mean age 51 years (range 1-94 years; 45% women). Seven percent of the patients were <= 21 years and 4% were <= 16 years.

    Results: The purpose of the apheresis procedure was therapeutic in 67% and retrieval of blood components in 33% Main indications: neurological and hematological diseases, lipid apheresis and stemcell collection (autologous, and some allogeneic). Blood access: peripheral vessels (71%), central dialysis catheter through jugular (6.5%) or subclavian veins (6.7%), femoral vein (8%) and AV fistula (4%). ACD was used for anticoagulation in 73% of the procedures. Albumin was mainly used as replacement fluid.

    Adverse events (AE) were registered in 5.7% of the procedures. AE was graded as mild (2.5%), moderate (2.7%) or severe (0.5%). No death occurred due to treatment. The procedures were interrupted in 2.6%. Most frequent AEs were blood access problems (29%), tingling around the mouth (20%), hypotension (18%), and urticaria (9%). There were significant differences between the centers regarding mild and moderate AEs. Data indicate that centers using continuous infusion of calcium had fewer AEs.

    Conclusion: There was a limited number of severe AEs. Centers use various standard procedures for apheresis. By learning from the experience of others the treatment quality will improve further. In the near future, an update of the registry will enable more extensive evaluation of the data.

  • 37. Stegmayr, B
    et al.
    Ptak, J
    Wikström, B
    Mokvist, K
    Berlin, Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Transfusion Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Axelsson, CG
    Griskevicius, A
    Audzijoniene, J
    Centoni, P
    Liumbruno, G
    Nilsson Sojka, B
    World aphreresis registry - Report of 2004 data2005In: Transfusion and Apheresis Science,2005, 2005, p. 245-Conference paper (Refereed)
  • 38.
    Södergren, Anna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Tynngård, Nahreen
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Berlin, Gösta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Ramström, Sofia
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Responsiveness of platelets during storage studied with flow cytometry - formation of platelet subpopulations and LAMP-1 as new markers for the platelet storage lesion2016In: Vox Sanguinis, ISSN 0042-9007, E-ISSN 1423-0410, Vol. 110, no 2, p. 116-125Article in journal (Refereed)
    Abstract [en]

    Background and ObjectivesStorage lesions may prevent transfused platelets to respond to agonists and arrest bleeding. The aim of this study was to evaluate and quantify the capacity of platelet activation during storage using flow cytometry and new markers of platelet activation. Materials and MethodsActivation responses of platelets prepared by apheresis were measured on days 1, 5, 7 and 12. In addition, comparisons were made for platelet concentrates stored until swirling was affected. Lysosome-associated membrane protein-1 (LAMP-1), P-selectin and phosphatidylserine (PS) exposure were assessed by flow cytometry on platelets in different subpopulations in resting state or following stimulation with platelet agonists (cross-linked collagen-related peptide (CRP-XL), PAR1- and PAR4-activating peptides). ResultsThe ability to form subpopulations upon activation was significantly decreased already at day 5 for some agonist combinations. The agonist-induced exposure of PS and LAMP-1 also gradually decreased with time. Spontaneous exposure of P-selectin and PS increased with time, while spontaneous LAMP-1 exposure was unchanged. In addition, agonist-induced LAMP-1 expression clearly discriminated platelet concentrates with reduced swirling from those with retained swirling. This suggests that LAMP-1 could be a good marker to capture changes in activation capacity in stored platelets. ConclusionThe platelet activation potential seen as LAMP-1 exposure and fragmentation into platelet subpopulations is potential sensitive markers for the platelet storage lesion.

  • 39.
    Tynngård, Nahreen
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Chemistry.
    Berlin, Gösta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Samuelsson, Anders
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Berg, Sören
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Low dose of hydroxyethyl starch impairs clot formation as assessed by viscoelastic devices2014In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 74, no 4, p. 344-350Article in journal (Refereed)
    Abstract [en]

    Objective. High doses of the synthetic colloid hydroxyethyl starch (HES) used for plasma expansion have been associated with impaired haemostasis and hypocoagulation. Less is known about effects on clot formation in the low haemodilutional range (less than 40%). This study evaluated the effects of low haemodilution with HES and albumin on coagulation using two different viscoelastic methods. Methods. Clot formation was studied in vitro in healthy donor blood after 10% and 30% haemodilution with 60 g/L HES 130/0.4 or 50 g/L albumin with free oscillation rheometry (FOR) and rotational thromboelastography. Results. Clotting time was not significantly affected at 10% haemodilution but was prolonged with both substances at 30% dilution (p less than 0.01-0.001). The effect was significantly more pronounced with HES than with albumin. The elasticity of the clot was slightly reduced at 10% dilution with albumin, more pronounced at 10% dilution with HES (p less than 0.05), further reduced at 30% dilution with albumin and to a still greater extent at 30% dilution with HES (p less than 0.05). With albumin the functional activity of fibrinogen was not reduced in excess of the dilutional effect. HES in contrast produced a further reduction in clot elasticity than caused by mere dilution at both 10% and 30% dilutions (p less than 0.001). Conclusions. There is an adverse effect on clot formation even at low grade haemodilution with both albumin and HES. The effect on coagulation is significantly more pronounced with HES than with albumin.

  • 40.
    Tynngård, Nahreen
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Transfusion Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Johansson, Britt-Marie
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Lindahl, Tomas L
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Chemistry.
    Berlin, Gösta
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Hansson, Mona
    Karolinska University Hospital and Karolinska Institute.
    Effects of intercept pathogen inactivation on platelet function as analysed by free oscillation rheometry2008In: Transfusion and apheresis science, ISSN 1473-0502, E-ISSN 1878-1683, Vol. 38, no 1, p. 85-88Article in journal (Refereed)
    Abstract [en]

    Introduction: The Intercept Blood System, using InterSol as additive solution, is used for inactivation of contaminating pathogens in PCs, thus reducing the risk for transfusion transmitted infection and making it possible to prolong the storage period. This study aimed at investigating the ability of Intercept treated platelets to induce clot formation, as measured by coagulation time using free oscillation rheometry (FOR), and to compare with that of platelets in concentrates with the additive solution T-Sol or plasma.

    Methods: Seventy-four single-donor platelet units were diluted in InterSol (n = 27) or T-Sol (n = 47) to a mean plasma concentration of 38%. The Intercept treatment was performed by addition of amotosalen HCl to the InterSol PCs followed by UVA irradiation and treatment with a compound adsorption device (CAD). Forty-six units were collected and stored in 100% plasma for comparison. Clotting time was measured by FOR in fresh PCs (within 26 h after collection) after stimulation by a platelet activator. Soluble P-selectin was analysed as a marker of platelet activation in the Intercept and T-Sol PCs.

    Results: The clotting time was shorter for Intercept treated platelets compared to platelets in T-Sol and plasma (p < 0.05). There was no difference in clotting time between T-Sol and plasma PCs. Soluble P-selectin was higher for Intercept platelets than platelets in T-Sol (p < 0.05).

    Conclusions: The platelets treated with the Intercept procedure had good clot promoting capacity.

  • 41.
    Tynngård, Nahreen
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Transfusion Medicine . Linköping University, Faculty of Health Sciences.
    Lindahl, Tomas L
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Ramström, Sofia
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Berlin, Gösta
    Linköping University, Department of Clinical and Experimental Medicine, Transfusion Medicine . Linköping University, Faculty of Health Sciences.
    Effects of different blood components on clot retraction analysed by measuring elasticity with a free oscillating rheometer2006In: Platelets, ISSN 0953-7104, Vol. 17, no 8, p. 545-554Article in journal (Refereed)
    Abstract [en]

    Free oscillation rheometry (FOR) using the ReoRox® 4 instrument makes it possible, at bedside, to study the coagulation process in blood over time and gives information on clotting time and coagulum elastic properties. In order to find out how various factors influence the FOR analysis we studied the coagulation process and change of elasticity over time in non-anticoagulated and citrated blood samples, plasma samples with various platelet concentrations (0-200 109/l) and blood samples with various haematocrit (0-40%). Blood samples supplemented with fibrinogen were analysed to elucidate the importance of fibrinogen on elasticity. The importance of the GPIIb/IIIa receptor on platelets was investigated by comparing the elasticity development in blood samples in presence and absence of a GPIIb/IIIa receptor inhibitor, abciximab. Anticoagulation with citrate did not have major influence on the viscoelastic properties of the coagulum. Increasing number of platelets and increasing fibrinogen concentration resulted in higher elasticity while increasing haematocrit gave lower elasticity. Blood samples with GPIIb/IIIa receptor inhibitor had very low elasticity indicating the importance of functional GPIIb/IIIa receptors. In conclusion we consider FOR to be a useful method to study the elastic properties of the coagulum. Various factors such as the number of red blood cells and platelets as well as the fibrinogen concentration should be taken into consideration when evaluating the results. The ReoRox® 4 instrument had excellent measuring range and unusually small artefactual effects on clot elasticity induced by the instrument in comparison with published results on other instruments.

  • 42.
    Tynngård, Nahreen
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Transfusion Medicine. Linköping University, Faculty of Health Sciences.
    Lindahl, Tomas L
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Ramström, Sofia
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Räf, Tuulia
    Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Chemistry.
    Rugarn, Olof
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Berlin, Gösta
    Linköping University, Department of Clinical and Experimental Medicine, Transfusion Medicine. Linköping University, Faculty of Health Sciences.
    Free oscillation rheometry detects changes in clot properties in pregnancy and thrombocytopaenia2008In: Platelets, ISSN 0953-7104, Vol. 19, no 5, p. 373-378Article in journal (Refereed)
    Abstract [en]

    Improved methods are needed to identify patients at risk for thrombotic or bleeding events. Free oscillation rheometry (FOR) is a technique that offers information on coagulation, based on contributions of all blood components, by measurement of clotting time and changes in clot elasticity. This is the first study that evaluates FOR parameters in subjects likely to represent hypercoagulability (pregnant women) and hypocoagulability (thrombocytopenic patients). Clotting time and blood clot elasticity were measured by FOR in blood samples obtained from women in different pregnancy trimesters (n = 58), in thrombocytopenic patients before and after a platelet transfusion (n = 20) and in healthy blood donors (n = 60). The clotting time was shorter and the clot elasticity higher in pregnant women compared to the non-pregnant female blood donors. The elasticity was higher in late pregnancy compared to early pregnancy. Compared to the blood donors, the thrombocytopenic patients had lower elasticity, which was increased by a platelet transfusion, but there was no difference in clotting time. The results suggest that FOR can provide new information on the haemostatic status of patients at risk of thrombotic or bleeding events as well as information on the haemostatic effect of a platelet transfusion.

  • 43.
    Tynngård, Nahreen
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Transfusion Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Lindahl, Tomas
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Chemistry.
    Trinks, Marie
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Studer, Monika
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Berlin, Gösta
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    The quality of platelet concentrates produced by COBE Spectra and Trima Accel during storage for 7 days as assessed by in vitro methods2008In: Transfusion, ISSN 0041-1132, E-ISSN 1537-2995, Vol. 48, no 4, p. 715-722Article in journal (Refereed)
    Abstract [en]

    Background: The quality of PLT concentrates (PCs) can be evaluated using various in vitro methods. A new technique, free oscillation rheometry (FOR), can be used to monitor coagulation properties of PCs and gives information on clotting time and coagulum elasticity. This study compared the quality of apheresis PCs produced by COBE Spectra and Trima Accel during storage for 7 days using in vitro tests including FOR.

    Study design and methods: Apheresis PCs were collected with the COBE Spectra (n=10) and Trima Accel (n=10) cell separators. Swirling, blood gases and metabolic parameters were analyzed on day 0. Samples taken on day 1, 5 and 7 were also analyzed for hypotonic shock response (HSR), P-selectin and GPIb expression and evaluation of coagulation by FOR.

    Results: Swirling, HSR and percent GPIb expressing PLTs were well maintained for 7 days whereas glucose decreased and lactate increased significantly during storage for both Spectra and Trima PCs. Percent P-selectin expressing cells increased to the same extent in both types of PCs during storage. pH increased between day 0 and 1 but then decreased. The clotting time remained constant throughout the storage period whereas the development of elasticity was reduced on day 5 and 7 compared to day 1 (p<0.05) for both types of PCs.

    Conclusion: The results indicate that the PLT quality after storage for 7 days is well preserved although activation of PLTs occurs during storage as assessed by in vitro tests. No difference in platelet quality was observed between Spectra and Trima produced PCs.

  • 44.
    Tynngård, Nahreen
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Transfusion Medicine . Linköping University, Faculty of Health Sciences.
    Studer, Monika
    Lindahl, Tomas L
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Trinks, Marie
    Berlin, Gösta
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    The effect of gamma irradiation on the quality of apheresis platelets during storage for 7 days2008In: Transfusion, ISSN 0041-1132, E-ISSN 1537-2995, Transfusion, Vol. 48, no 8, p. 1669-1675Article in journal (Refereed)
    Abstract [en]

    Background:This study compares the quality of gamma-irradiated versus nonirradiated platelet (PLT) concentrates (PCs) during storage for 7 days as assessed by various in vitro methods. A new technique, free oscillation rheometry (FOR), which measures clotting time and coagulum elasticity, was also used to evaluate the PLT function.

    Study design and methods: Single-donor PLTs were collected by apheresis technique (n = 20). The PLTs from each donor were divided into two PCs, one gamma-irradiated with 25 Gy and the other used as a nonirradiated control. Blood gases, metabolic variables, and swirling were analyzed from Day 0. Samples taken on Days 1, 5, and 7 were also analyzed for hypotonic shock response (HSR), P-selectin, and glycoprotein (GP)Ib expression by flow cytometry and coagulation by FOR.

    Results: Swirling, HSR, and the percentage of GPIb-expressing cells were well maintained for 7 days of storage. pH was always within accepted range (6.4-7.4). Glucose decreased and lactate increased during the storage period (p < 0.05). P-selectin expression increased during storage (p < 0.05). The FOR clotting time remained constant, whereas the build-up of elasticity was slower after storage (p < 0.05). No difference was found between irradiated and nonirradiated PCs.

    Conclusion: The results indicate a well-preserved quality of gamma-irradiated apheresis PLTs during storage for 7 days as assessed by in vitro methods, with no difference compared to nonirradiated PLTs.

  • 45.
    Tynngård, Nahreen
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Transfusion Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Trinks, M.
    Linköping University, Department of Clinical and Experimental Medicine, Transfusion Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Berlin, Gösta
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    In vitro quality of platelets during prolonged storage after washing with three platelet additive solutions2012In: Vox Sanguinis, ISSN 0042-9007, E-ISSN 1423-0410, Vol. 102, no 1, p. 32-39Article in journal (Refereed)
    Abstract [en]

    Background and Objectives Patients with anaphylactic transfusion reactions require washed platelet concentrates (PCs) for subsequent platelet (PLT) transfusions. New PLT additive solutions (PASs) contain substances that might be beneficial for the preservation of PLT function during storage. This study compares the quality of PLTs washed and stored with T-Sol, Composol or SSP+. Study Design and Methods Fifteen buffy coats were pooled and divided into three parts. PCs with 30% plasma and 70% PAS (T-Sol, Composol or SSP+) were prepared. Washing was performed on day 5 of storage. Ten PCs were prepared and washed with each PAS. In vitro variables including haemostatic function (clotting time and clot retraction) were analysed on day 5 before, directly after and up to 2days after washing. Results Swirling was well preserved, and pH was within acceptable limits (6·4-7·4) during storage for all PASs. The PLT number was reduced by washing for all PASs, and T-Sol PCs had a further decrease during storage. PLTs in T-Sol were spontaneously more activated and had lower capacity to respond to an agonist than Composol or SSP+ PLTs. The haemostatic function was only slightly changed by washing and during postwashing storage. Conclusion PLTs washed with T-Sol, Composol or SSP+ had good in vitro quality for two days after washing despite absence of glucose. PLTs in T-Sol were more affected by the washing procedure and subsequent storage than Composol or SSP+ PLTs as judged by higher spontaneous activation. © 2011 The Author(s). Vox Sanguinis © 2011 International Society of Blood Transfusion.

  • 46.
    Tynngård, Nahreen
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Transfusion Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Trinks, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Transfusion Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Berlin, Gosta
    Linköping University, Department of Clinical and Experimental Medicine, Transfusion Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Platelet quality after washing: the effect of storage time before washing2010In: TRANSFUSION, ISSN 0041-1132, Vol. 50, no 12, p. 2745-2752Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients who have experienced anaphylactic transfusion reactions receive washed platelet (PLT) concentrates (PCs) where the plasma has been substituted with a PLT additive solution. This study compares the in vitro quality of PCs washed at the beginning of the storage period (Day 1) to PCs washed at the end of storage (Day 7). STUDY DESIGN AND METHODS: PLTs were prepared by the buffy coat procedure. Two concentrates were pooled and then split to obtain an identical pair of PCs. One of the PCs was washed with T-Sol on Day 1 and the other on Day 7 of storage. Swirling, blood gases, and metabolic variables were analyzed before washing. Analyses of surface expression of CD62P and coagulation by free oscillation rheometry (FOR) were performed before and after washing. RESULTS: pH was acceptable in all PCs. Washing on Days 1 and 7 increased the CD62P surface expression. The FOR variables clotting time and clot retraction were not influenced by washing on either day. Washing resulted in a decrease in the number of PLTs and the decrease was larger on Day 7 compared to Day 1. CONCLUSIONS: PLTs washed on Days 1 and 7 of storage are effected by washing in a similar manner. However, a larger loss of PLTs occurred during washing on Day 7.

  • 47.
    Tynngård, Nahreen
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Transfusion Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Trinks, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Transfusion Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Berlin, Gosta
    Linköping University, Department of Clinical and Experimental Medicine, Transfusion Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    QUALITY OF PLATELETS IN CONCENTRATES DURING STORAGE IN THREE ADDITIVE SOLUTIONS: T-SOL, COMPOSOL AND SSP in VOX SANGUINIS, vol 99, issue , pp 214-2142010In: VOX SANGUINIS, Blackwell Publishing Ltd , 2010, Vol. 99, p. 214-214Conference paper (Refereed)
    Abstract [en]

    n/a

  • 48.
    Tynngård, Nahreen
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Transfusion Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Trinks, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Transfusion Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Berlin, Gosta
    Linköping University, Department of Clinical and Experimental Medicine, Transfusion Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    THE INFLUENCE OF DIFFERENT PLATELET ADDITIVE SOLUTIONS ON THE QUALITY OF PLATELETS AFTER WASHING in VOX SANGUINIS, vol 99, issue , pp 214-2142010In: VOX SANGUINIS, Blackwell Publishing Ltd , 2010, Vol. 99, p. 214-214Conference paper (Refereed)
    Abstract [en]

    n/a

  • 49.
    Tynngård, Nahreen
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Trinks, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Berlin, Gösta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    In vitro function of platelets treated with ultraviolet C light for pathogen inactivation: a comparative study with nonirradiated and gamma-irradiated platelets2015In: Transfusion, ISSN 0041-1132, E-ISSN 1537-2995, Vol. 55, no 6, p. 1169-1177Article in journal (Refereed)
    Abstract [en]

    BackgroundDuring storage of platelet concentrates (PCs) replication of contaminating pathogens might occur, which can be prevented by various pathogen inactivation (PI) methods using photoactive substances in combination with ultraviolet (UV) light. A new method uses only UVC light for PI without photoactive substances. This study evaluates the in vitro function, including hemostatic properties (clot formation and elasticity), of platelets (PLTs) treated with UVC light. Study Design and MethodsA PC with 35% plasma and 65% PLT additive solution (SSP+) was prepared from five buffy coats. Three PCs were pooled and divided into 3units. One unit was used as a nonirradiated control, the second was a gamma-irradiated control, and the third unit was treated with UVC light. In vitro variables including analysis of coagulation by free oscillation rheometry were analyzed on Days 1, 5, and 7 of storage. Ten units in each group were investigated. ResultsSwirling was well preserved, and the pH level was higher than the reference limit (6.4) during storage of PLTs in all groups. Glycolysis and PLT activation were higher for UVC-treated PLTs but the clot-forming capacity was unaffected. However, immediately after UVC treatment, the clot elastic properties were slightly affected. Hypotonic shock response decreased immediately after UVC treatment but recovered partly during the storage period. ConclusionUVC treatment affected the in vitro properties, but PLT quality and storage stability were well preserved for up to 7 days, and the in vitro hemostatic capacity of UVC-treated PLTs was only minimally altered. The clinical relevance of these changes needs to be evaluated in controlled trials.

  • 50.
    Tynngård, Nahreen
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Chemistry.
    Trinks, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Berlin, Gösta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    In vitro properties of platelets stored in a small container for pediatric transfusion2014In: Transfusion, ISSN 0041-1132, E-ISSN 1537-2995, Vol. 54, no 6, p. 1562-1568Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The quality of a platelet (PLT) concentrate (PC) is affected by the number of PLTs in relation to the size and gas permeability of the container. This study evaluates the in vitro function, including hemostatic properties (clot formation and elasticity), of PLTs stored in a container of standard or small size.

    STUDY DESIGN AND METHODS:

    PCs with 30% plasma and 70% PLT additive solution were prepared from buffy coats. Two PCs were pooled and divided into the following containers: 1 unit and ½ a unit into a 1.8-L container (reference container) and ½ a unit into a 0.45-L container (test container). In a second set of experiments ¼ of a unit was stored in the reference and test containers. Swirling, PLT count, blood gases, metabolic variables, PLT activation markers, hypotonic shock response (HSR), and coagulation by free oscillation rheometry were analyzed during 7 days of storage.

    RESULTS:

    Swirling was well preserved and pH was acceptable (6.4-7.4) during storage of PLTs in both containers. Glycolysis and PLT activation were higher when storing ½ and ¼ of a unit in the reference container and storage of ¼ of a unit in the reference container resulted in the largest decrease in HSR. The clotting time was similar whereas the clot elasticity was slightly lower for PLTs when stored as ½ and ¼ of a unit in the reference container.

    CONCLUSION:

    Storage of a low number of PLTs benefits by storage in a small container in terms of better maintained in vitro properties.

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