P106 Quality measurements from blood donation to separation

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antibodies at Szeged Regional Blood Center together with the introduction of increasingly stringent donor-selection criteria since September 1992. All voluntary blood donor’ specimens were routinely tested for anti-HCV antibodies by different type immunoassays (enzyme and chemiluminescence) in our laboratory. To investigate the presence of these antibodies we have used different ABBOTT automats (Quantum II, PPC, AXSYM and PRISM). HCV screening-test-positive results were verified with independent supplemental tests with high specificity and NAT for HCV RNA in the central laboratory of Hungarian National Blood Transfusion Service. We also investigated alanine aminotransferase (ALT) till 2003. Among voluntary blood donors, the rate of verified HCV antibody-positives was 0.52% (267 of 50,939 donors). P103 Development of compatibility testing techniques in Hungary A. Friss *. National Blood Transfusion Service, Reference Laboratory, Budapest, Hungary The Hungarian Blood Transfusion Service was founded in 1950. From the AB0 matching of the donors and recipients it has been a long way to the present sophisticated methods. Surveying the available stored documents and interviewing the veterans of the transfusion service made it possible to establish the main steps in the development of the compatibility testing methods and techniques. 1. stage: only AB0 matching from the start till the early 60ies. 2. stage: AB0+RhD matching. 3. stage: AB0+RhD matching and occasionally Xmatching. 4. stage: 1972: the Transfusion Regulation defines the category of endangered recipient for whom the Xmatch is compulsory. 5. stage: transition from slide antiglobulin test to tube agt; identification of irregular antibodies. 6. stage: restriction of compatibility methods to antiglobulin test. 7. stage: extension of antibody screening to all transfusion recipients. The methods used in compatibility testing developed from the exclusionary slide methods to the present varied manual and automated tube, microplate and column agglutination techniques. P104 Red cell antibody screening with DiaMed card and with ACT 24 semi-automatic agglutination analyser based on the detection of red cell antibodies K. Szabo1 *, I. Zsigmond-So´ os2 , J. Jakab2 , N. Gol´ acs2 , as2 , M. Vagner2 , I. Hoffer2 . 1 Blood Zs. Krist´ ofi2 , R. Tam´ Bank of Hospital Vaszary Kolos in Esztergom, Hungary, 2 Immunohematology Department of the National Blood Transfusion Service (OVSZ) Regional Blood Transfusion Centre in Buda (BRVK) Budapest, Hungary Antibody Screening is an important part of pre-transfusion examination. Examinations have been based on tube tests for decades. Through the modifications of the tube test, several microgel technical methods and solid-phase test methods have been elaborated. There is a tube test-based ACT 24 semiautomatic agglutination analysis with enzyme and indirectCoombs test is applied generally in the blood group serology on red cell antibodies in Hungary. Red cell antibodies were detected with ACT 24 semi-automatic agglutination analysis in the Blood Bank of Hospital Vaszary Kolos in Esztergom and the positive antibody screening was identified in the Immunhematology Department of the National Blood Transfusion Service (OVSZ) Regional Blood Transfusion Centre in Buda (BRVK). In the examined period out of the 18,030 antibody screening cases 596 cases (3.3%) have been positive. Antibody identification has been made in each positive case in the Immunhematology Department of BRVK. Out of the total examined cases, antibody has not been detected in 44 cases (7.0%) during the antibody identification. Out of the 596 positive

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cases microtube column agglutination technique (DiaMed) has also been applied in 85 cases. Examination results of the two different methods and the antibody identification has been done. Based on the retrospective examination of the authors, antibody screening with ACT 24 agglutination analysis has proven to be a reliable and efficient pre-transfusion examination. P105 Evaluation of automated immunohematologic system in routine blood group serology testing os2 , G. Bek˝ o1 . 1 Semmelweis University A. Feh´ er1 *, I.Zs. So´ Central Laboratory, Budapest, Hungary, 2 OVSZ-Buda-side Regional Blood Diagnostic Department, Budapest, Hungary Introduction: Since June 2006, our laboratory uses complete automation for routine blood group serology testing with micro gel typing technology. The aim of this study was to evaluate the automated WADiana Compact (Diagnostic Grifols, Spain) system and estimate the frequency of antibodies in our pool, comparing Grifols DG Gel and DiaMed ID cards. Methods: With Grifols gel cards and two interconnected Wadiana Compact instrument, we determined the blood group, Rh factor, direct Coombs and antibodies in samples using enzyme and Coombs medium (Jun Dec 2006). The frequencies were compared with results obtained at ID cards in 2003. Results: Antibody frequency was 1.7% with Grifols automated DG Gel system from 8474 consecutive samples (Jun Dec, 2006) compared to 2.8% with DiaMed manual gel card systems from 3832 samples (2003). Significant differences in antibody frequencies were observed for some antibodies. Direct Coombs positivity was, as expected, more frequent in the sera of the haematological and oncological disease group. Conclusion: We conclude that DG Gel WADiana analyzer is a time saving, online available immunhaematologic system for routine antibody screening with high diagnostic accuracy. It helped our clinicians in close contact with the blood supplier in the patient matched blood selection for department transfusion. The method is cost effective with minimal manual needs. P106 Quality measurements from blood donation to separation ´. Horv´ M. Aleksza1 *, I. Bodork´ os1 , E ath1 , I. Katovics2 , K. Bar´ oti2 , T. Dancza1 . 1 National Blood Centre of Hungary, Regional Blood Bank of Zalaegerszeg, 2 Quality Control Laboratory, Hungary Introduction: Quality of the blood products is primary importance from the point of view of the effective transfusion. We have two possibilities to the control: checking donors’ haemoglobin level and controlling quality of the basic blood products. Methods: Donors’ haemoglobin level was measured by Hemocue Hb 201+ analyser. Quality examination of red cell, thrombocyte and plasma units was detected by SYSMEX SF-3000 haematology automata in the Quality Control Laboratory. Results: The Regional Blood Blank of Zalaegerszeg has done 16220 haemoglobin detections in the last 14 months (donors’ haemoglobin measurement: 14292, repetition: 1307, quality control: 534, autotransfusion: 87). Cause of 78.6% of repetition was the low level of the donor’s haemoglobin, while 21.4% was unsuitable sampling (non-wiped disinfectant, lymph-mixed blood drop). We analysed haemoglobin level of 1005 donors. The number of excluded donors with low haemoglobin concentration was 81 (8 male, 73 female). The average haemoglobin levels were 150.5 ± 10.9 (male) and 133.2 ± 10.3 (female) g/l. We controlled 337 blood units during the one year. Quality of all plasma units was suitable (n = 57); moreover red cell and thrombocyte units were relevant quality over than 90% (n = 155 and 125). The most repeated mistakes: low haemoglobin level

Posters, ISH EAD 2007, Budapest, Hungary, 29 August (6/155), high white cell number (13/155) (red cell unit) or low thrombocyte number (14/125) (thrombocyte unit). Summary: Donors with low hemoglobin levels have to be excluded from the blood donation service for 3 months. So, in theory haemoglobin concentration of all total blood units is suitable for preparation the good quality basic units. If we systematically check the quality of the basic units, we can avoid or repair the technical faults of production.

CMPD, Friday 31 August 2007 P107 Chromosomal abnormalities in Philadelphia chromosome-negative metaphases appearing during imatinib mesylate therapy in patients with Philadelphia chromosome positive chronic myeloid leukemia in chronic phase S. Jootar *. Ramathibodi Hospital, Rama 6 Road, Bangkok 10400, Thailand Introduction: Cases of chromosomal abnormalities in Philadelphia chromosome (Ph)-negative metaphases have been reported in patients with CML in chronic phase during treatment with interferon and, more recently, with imatinib. This phenomenon is different from true clonal evolution in that the additional cytogenetic abnormality occurs in Ph-negative cells. The incidence of this phenomenon varied from 1% to 15%. Most publications are case reports or small studies. There were only seven series with more than 100 cases and the incidence was between 1.5 to 3.8%. We report here a series of 100 patients with 15% incidence. Methods: One hundred cases of CML in chronic phase treated with imatinib mesylate were analyzed for the frequency and the significance of chromosomal abnormalities in Philadelphia chromosome negative metaphases. Results: After a median follow up of 32 months (range, 18 75 months), 15 patients (15%) developed chromosomal abnormalities in Ph-negative cells. The median time from the treatment with imatinib to the appearance of the abnormalities was 12 months (range, 9 57 months) The most common cytogenetic abnormality was trisomy 8 (53%). Twelve of 15 patients achieved complete (Ph 0%) cytogenetic response (80%), one patient had partial cytogenetic response (Ph chromosome less than 35%) and two patients had minor cytogenetic response (Ph chromosome 35 95%). After a median follow up of 32 months (range, 18 75 months) fourteen patients were alive, one patient died in blastic crisis. Twelve of them were in chronic phase and in complete hematological response. One patient had minor cytogenetic response and remained in chronic phase. One patient lost his partial cytogenetic response and progressed to accelerated phase. None of the patients showed features of myelodysplasia. Conclusion: Cytogenetic abnormalities occur in Ph-negative cells in a fraction of patients with CML in chronic phase treated with imatinib. With a short follow up, no clear clinical consequences can be identified. P108 Central nervous system blastic phase in chronic myeloid leukaemia during imatinib treatment A. Kiss1 *, A. Ujfalusy2 , T. Csepany3 , Gy. Remenyi1 , P. Batar1 , E. Balogh2 , M. Udvardy1 . 1 2nd Department of Medicine, 2 Pediatry, 3 Neurology Clinic, University Debrecen, Hungary Introduction: Since the Hungarian introduction (2002) of Glivec (imatinib mesylate), the fundamental life-expectancy of Ph1 CML-patients has changed in Hungary. As Glivec is a new drug, it might have adverse side-effects and may be responsible for the development of a so called “haematological crisis condition”. Materials and Methods: The currently 63-year-old female patient was diagnosed with the disease in July 2003.

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Her laboratory data showed an extreme leukocyte number (400×109 /L). After fast therapy changes (hydroxyurea and interferone) she was in complete haematological, and partial cytogenetical remission within six months due to the influence of Glivec. In the 31st month of her disease (02. 2006), she developed a stiffness of the limbs and of the right side of the face, temporary aphasia, dizziness and nausea. Results: Her blood picture was characteristic of a quiet phase. Molecular-biological examinations verified a sufficient partial remission in this phase of complete remission (the pcr value of bcr/abl was 0.39). During a characteristic seizure-like attack of the symptoms of the disease the findings of a liquor test verified that the central nervous system was in a myeloid CML blastic phase. Glivec dosage was increased via intrathecale combined chemotherapy (methotrexate, cytosine arabinoside, dexamethasone) and cranial irradiation. The patient’s condition stabilised, and her life-quality was adequate in the past eleven months. Conclusion: A complication of the central nervous system is very rare during Glivec therapy, however, some cases are mentioned in the literature. Some of the reasons for the complication can be a high tumor mass at the onset of the disease and the inadequate liquor-blood penetrability for Glivec. Similar complications may be expected to occur in other haematological centres in the future. P109 Systemic mastocytosis with partial response to cladribine ˇ oloviˇ N. C c *, M. Sretenoviˇ c, T. Terziˇ c, M. Colovic, V. Juriˇsiˇ c. Institute of Hematology, Clinical Center of Serbia, Koste Todoroviˇca 2, Belgrade, Serbia Introduction: Systemic mastocytosis is a heterogeneous group of hematological disorders characterized by accumulation of mast cells in different organs. Therapy for aggressive forms of systemic mastocytosis consisted of cytoreductive agents and interferon-alpha. We here present a rare case of systemic mastocytosis treated with cladribine. Material and Method: A 41 year-old caucasian woman presented with 2 year history of fatigue, occasional diarrhea, mild fever and rash. Clinical inspection revealed pale skin with disseminated itching rash, splenomegaly 4 cm below left costal margin. Laboratory data showed severe anemia with hemoglobin59 g/l, thrombocytopenia 18×109 /l, white cell blood count 5.l×109 /l (differential leukocyte formula: myelocytes 1%, bands 3%, segmented 29%, eosinophils 3%, lymphocytes 51%, monocytes 13%, erythroblasts 21/100). Level of serum histamine and lactate dehydrogenase (786 U/l) was significantly increased. Cytologic and histologic investigation of bone marrow revealed a marked increase of mast cells. Immunohistochemistry of these cells showed CD117+, CD68+, CD34 , MPO , CD15 . Cytogenetic analysis revealed normal female karyotype 46,XX. Cultures of hematopoietic progenitor cells showed increased number of CFU-GM colonies, spontaneous growth of BFUE and increased number of eritropoetin stimulated BFU-E, comparing to control and absence of CFU-MK. Serum ferritin was 743.0 mg/l (normal range 5.00 170.00). As reported in the literature, this patient presents with a classical picture of systemic mast cell disease*. The systemic mast cell disorders are clinically defined by some or all of the following: anemia, thrombocytopenia, monocytosis, leukocytosis with increased neutrophils, qualitative peripheral smear changes, increased serum alkaline phosphatase, LDH, and histamine, and the physical findings of hepatosplenomegaly and lymphadenopathy. The bone marrow findings are consistent with systemic mast cell disease type 2, also known as malignant mastocytosis*. The patient was treated with cladribine 0.15 mg/kg body weight from day 1 to day 5, 6 cycles. She achieved a good partial response with normalization of spleen size and CBC. Response lasted 10 months when she relapsed with splenomegaly and