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• W1431969187 abstract "British Journal of HaematologyVolume 124, Issue 4 p. 433-453 Free Access Transfusion guidelines for neonates and older children First published: 23 January 2004 https://doi.org/10.1111/j.1365-2141.2004.04815.xCitations: 267 Dr F. Boulton, National Blood Service, Southampton Centre, Oxford Road, Southampton SO16 5AF, UK. E-mail: frank.boulton@nbs.nhs.uk AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat This document updates the ‘Guideline for the Administration of Blood Products: Transfusion of Infants and Neonates’, published in 1994. In doing so it acknowledges changes in transfusion practice during the past decade, particularly in respect of safety issues and further published transfusion-related guidelines. The transfusion requirements of the neonate are recognized as unique, but there are other groups of children who are regularly transfused and who have very specific transfusion needs. There remains a lack of evidence for many transfusion practices in the neonatal period and childhood, making recommendations difficult in a number of areas. The British Committee for Standards in Haematology published its last Guideline for the Administration of Blood Products regarding the Transfusion of Infants and Neonates in 1994 (British Committee for Standards in Haematology, 1994). This highlighted the lack of scientific evidence for many of the then widely accepted practices, which were often based on outdated information, particularly in neonatal transfusion. It sought to replace these with recommendations for which there was some scientific support or, at a minimum, defendable broad agreement. It influenced practice positively, but a number of transfusion guideline documents have been published in the last few years incorporating recommendations for transfusion practice in neonates and children. However, in the absence of controlled evaluation, many areas of uncertainty still remain. In addition, the National Health Service Executive (2002), entitled ‘Better blood transfusion: appropriate use of blood’ is as applicable to children as it is to adults. Transfusion practice has advanced since 1994, particularly with respect to safety issues regarding the risk of transfusion-transmitted variant Creutzfeldt-Jacob disease (vCJD). (See the Guidelines for the use of fresh frozen plasma (FFP), cryoprecipitate and cryosupernatant (http://www.bcshguidelines.com) and the vCJD position statement in the document library of the UK Blood Services; http://www.transfusionguidelines.org.uk.) Although there is no current alternative to red cells and platelets from UK donors if the UK demand for these products is to be satisfied, sourcing FFP from donors residing in areas where bovine spongiform encephalopathy (BSE) and vCJD have never been endemic is more feasible. However, this may introduce other risks (e.g. if the prevalence of transfusion-transmissible diseases caused by known organisms is relatively high in such areas), but most of these diseases can be effectively eliminated from plasma by virus inactivation procedures. Although these procedures do not inactivate prions, by applying them to imported plasma the overall risks of transmitting infection (including vCJD) from treated products will be reduced. Important changes in transfusion practice include: • Leucocyte depletion (LD) of blood components, operative throughout the UK from 1 November 1999. This Guideline assumes that all cellular blood components, except granulocyte concentrates, are leucocyte depleted at the point of manufacture to comply with recent specifications (The Stationary Office, 2002) (<5 × 106 white blood cells per component in at least 99% of components with 95% confidence). This is monitored by a statistical control process as the residual leucocyte content is not ascertained in all components issued (3·52 million in the UK in 2000/2001). • The manufacture of fractionated pooled products from non-UK sourced plasma from November 1999. • Although single donor plasma products (FFP, cryoprecipitate and cryosupernatant) are currently still prepared from UK-sourced plasma, FFP subjected to virus inactivating procedures (‘virus inactivated plasma’, VIP), such as photo-inactivation in the presence of methylene blue (MB FFP) or treatment with solvent detergent (SD FFP), has been available in limited quantities since 2002. However, virus inactivated cryoprecipitate is not yet available. Recipients of SD FFP have been infected with parvovirus B19 (a non-lipid enveloped virus which is less susceptible to inactivation) (Koenigbauer et al, 2000). • The SD FFP is sourced from the USA where neither BSE nor vCJD are endemic. MB FFP, sourced from the USA, will become available from 2004. These are suited to children born after January 1996 who have therefore not been exposed to BSE in the food chain. • Plasma treated with psoralen S-59 and UVA light has undergone clinical trials in the USA in patients with liver disease and those with rare single clotting factor deficiencies. No significant differences from other VIP have been noted. S-59-UVA-treated FFP is produced from single units of plasma and may become available in the UK soon. Clinical advances have proceeded at an even greater pace. Progress in neonatal intensive care, extra corporeal membrane oxygenation (ECMO), cardiac bypass surgery, bone marrow and solid organ transplantation, and the management of haemoglobinopathies and malignancy means that any neonate or child requiring transfusion will be among the most intensively transfused of all hospital patients. Furthermore, they are likely to need highly specified products; the intensity of their transfusion, their age and potential life expectancy makes safety paramount. This Guideline re-evaluates current transfusion practices, particularly evidence-based practices where they exist, and updates recommendations in existing guidelines in the light of developments in transfusion and clinical practice. Indications for transfusion, product selection, compatibility testing and administration of blood products, will be considered (see Appendix 1 for detailed recommendations). 1. Blood and blood component specification 1.1. General recommendations (fetuses, neonates, infants and children) More precise product specifications for cellular and plasma components, including cryoprecipitate, are given in the ‘Guidelines of the UK Blood Transfusion Services’ (The Stationary Office, 2002). More details on granulocyte preparations are given in Section 3.2.4 of this Guideline. 1.1.1. Donors Components for transfusion in utero or to children under 1 year of age must be prepared from blood donated by donors who have given at least one previous donation within the past 2 years, which was negative for all mandatory microbiological markers. 1.1.2. Leucocyte depletion All components other than granulocytes should be leucocyte depleted (not more than 5 × 106 leucocytes per unit) at the time of manufacture (level IV evidence, grade C recommendation). 1.1.3. Cytomegalovirus The ‘Guidelines of the UK Transfusion Services’ (The Stationary Office 2002) state that blood transfused in the first year of life should be cytomegalovirus (CMV) seronegative. The evidence for this is still under review, so this advice holds for the present. Other authorities state that components that have been leucodepleted to <5 × 106/unit have a significant reduction in risk of CMV transmission (American Association of Blood Banks, 2000; Council of Europe, 2002: level IIb evidence, grade A recommendation). Those at greatest risk of transfusion transmitted CMV are fetuses and infants weighing under 1·5 kg, immunodeficient patients and stem cell transplant recipients. Some clinicians may prefer CMV seronegative components for recipients of haematopoietic stem cell transplants and patients with cellular immunodeficiency who are considered to be particularly susceptible to severe CMV infection. Although the efficiency with which blood products in the UK are depleted of leucocytes is high, only a few products are directly tested for compliance with the specification. This means that there is no guarantee that an individual product has been sufficiently depleted, so that the use of products that are CMV seronegative is still recommended where CMV-free products are indicated. However, in an emergency and where seronegative blood components are not available, transfusion of leucodepleted components is an acceptable, although less desirable, alternative (American Association of Blood Banks, 2000; Ronghe et al, 2002; The Stationary Office, 2002). 1.1.4. Irradiation Blood components should be irradiated prior to transfusion in line with the Guidelines published by the British Committee for Standards in Haematology (1996a) (see also Appendix 2). It is essential to irradiate all red cell and platelet components (with the exception of frozen red cells) for: 1 Intrauterine transfusion (IUT) (level III evidence, grade B recommendation). 2 Exchange transfusion (ET) of red cells after IUT (level III evidence, grade B recommendation). 3 Top-up transfusion after IUT (level III evidence, grade B recommendation). 4 When the donation is from a first- or second-degree relative or a human leucocyte antigen (HLA)-selected donor (level III evidence, grade B recommendation). 5 When the child has proven or suspected immunodeficiency (level III evidence, grade B recommendation). 6 Other indications as listed in the above Guidelines. The component must be irradiated to a minimum dose of 25 Gy. For IUT and large volume transfusion (e.g. ET), the component should be used within 24 h of irradiation and within 5 d of donation (level IV evidence, grade C recommendation). Red cells for top-up transfusion may be irradiated at any time up to 14 d after collection, and thereafter stored for a further 14 d from irradiation (level IV evidence, grade C recommendation). Platelets transfused in utero to treat alloimmune thrombocytopenia and platelet transfusions given after birth to infants who have received either red cells or platelets in utero should be irradiated. However, there is no need to irradiate other platelet transfusions in preterm or term infants, unless they are from first- or second-degree relatives (level III evidence, grade B recommendation). All granulocytes should be irradiated for patients of any age and transfused as soon as possible after irradiation (level III evidence, grade B recommendation). 1.1.5. Plasma and platelet compatibility Platelets should be ABO and RhD identical with the recipient. If this cannot be ensured, then compatible components lacking high titre anti-A or anti-B should be transfused to group A or B recipients. Group AB FFP, specifically for transfusion in the first year of life, may be given. For platelet and FFP transfusions, plasma compatibility should be ensured whenever possible. Both products contain enough red cell stroma to stimulate Rh immunization (level IIb evidence, grade B recommendation and level IV evidence, grade B recommendation). Therefore, RhD-negative girls for whom only RhD positive products are available should receive anti-D immunoglobulin. The dose should be 50 IU anti-D per unit of FFP (200–300 ml) or per 500 ml of platelets transfused, or 250 IU per adult therapeutic dose of platelets (c. 250–350 ml, whether from a single aphaeresis donation or from a pack derived from a buffy coat pool from four donations). Components must not contain other clinically significant red cell antibodies. 1.1.6. Administration All components should be transfused through a standard blood giving set with a screen filter (170–200 μ) or an alternative system incorporating the same filtration. Where small volumes are drawn into a syringe an appropriate filter must be used. Microaggregate filters (40 μ) are not required for LD components. 1.2. Pretransfusion testing for neonates and infants within the first four postnatal months Wherever possible, samples from both mother and infant should be obtained for initial ABO and RhD group determination. Investigations on the maternal sample: • ABO and RhD group. • Screen for the presence of atypical red cell antibodies. Investigations on the infant sample: • ABO and RhD. ABO by cell group only, repeated on same sample if no historical result (a reverse group would detect passive maternal antibodies). • Direct antiglobulin test (DAT) performed on the neonate's red cells. • In the absence of maternal serum, screen infant's serum for atypical antibodies by an indirect antiglobulin technique (IAT). A positive DAT on the neonate's red cells or an atypical red cell antibody in maternal or neonatal serum suggests possible haemolytic disease of the newborn (HDN). In such cases, special serological procedures will be necessary to allow selection of appropriate blood (level IV evidence, grade C recommendation). 1.2.1. Selection of blood component Components should be • Of the neonate's own ABO and RhD group, or an alternative compatible ABO and RhD group. • Compatible with any ABO or atypical red cell antibody present in the maternal or neonatal plasma. • An electronic cross-match may not select blood that is compatible with maternally derived ABO antibodies in the neonate's plasma. Therefore, it may not be appropriate to include neonatal samples in electronic cross-match protocols unless an appropriate algorithm has been created. ABO identical adult blood transfused to an infant with maternal anti-A or anti-B may haemolyse even if the pretransfusion DAT is negative, due to stronger ABO antigen expression on adult cells (see Section 3.1.3; level IV evidence, grade C recommendation). • Small volume transfusions can be given repeatedly over the first 4 months of life without further serological testing, provided that there are no atypical maternal red cell antibodies in the maternal/infant serum, and the infant's DAT is negative when first tested. • If either the antibody screen and the DAT (or both) are positive, serological investigation or full compatibility testing will be necessary. Infants rarely produce atypical red cell antibodies other than following repeated large volume transfusion and (possibly) the use of blood from donations collected up to 5 d before transfusion. It is only under these circumstances that repeat antibody screening of the recipient is advised (level IIb evidence, grade B recommendation). After the postnatal age of 4 months, compatibility tests should be conducted in accordance with national guidelines for pretransfusion testing in adult practice (British Committee for Standards in Haematology, 1996b, 2003a) (see Table I). Table I. Choice of ABO group for blood products for administration to children. Patient's ABO group ABO group of blood product to be transfused Red cells Platelets FFP* O First choice O O O Second choice – A A or B or AB A First choice A A A or AB Second choice O† O† – B First choice B B‡ B or AB Second choice O† A or O† – AB First choice AB AB‡ AB Second choice A, B A A Third choice O† *Group O fresh frozen plasma (FFP) should only be given to patients of group O. Although group AB FFP can be given to people of any ABO blood group, supplies are usually limited. †Group O components which test negatively for ‘high titre’ anti-A and anti-B should be selected. ‡Platelet concentrates of group B or of group AB may not be available. 2. Intrauterine transfusion 2.1. Indications and aims Intrauterine transfusions are usually administered only on specialized units. Intrauterine red cell transfusion is indicated to correct fetal anaemia caused by red cell alloimmunization (most important antigen-RhD followed by Rhc and K) or, less commonly, for fetal parvovirus infection. Intrauterine platelet transfusions are indicated to correct fetal thrombocytopenia caused by platelet alloimmunization. The aims of IUT are (i) to prevent or treat fetal hydrops before the fetus can be delivered and (ii) to enable the pregnancy to advance to a gestational age that will ensure survival of the neonate (in practice, up to 36–37 weeks) with as few invasive procedures as possible (because of the risk of fetal loss). This is achieved by (i) starting the transfusion programme as late as safely possible but before hydrops develops and (ii) maximizing the intervals between transfusions, by transfusing as large a volume of red cells as is considered safe. Cell counting should be available close to fetal sampling or transfusion to provide an immediate haematocrit/haemoglobin or platelet count. 2.2. Component and procedure specification (see ) 2.2.1. Red cells preparations Red Table II cells preparations for IUT should Table II. Component volumes to be transfused to children and neonates. Component Volume Red cell concentrates A. Exchange transfusion For a term infant 80–160 ml/kg For a preterm infant 100–200 ml/kg B. Top-up transfusion Desired Hb (g/dl) − actual Hb × weight (kg) × 3 (usually 10–20 ml/kg) Platelet concentrates Children weighing <15 kg 10–20 ml/kg Children weighing >15 kg Single aphaeresis unit/standard pool Fresh frozen plasma 10–20 ml/kg Cryoprecipitate 5 ml/kg or 15–30 kg = 5 units, >30 kg = 10 units • be group O (low titre haemolysin) or ABO identical with the fetus (if known) and RhD negative. K-negative blood is recommended to reduce additional maternal alloimmunization risks. In exceptional cases, e.g. for haemolysis because of maternal anti-c, it may be necessary to give RhD positive, c-negative blood; • be IAT-cross-match compatible with maternal serum and negative for the relevant antigen(s) determined by maternal antibody status. • be <5 d old and in citrate phosphate dextrose (CPD) anticoagulant; • be CMV seronegative; • be irradiated as above (see Section 1.1.4); • be have a haematocrit (packed cell volume, PCV) of up to but not more than 0·75; • not be transfused straight from 4°C storage. As no specifically designed warming systems exist for the small volume of blood used for IUT, any active warming must be carried out with great care and the blood product not exposed to temperatures higher than 30°C. Active warming may not be necessary if the infusion is conducted carefully and at an appropriate rate (see below); • be in a volume calculated from the formula of Rodeck and Deans (1999): where BV is blood volume; • be transfused at a rate of 5–10 ml/min. 2.2.2. Platelet preparations Platelet preparations for IUT should • be group O RhD negative and test negatively for high-titre anti-A or anti-B (i.e. have a low titre haemolysin) or group specific/compatible with maternal antibody; • be human platelet-specific alloantigen (HPA) compatible with maternal antibody; • preferably be collected by aphaeresis. A platelet concentrate derived from whole blood donations is less preferred; • be irradiated as above (see Section 1.1.4); • be concentrated to a platelet count of at least 2000 × 109/l; • be warmed, if warmed at all, with extreme care. As the ambient temperature for storing platelet concentrates is 22°C, and as the recommended rate of infusion (see below) is slower than that for red cells, active warming may not be needed. If it is conducted, it should not be beyond 30°C; • be in a volume calculated from the formula • be transfused at a rate of 1–5 ml/min (transfused more slowly than red cells because of the increased risk of fetal circulatory stasis and asystole). Compatible platelets should be available at the time of diagnostic fetal sampling for alloimmune thrombocytopenia, even if the primary purpose is not that of transfusion, because in the presence of severe fetal thrombocytopenia, fetal haemorrhage can be prevented by platelet transfusion. Teflon-coated needles should be used because they are considered to allow samples of fetal blood which give more accurate cell counts (Welch et al, 1995: level IIb evidence, grade B recommendation). 3. Neonatal transfusion 3.1. Exchange transfusion 3.1.1. Indication and aims Exchange transfusion may be used to manage severe anaemia at birth, particularly in the presence of heart failure, and to treat severe hyperbilirubinaemia, usually caused by HDN. In the treatment of HDN, the aim is to remove both the antibody-coated red cells and the excess bilirubin. Controversial indications such as metabolic disease, septicaemia and disseminated intravascular coagulation (DIC) have not been subjected to adequate clinical evaluation. Exchange transfusion is a specialist procedure associated with a potential for serious adverse events. As such, it should be undertaken only by staff who are experienced in the procedure. 3.1.2. Principles While there is, as yet, no consensus amongst neonatologists, plasma-reduced red cells with a haematocrit of 0·50–0·60 should be suitable for ET for both hyper-bilirubinaemia and severe anaemia (level IV evidence, grade C recommendation). Whole blood, with a haematocrit of 0·35–0·45 may result in a postexchange Hb of <12 g/dl in a severely anaemic baby and thus increase subsequent donor exposure. Packed red cells may have a haematocrit of up to 0·75, leading to an unacceptably high postexchange haematocrit. Exchanging the estimated volume of the baby's blood in a ‘single-volume exchange’ will remove 75% of red cells, while a double-volume exchange (160–200 ml/kg, depending on gestation) removes 90% of the initial red cells. A double-volume exchange can remove 50% of available intravascular bilirubin. The pH of a unit of whole blood or plasma-reduced red cells is around 7·0. This does not contribute to acidosis in the infant. Acidosis is more likely to be a result of underlying hypovolaemia, sepsis or hypoxia. ‘Correction’ of pH to physiological levels by the addition of buffer solutions is not indicated. 3.1.2.1. Component and procedure specifications. Red cells for ET should • be group O or ABO compatible with maternal and neonatal plasma, RhD negative (or RhD identical with neonate); • be negative for any red cell antigens to which the mother has antibodies; • be IAT-cross-match compatible with maternal plasma; • be 5 d old or less (to ensure optimal red cell function and low supernatant potassium levels); • be collected into CPD anticoagulant; • be CMV seronegative; • be irradiated and transfused within 24 h of irradiation. Irradiation is essential if the infant has had a previous IUT and is recommended for all ETs (see Section 1.1.4 and Appendix 2). Irradiation for ET in absence of IUT is not essential if this would lead to clinically significant delay; • have a haematocrit of 0·50–0·60; • not be transfused straight from 4°C storage. If it is decided to warm the product prior to transfusion, extreme care must be taken to avoid over-heating. There is no easy way of achieving this for babies as the equipment designed to warm whole packs of blood warms it immediately prior to infusion; this arrangement is not suited to the intermittent bolus nature of ET procedures. Most clinical units allow the infusate to approximate the ambient temperature while the blood is flowing from the primary pack through the syringes and filters before finally entering the patient's blood circulation; • volume transfused is usually 80–160 ml/kg for a term infant and 100–200 ml/kg for a preterm infant (i.e. 1–2 × blood volume) depending on the clinical indication (see Table I; all level IV evidence, grade C recommendation). 3.1.3. ABO haemolytic disease of the newborn Haemolysis may develop in fetuses and neonates who are ABO incompatible with their mother. Clinically significant haemolysis generally occurs only if the mother is group O and the infant group A (occasionally in group B babies). The haemolysis is due to the IgG anti-A or anti-B crossing the placenta and binding to the fetal red cells. Group A babies of group O mothers have a lower mean Hb and a higher mean cord bilirubin than in ABO compatible pairs. Nevertheless, clinically significant haemolysis is uncommon. The expression of A and B antigens on neonatal red cells is much weaker than on adult red cells which reduces the number of molecules of IgG which can bind, thus reducing or preventing haemolysis. The diagnosis of HDN is complicated. Mothers with a high titre of IgG anti-A or anti-B are more likely to have affected babies but there is no direct relationship with the antibody titre. In addition, although severely affected babies will almost always have a positive DAT, this is not always the case. The preparation of eluates from DAT negative cells has been recommended but a positive DAT and positive eluate can be found in infants who have no evidence of haemolysis. Thus, at times the diagnosis of ABO HDN must be a diagnosis of exclusion: a relatively low cord blood Hb which continues to fall, a raised bilirubin level, ABO incompatibility with the mother and a positive DAT in the absence of any other alloantibodies. Spherocytes are a prominent feature on the blood smear. A high titre IgG anti-A or anti-B in the mother is supportive evidence but a low titre does not exclude the diagnosis. If transfused with blood of their own group, group A or B babies who have maternal anti-A or anti-B in their plasma may convert to DAT positivity and develop haemolysis. This is due to the increased expression of A and B antigens on adult cells of those groups. Group O blood, compatible with the maternal plasma, should be used for transfusion (level IV evidence, grade C recommendation). If an ET is required in ABO HDN, this should be with group O red cells with low titre plasma anti-A and anti-B, or with group O red cells suspended in AB plasma (level IV evidence, grade C recommendation). 3.2. Small volume transfusion Most neonatal transfusions are small volumes (10–20 ml/kg), given to replace phlebotomy losses (see Tables II and III). Most departments have local guidelines with a range of haemoglobin values, depending on clinical status, at which to initiate transfusion. Table III. Suggested transfusion thresholds for infants under 4 months of age. Transfusion of red blood cells Anaemia in the first 24 h Hb 12 g/dl (Hct c. 0.36) Cumulative blood loss in 1 week, neonate requiring intensive care 10% blood volume Neonate receiving intensive care Hb 12 g/dl Acute blood loss 10% Chronic oxygen dependency Hb 11 g/dl Late anaemia, stable patient Hb 7 g/dl Administration of platelets Preterm or term neonate, with bleeding 50 × 109/l Sick preterm or term infant, not bleeding 30 × 109/l Stable preterm or term infant, not bleeding 20 × 109/l Dedicating aliquots from a single donation of red cells (or aphaeresis platelets) to allow sequential transfusions from the same donor for neonates and small children who are likely to be repeatedly transfused is considered good practice. These must be transfused within the normal shelf-life (currently 35 d for red cells in additive solution, 5 d for platelets). 3.2.1. Guidelines for administration of red cells It is impossible to produce clear evidence-based criteria for the administration of red cells in the neonatal period. However, clinicians who transfuse according to agreed local guidelines give fewer transfusions and it is recommended that local transfusion protocols be established in all neonatal units (Ross et al, 1989: level Ib evidence, grade A recommendation). Furthermore, there is no difference in outcome as determined by mortality or duration of hospital stay by transfusion approach. Table II gives proposals for neonatal red cell audit criteria. These are not ‘transfusion triggers’per se, but represent standards against which individual nurseries can assess the appropriateness of their local transfusion policies (level IV evidence, grade C recommendation). Surrogate markers of anaemia include respiratory irregularity, tachycardia, poor weight gain, lethargy, poor suck and increased blood lactate levels. All of these are susceptible to influence from confounding factors. Patients with a higher oxygen extraction ratio (>40%), a measure of adequacy of oxygen delivery, seem more likely to benefit from transfusion (Ross et al, 1989). Although red cell transfusions may improve these parameters, there is no clear evidence of an associated improved outcome, such as reduced mortality or hospital stay. Furthermore, similar benefits may be obtained simply by volume expansion, implying that some of these surrogate markers may reflect a hypovolaemic state (Alverson et al, 1988). 3.2.1.1. Anaemia of prematurity. The aim of a top-up transfusion is to restore or maintain adequate tissue oxygen delivery without a marked increase in oxygen consumption (Alverson et al, 1988; Maier et al, 2000). 3.2.1.2. Oxygen dependency. Neonates with severe pulmonary disease are thought to benefit from a higher haemoglobin or haematocrit (0·40), which allows oxygen delivery to be optimized in the presence of underlying respiratory insufficiency. There is now some evidence that systemic oxygen delivery is improved and o" @default.
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• W1431969187 title "Transfusion guidelines for neonates and older children" @default.
• W1431969187 cites W101960117 @default.
• W1431969187 cites W145079087 @default.
• W1431969187 cites W1506035634 @default.
• W1431969187 cites W151627377 @default.
• W1431969187 cites W1518706661 @default.
• W1431969187 cites W1546619554 @default.
• W1431969187 cites W1554783366 @default.
• W1431969187 cites W1576188136 @default.
• W1431969187 cites W1576345300 @default.
• W1431969187 cites W1593763878 @default.
• W1431969187 cites W196336819 @default.
• W1431969187 cites W1964252841 @default.
• W1431969187 cites W1965971764 @default.
• W1431969187 cites W1973375897 @default.
• W1431969187 cites W1988974302 @default.
• W1431969187 cites W1992106745 @default.
• W1431969187 cites W1998136164 @default.
• W1431969187 cites W2004525639 @default.
• W1431969187 cites W2006103263 @default.
• W1431969187 cites W2008358579 @default.
• W1431969187 cites W2008552288 @default.
• W1431969187 cites W2009536651 @default.
• W1431969187 cites W2015024619 @default.
• W1431969187 cites W2017301715 @default.
• W1431969187 cites W2017594278 @default.
• W1431969187 cites W2020343070 @default.
• W1431969187 cites W2023377303 @default.
• W1431969187 cites W2025636815 @default.
• W1431969187 cites W2026639883 @default.
• W1431969187 cites W2031113061 @default.
• W1431969187 cites W2035359187 @default.
• W1431969187 cites W2037956912 @default.
• W1431969187 cites W2040785298 @default.
• W1431969187 cites W2046325862 @default.
• W1431969187 cites W2048176236 @default.
• W1431969187 cites W2050979052 @default.
• W1431969187 cites W2052798762 @default.
• W1431969187 cites W2055241974 @default.
• W1431969187 cites W2056257280 @default.
• W1431969187 cites W2056710986 @default.
• W1431969187 cites W2058587587 @default.
• W1431969187 cites W2058736766 @default.
• W1431969187 cites W2065748913 @default.
• W1431969187 cites W2065877867 @default.
• W1431969187 cites W2066856911 @default.
• W1431969187 cites W2069202531 @default.
• W1431969187 cites W2072332078 @default.
• W1431969187 cites W2072362298 @default.
• W1431969187 cites W2080615061 @default.
• W1431969187 cites W2081904812 @default.
• W1431969187 cites W2082296736 @default.
• W1431969187 cites W2083893791 @default.
• W1431969187 cites W2086327385 @default.
• W1431969187 cites W2087497959 @default.
• W1431969187 cites W2089785119 @default.
• W1431969187 cites W2094692973 @default.
• W1431969187 cites W2109273369 @default.
• W1431969187 cites W2110711267 @default.
• W1431969187 cites W2118953346 @default.
• W1431969187 cites W2125058683 @default.
• W1431969187 cites W2126639731 @default.
• W1431969187 cites W2126956249 @default.
• W1431969187 cites W2130661964 @default.
• W1431969187 cites W2135183783 @default.
• W1431969187 cites W2136512906 @default.
• W1431969187 cites W2142733946 @default.
• W1431969187 cites W2147822372 @default.
• W1431969187 cites W2149809765 @default.
• W1431969187 cites W2154134557 @default.
• W1431969187 cites W2158441687 @default.
• W1431969187 cites W2163095381 @default.
• W1431969187 cites W2163634077 @default.
• W1431969187 cites W2172076494 @default.
• W1431969187 cites W2223511072 @default.
• W1431969187 cites W2224339414 @default.
• W1431969187 cites W2232626615 @default.
• W1431969187 cites W2323849691 @default.
• W1431969187 cites W2330845108 @default.
• W1431969187 cites W2415631549 @default.

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