bluuebunny/crossref_metadata_2025 huggingface dataset:
The Relationship Between Blood Pressure and Mortality in the Oldest Old
Authors: Satish Shiva , Freeman Daniel H. , Ray Laura , Goodwin James S.
Published: March 2003

OBJECTIVES: To explore the relationship between systolic and diastolic blood pressure and risk of 6‐year, all‐cause mortality in men and women age 65 to 84 versus those 85 and older.

DESIGN: A population‐based longitudinal study.

SETTING: This study was conducted at four different sites: East Boston, Massachusetts; New Haven, Connecticut; two rural counties in Iowa; and Piedmont, North Carolina.

PARTICIPANTS: 12,802 community‐dwelling persons age 65 and older.

MEASUREMENTS: Baseline measurements collected include demographics, self‐reported chronic medical conditions, blood pressure measurements, medications, health habits, and hospitalizations.

RESULTS: Unadjusted actuarial survival analyses show that men age 65 to 84 years with systolic blood pressure <130 mmHg have significantly lower mortality compared with those with systolic blood pressure ≥180 mmHg (P < .0001). In contrast, men 85 and older with systolic blood pressure ≥180 mmHg have significantly lower mortality compared with those with systolic blood pressure <130 mmHg (P < .0001). In Cox proportional hazards analyses controlling for other predictors of survival, the hazard of death associated with each 10‐mmHg increase in systolic blood pressure is positively associated among men age 65 to 84 years and negatively associated among men age 85 and older (Hazard ratio and 95% confidence interval (CI): 1.04 (1.01, 1.07) for younger men vs 0.92 (0.86, 0.99) for older men). Among women age 65 to 84, the hazard of death significantly increased with increase in systolic blood pressure (P < .0001), while there was no relationship between level of systolic blood pressure and survival in women 85 and older. Both men 65 to 84 years old and those 85 and older showed a negative relationship between diastolic blood pressure and all‐cause mortality (Hazard ratio 0.93, 95% CI (0.88–0.97) for men age 65–84 years, and Hazard ratio 0.90, 95% CI 0.80–1.02 for men 85 and older).

CONCLUSION: In men age 85 and older, higher systolic blood pressure is associated with better survival.
Medical Comorbidity and Rehabilitation Efficiency in Geriatric Inpatients
Authors: Patrick Louise , Knoefel Frank , Gaskowski Peter , Rexroth Daniel
Published: March 2003

OBJECTIVES: To measure and describe medical comorbidity in geriatric rehabilitation patients and investigate its relationship to rehabilitation efficiency.

DESIGN: Prospective, multivariate, within‐subject design.

SETTING: The Geriatric Rehabilitation inpatient unit of the SCO Health Service in Ottawa, Canada.

MEASUREMENTS: The rehabilitation efficiency ratio, based on gains in functional status achieved with rehabilitation treatment, and the length of stay were computed for all patients. Values were regressed on the scores of the Cumulative Illness Rating Scale (CIRS), the Mini‐Mental State Examination, and the Geriatric Depression Scale to establish predictive power.

RESULTS: The findings suggest that geriatric rehabilitation patients experience considerable medical comorbidity. Sixty percent of patients had impairments across six of the 13 dimensions of the CIRS, whereas 36% of patients had impairments across 11 of the 13 dimensions. In addition, medical comorbidity was negatively related to rehabilitation efficiency. This relationship was significant even after controlling for age, cognitive status, depressive symptoms, and functional independence status at admission.

CONCLUSION: Medical comorbidity was a significant predictor of rehabilitation efficiency in geriatric patients. Comorbidity scores> 5 were prognostic of poorer rehabilitation outcomes and can serve as an empirical guide in estimating a patient's suitability for rehabilitation. Medical comorbidity predicted both the overall functional change achieved with rehabilitation (Functional Independence Measure gains) and the rate at with which those gains were reached (rehabilitation efficiency ratio).
Highlights of Papers in Clinical Investigations Section: Illness Representations According to Age and Effects on Health Behaviors Following Coronary Artery Bypass Graft Surgery
Authors: Gump BB , Matthews KA , Scheier MF
Published: March 2003

Illness representations—the perception of what the cause of a disease is and its impact on symptoms, duration, consequences, and control of the illness—differ with age. In this study of 309 patients scheduled for coronary bypass graft surgery, older patients were more likely to view old age as the cause of their coronary artery disease than genetics, health‐damaging behaviors, health‐protective behaviors, or emotion in comparison with younger patients awaiting surgery. Furthermore, older patients were substantially more likely to believe that they had no control over their disease and thatthe disease would be eliminated after surgery and to report less postoperative health‐behavior changes than younger patients.
Highlights of Papers in Clinical Investigations Section: Racial Differences in the Cost of Treating Men with Early‐Stage Prostate Cancer
Authors: Brandeis J , Pashos CL , Henning JM
Published: March 2003

This study examined Medicare records to compare the cost and resource utilization in the management of early‐stage prostate cancer in African‐American and White men age 65 years and older. African‐American men undergoing radical prostatectomy or external beam radiation therapy had significantly greater costs than did White men. It is speculated that the greater costs related to radical prostatectomy may be related to unmeasured comorbidity and those greater costs for external beam radiation may reflect a more advanced tumor stage in African‐American men.
The Appropriateness of Drug Use in an Older Nondemented and Demented Population
Authors: Giron Maria Stella T. , Wang Hui‐Xin , Bernsten Cecilia , Thorslund Mats , Winblad Bengt , Fastbom Johan
Published: March 2003

OBJECTIVE: To assess the extent of inappropriateness of drug use in an older nondemented and demented population.

DESIGN: Descriptive analysis based on data from a sample of older subjects age 81 years and older. Data were collected from the second follow‐up conducted in 1994–1996.

SETTING: A population‐based study of the Kungsholmen project in Stockholm, Sweden.

PARTICIPANTS: Drug information was obtained from 681 subjects with a mean age of 86.9 years. The subjects were predominantly women (78%). Thirteen percent resided in institutions and 27.6% were diagnosed with dementia.

MEASUREMENTS: Dementia diagnosis based on DSM III‐R. Criteria for inappropriateness of drug use: use of drugs with potent anticholinergic properties, drug duplication, potential drug‐drug and drug‐disease interactions, and inappropriate drug dosage.

RESULTS: The mean number of drugs used was 4.6: 4.5 drugs for nondemented and 4.8 for demented subjects. Nondemented subjects more commonly used cardiovascular‐system drugs and demented subjects used nervous‐system drugs. Demented subjects were more commonly exposed to drug duplication and to drugs with potent anticholinergic properties, both involving the use of psychotropic drugs. Nondemented subjects were more commonly exposed to potential drug‐disease interactions, mostly with the use of cardiovascular drugs. The most common drug combination leading to a potential interaction was the use of digoxin with furosemide, occurring more frequently among nondemented subjects. The most common drug‐disease interaction was the use of beta‐blockers and calcium antagonists in subjects with congestive heart failure. The doses of drugs taken by both nondemented and demented subjects were mostly lower than the defined daily dose.

CONCLUSION: There was substantial exposure to presumptive inappropriateness of drug use in this very old nondemented and demented population. The exposure of demented subjects to psychotropic drugs and nondemented subjects to cardiovascular drugs reflect the high frequency of prescribing these drugs in this population.
Taking Off the White Coat: Can Family Members Who Are Physicians Be Good Surrogate Decision‐Makers?
Authors: Issa Amalia M.
Published: March 2003

The challenges inherent in physicians treating members of their own families are well known. However, the issues related to physicians acting as surrogate decision‐makers on behalf of relatives have not been addressed. The growing number of older persons will increase the need not only for healthcare resources, but also for physicians to act on behalf of incapacitated family members as surrogate decision‐makers. In this paper, some of the clinical and ethical tensions evoked by physicians serving as surrogate decision‐makers for family members are explored. Some recommendations for managing these tensions are suggested.
Screening for Depression in Patients in Long‐Term Care Facilities: A Randomized Controlled Trial of Physician Response
Authors: Soon Judith A. , Levine Marc
Published: March 2003

OBJECTIVES: To determine the effect of a screening protocol using the Geriatric Depression Scale (GDS) on the frequency of primary care physicians' decisions to prescribe drug therapy or refer long‐term care patients with possible depression to mental health care.

DESIGN: Case‐finding phase, followed by a randomized controlled trial of the effect of a physician‐targeted intervention on antidepressant prescribing or referral to mental health services.

SETTING: Twenty‐two nonacademic long‐term care facilities.

PARTICIPANTS: One hundred three of 1,602 patients aged 65 and older who met criteria for cognitive function and untreated symptoms of depression.

INTERVENTION: The 77 physicians of these patients were randomized as clusters into an early notification (experimental) or a delayed notification (control) group.

MEASUREMENTS: Frequency of physician response (mental health consult or antidepressant therapy) at 4 and 8 weeks from notification, physician follow‐up, and factors associated with physician response.

RESULTS: Frequency of physician response in the early group (25%) was greater than in the delayed group (2%) (P < .005) 4 weeks from baseline. Physician response rate when the groups were combined was 36% (95% confidence interval (CI) = 26%–46%) 8 weeks from notification. Overall, there was evidence of physician action after letters of notification in 69% (95% CI = 60%–78%) of cases. Univariate logistic regression suggested that physicians' decisions were primarily associated with physician‐related characteristics.

CONCLUSIONS: Screening of long‐term care patients for depression can increase the frequency of treatment or referral by primary care physicians.
Attitudes Toward Working on Interdisciplinary Healthcare Teams: A Comparison by Discipline
Authors: Leipzig Rosanne M. , Hyer Kathryn , Ek Kirsten , Wallenstein Sylvan , Vezina Maria L. , Fairchild Susan , Cassel Christine K. , Howe Judith L.
Published: March 2003

Interdisciplinary teams are important in providing care for older patients, but interdisciplinary teamwork is rarely a teaching focus, and little is known about trainees' attitudes towards it. To determine the attitudes of second‐year post‐graduate (PGY‐2) internal medicine or family practice residents, advanced practice nursing (NP), and masters‐level social work (MSW) students toward the value and efficiency of interdisciplinary teamwork and the physician's role on the team, a baseline survey was administered to 591 Geriatrics Interdisciplinary Team Training participants at eight U.S. academic medical centers from January 1997 to July 1999.

Most students in each profession agreed that the interdisciplinary team approach benefits patients and is a productive use of time, but PGY‐2s consistently rated their agreement lower than NP or MSW students. Interprofessional differences were greatest for beliefs about the physician's role; 73% of PGY‐2s but only 44% to 47% of MSW and NP trainees agreed that a team's primary purpose was to assist physicians in achieving treatment goals for patients. Approximately 80% of PGY‐2s but only 35% to 40% of MSW or NP trainees agreed that physicians have the right to alter patient care plans developed by the team. Although students from all three disciplines were positively inclined toward medical interdisciplinary teamwork, medical residents were the least so. Exposure to interdisciplinary teamwork may need to occur at an earlier point in medical training than residency. The question of who is ultimately responsible for the decisions of the team may be an “Achilles heel,” interfering with shared decision‐making.
Validity of Divided Attention Tasks In Predicting Falls in Older Individuals: A Preliminary Study
Authors: Verghese Joe , Buschke Herman , Viola Lisa , Katz Mindy , Hall Charles , Kuslansky Gail , Lipton Richard
Published: March 2003

OBJECTIVES: Although cognitive impairment is known to be a major risk factor for falls in older individuals, the role of cognitive tests in predicting falls has not been established. Limited attentional resources may increase the risk for falls in older individuals. We examined the reliability and validity of divided attention tasks, walking while talking (WWT), in predicting falls.

DESIGN: A prospective cohort study of 12‐months' duration.

SETTING: Community‐based longitudinal aging study, the Einstein Aging Study.

PARTICIPANTS: Sixty nondemented community‐living subjects, aged 65 to 98 (mean age ± standard deviation = 79.6 ± 6.3).

MEASUREMENTS: Simple and complex versions of the WWT task in addition to standard balance and cognitive assessments. The primary outcome was cumulative incidence of falls at 12 months.

RESULTS: Thirteen subjects fell over the 12 months, four of whom had major injuries. The WWT task had good interrater reliability (r = 0.602, P < .001). Poor performance on simple (odds ratio (OR) = 7.02, 95% confidence interval (CI) = 1.7–29.4) and complex WWT tasks (OR = 13.7, 95% CI = 2.3–83.6) was highly predictive of falls. The simple task had a sensitivity of 46% and specificity of 89%. For the complex task, sensitivity was 39%, and specificity was 96%.

CONCLUSIONS: The WWT is a reliable and valid test to identify older individuals at high risk for falls. Future studies with larger sample sizes and in different settings are needed to confirm the findings of this study.
Use of Artificial Networks in Clinical Trials: A Pilot Study to Predict Responsiveness to Donepezil in Alzheimer's Disease
Authors: Mecocci Patrizia , Grossi Enzo , Buscema Massimo , Intraligi Marco , Savarè Rita , Rinaldi Patrizia , Cherubini Antonio , Senin Umberto
Published: March 2003

OBJECTIVES: To evaluate the accuracy of artificial neural networks compared with discriminant analysis in classifying positive and negative response to the cholinesterase inhibitor donepezil in a group of Alzheimer's disease (AD) patients.

DESIGN: Convenience sample.

SETTING: Patients with mild to moderate AD consecutively admitted to a geriatric day hospital and treated with donepezil 5 mg/day.

PARTICIPANTS: Sixty‐one older patients of both sexes with AD.

MEASUREMENTS: Accuracy in detecting subjects sensitive (responders) or not (nonresponders) to 3‐month therapy with ANNs. The criterion standard for evaluation of efficacy was the scores of Alzheimer's Disease Assessment Scale—Cognitive portion and Clinician's Interview Based Impression of Change—plus scales.

RESULTS: ANNs were more effective in discriminating between responders and nonresponders than other advanced statistical methods, particularly linear discriminant analysis. The total accuracy in predicting the outcome was 92.59%.

CONCLUSIONS: ANNs appear to be a useful tool in detecting patient responsiveness to pharmacological treatment in AD.
Management of Nonmalignant Pain in Home‐Dwelling Older People: A Population‐Based Survey
Authors: Pitkala Kaisu H. , Strandberg Timo E. , Tilvis Reijo S.
Published: March 2003

OBJECTIVES: To investigate use of prescribed analgesic drugs in relation to experience of joint or back pain in a home‐dwelling older population, to study changes in the use of analgesic drugs over 10 years, and to investigate concomitant use of protective gastrointestinal drugs with prescribed analgesic drugs in 1999.

DESIGN: Cross‐sectional mailed surveys 10 years apart.

SETTING: Helsinki, Finland.

PARTICIPANTS: Random samples of older birth cohorts born in 1904, 1909, and 1914 in 1989 (n = 644) , and of three separate cohorts born in 1914, 1919, and 1924 in 1999 (n = 3,000).

MEASUREMENTS: Use of various types of analgesic and protective gastrointestinal drugs, prescribed and over the counter. Experience of joint and back pain that interferes with daily functioning.

RESULTS: The response rate of home‐dwelling older people was 83% in 1989 and 81% in 1999. Although the use of analgesic drugs as self‐treatment increased from 28.5% to 41.4% during the 10 years, in 1999, only 35.5% to 38.2% of those suffering joint or back pain that impaired daily functioning had been prescribed an analgesic drug for regular use. Of those using prescribed medication, 57.5% were on nonsteroidal antiinflammatory drugs (NSAIDs), 20.9% acetaminophen, and 18.5% weak opiates. Only one‐fifth of those individuals taking NSAIDs were on a concomitant gastroprotective drug.

CONCLUSIONS: Pain is markedly undertreated in community‐dwelling older people, which may have serious implications for their well‐being and functioning. Although we noted a tendency for safety in the use of prescribed analgesic drugs, a significant effort must sill be made to implement evidence‐based practice. Self‐treatment of pain has increased in 1 decade, which may reduce the overall safety of analgesic drug use among older people.
The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. (St. Gemma's Hospice, Leeds, United Kingdom) Pain. 2001;92:147–157.
Authors: Bennett Michael
Published: March 2003

This study described the development and validation of a novel tool for identifying patients in whom neuropathic mechanisms dominate their pain experience. The Leeds assessment of neuropathic symptoms and signs (LANSS) Pain Scale is based on analysis of sensory description and bedside examination of sensory dysfunction, and provides immediate information in clinical settings. It was developed in 2 populations of chronic pain patients. In the first, the use of sensory descriptors and questions were compared in patients with nociceptive and neuropathic pain, combined with an assessment of sensory function. This data was used to derive a 7‐item pain scale, consisting of grouped sensory description and sensory examination with a simple scoring system. The LANSS Pain Scale was validated in a second group of patients by assessing discriminant ability, internal consistency, and agreement by independent raters. Clinical and research applications of the LANSS Pain Scale are discussed.
Postherpetic Neuralgia
Authors: Watson C. Peter N. , Oaklander Anne Louise
Published: March 2003

Abstract: This article reviews the definition, epidemiology, pathology, clinical features, and treatment of postherpetic neuralgia (PHN). Much of this information is well established. However, there is some important new information about the pathology that may shed light on the pathogenesis of this disorder. The exciting prospect exists of the prevention of PHN by vaccination and by early, aggressive treatment of herpes zoster. This is important because current treatment approaches have significant limitations. We now have certain antidepressants, anticonvulsants, opioids, and the topical agent lidocaine that have been scientifically shown by randomized controlled trials to be effective in this disorder. However, all of these have a modest effect at best and newer treatments are necessary. Prevention may be very important for the 30% to 50% of the patients who either do not respond at all or do not respond well. Regional anesthetic procedures do not have a good scientific basis for either acute zoster or established PHN, but remain a reasonable alternative for some patients. This article addresses the issue of how effective the current treatments really are and gives practical guidelines for management.
Four crossmatch methods to select platelet donors
Authors: KAKAIYA R. M. , GUDINO M.D. , MILLER W. V. , SHERMAN L. A. , KATZ A. J. , WAKEM C. J. , KRUGMAN D. J. , KLATSKY A. U. , KIRALY T. R.
Published: March 2003

We employed four crossmatch techniques to select platelet donors for refractory patients. Forty‐four donor‐recipient pairs were studied in 32 patients. Analysis of effectiveness of platelet transfusions revealed that only 18 percent of transfusions gave a borderline response; the remainder were either effective or not effective at all. The corrected predictive values of three crossmatch tests were as follows: enzyme‐linked immuno‐specific assay, 81 percent; platelet immunofluorescence test, 73 percent; and lymphocytotoxicity, 70 percent (p greater than 0.05). The predictive value of these tests did not differ in HLA‐matched versus unmatched platelet transfusions. Donor selection by lymphocytotoxicity compatibility did not appear to be useful if donors were selected by either of the other two methods. The fourth test, antiglobulin‐modified lymphocytotoxicity, offered no advantage over lymphocytotoxicity. Our data suggest that platelet crossmatching assays are a useful adjunct to the selection process for the platelet donor in addition to ABO, Rh, and HLA matching.
Additional evidence for more than one agent of human non‐A, non‐B hepatitis. Transmission and passage studies in chimpanzees
Authors: Tabor E. , Snoy P. , Jackson D.R. , Schaff Z. , Blatt P.M. , Gerety R.J.
Published: March 2003

Evidence supporting the existence of two agents of human non‐A, non‐B hepatitis was obtained by the inoculation of chimpanzees sequentially with serum from a chronically infected human (Inoculum I) and with fibrinogen prepared from pooled plasma (Inoculum IV), each of which had transmitted non‐A, non‐B hepatitis to humans. Passage inoculations of serum samples obtained during the acute stages of chimpanzee infections transmitted by either the agent in Inoculum I or IV also transmitted non‐A, non‐B hepatitis to additional chimpanzees. Transmission and passage of the agent in Inoculum IV were conducted in chimpanzees which previously had recovered from infection by the agent in Inoculum I. Cytoplasmic tubules in hepatocytes, which have been described during non‐A, non‐B hepatitis, were observed by electron microscopy in liver biopsies obtained during all infections transmitted by the agent in Inoculum I. These cytoplasmic tubules were not detected in liver biopsies from chimpanzees infected by Inoculum IV, except in one chimpanzee inoculated by Inoculum IV without prior exposure to the agent in Inoculum I. The cytoplasmic tubules observed in this study were found to be composed of transverse bands arranged with a periodicity of approximately 17 nm. These studies suggest that two different agents or distinct serotypes of human non‐A, non‐B hepatitis may have been present in these inocula, although reactivation of latent infection or reinfection could not be ruled out completely.
Histamine levels in stored human blood
Authors: Frewin D. B. , Jonsson J. R. , Head R. J. , Russell W. J. , Beal R. W.
Published: March 2003

The histamine content in plasma samples obtained from a group of healthy blood donors, from blood stored in citrate‐phosphate‐dextrose supplemented with adenine (CPDA) packs for up 28 days, and from the side arm of a transfusion line was measured by radio‐enzymatic assay. Healthy donors had a mean plasma histamine content of 0.79 ng per ml. Blood stored in CPDA initially showed a similar histamine level (0.69 ng/ml on day 3 of storage), but there was a progressive rise with time, and at 28 days, the level was 20.5 ng per ml. The increase in histamine is best described by a positive exponential and may be explained by a process whereby the plasma histamine level increases the degree of histamine release from blood cells. The histamine levels in the blood infused into patients tended to be higher than those found in the stored units of the same age, if these packs were less than 7 days old. This may have been caused by the unit becoming warmer during transfusion. We speculate that the histamine levels in the older units of stored blood were high enough to cause or augment transfusion reactions and that the storage age of blood may have a bearing on the incidence of transfusion reactions.
The use of transfusion in terminal cancer patients
Authors: Wachtel T. J. , Mor V.
Published: March 2003

This study examines the usage of blood component products by terminal cancer patients in hospice and conventional care settings. Our results show that patients in conventional care settings are five times more likely to be transfused than are patients in hospital‐based hospices and ten times more likely to be transfused than are patients in home‐ care hospices (p = 0.003). Since the outcome of care was comparable for the three types of care settings, the transfusion of blood component products to terminal cancer patients may be overused in conventional care settings.
The manual preparation of leukocyte‐poor red cells for transfusion by a new filter
Authors: Rebulla P. , Parravicini A. , Reggiani E. , Sirchia G.
Published: March 2003

Standard and buffy‐coat‐depleted red cell concentrates were filtered through a new cellulose acetate filter with a manual procedure. No residual leukocytes could be detected in 19 of the 21 filtered units. Extracellular hemoglobin after red cell filtration and concentration never exceeded 10 mg per unit. No transfusion reaction occurred in 10 recipients with potent lymphocytotoxic antibodies in their serum and histories of febrile transfusion reactions. This filter allows the preparation of leukocyte‐poor red cell units with a safe, simple, and effective manual procedure.
Adverse affect of blood transfusions on survival of patients with gastric cancer
Authors: Kaneda M. , Horimi T. , Ninomiya M. , Nagae S. , Mukai K. , Takeda I. , Shimoyama H. , Chohno S. , Okabayashi T. , Kagawa S. , Orita K.
Published: March 2003

The effect of perioperative blood transfusions on the survival rate of patients with gastric cancer was studied. The survival rate of the transfusion group was significantly lower than that of the nontransfusion group in each of the 5 postoperative years. When no adjuvant immunochemotherapy was performed postoperatively, the prognosis was definitely worse in the transfusion group than in the nontransfusion group. Furthermore, the survival rate of the transfusion group was lower than that of the nontransfusion group in both histopathologic classifications of gastric cancer, and it was lower to a statistically significant extent among the well‐differentiated types. These results indicate that transfusions might adversely affect postoperative survival of patients with gastric cancer.
Epitope specificities and quantitative and serologic aspects of monoclonal complement (C3c and C3d) antibodies
Authors: Dobbie D. , Brazier D.M. , Gardner B. , Holburn A.M.
Published: March 2003

Twenty‐two monoclonal antibodies to human C3c and ten to C3d were obtained by hybridization after the immunization of mice with complement‐coated human red cells and/or purified human complement components. C3c antibodies were variable in their agglutination reactions with cells coated with C3 by antibody in vitro; more consistent and potent reactions with these cells were observed with anti‐C3d, and all anti‐C3d reacted with red cells coated with C3 in vivo. Immunoradiometric assays were used to estimate antibody concentration, affinity, and epitope specificity. The antibody content in ascitic fluids varied from less than 0.1 mg per ml to 5.6 mg per ml. The estimated values of antibody affinities for Sepharose‐coupled C3 ranged from 2.8 × 10(6) l per M to 5.0 × 10(8) l per M; on average, IgM antibodies had higher affinities than IgG antibodies. Competitive binding assays showed that the monoclonal antibodies recognized at least seven different epitopes, four on the C3c and three on the C3d fragment of C3. When the results of serologic and quantitative assays were compared, no convincing relationship was found between serologic performance and epitope specificity, antibody concentration, or affinity. IgM antibodies generally gave higher agglutination scores than IgG antibodies, and Ig class was the only useful predictor of serologic efficacy.
Experimental basis for the use of red cell transfusion in the management of anemic‐thrombocytopenic patients
Authors: Escolar G. , Garrido M. , Mazzara R. , Castillo R. , Ordinas A.
Published: March 2003

The Baumgartner perfusion technique was used as an experimental model to study the combined influence of red cell (RBC) and platelet counts on the interaction of platelets with the subendothelium. At normal hematocrit and a platelet count of 100,000 per microliter, platelet adhesion and platelet aggregate (PAG) formation on subendothelium were statistically decreased. At lower platelet counts (50,000/μliter), there was an even more marked reduction in the formation of PAGs. The critical role of RBCs was demonstrated in experiments at low hematocrit; the formation of PAGs was impaired in perfusions at 20 percent hematocrit at any platelet count tested. Platelet deposition on subendothelium was almost absent at 50,000 platelets per μliter, suggesting a negative synergistic effect for the association of low hematocrit (20%) with a low platelet count. Perfusion experiments carried out with nonanticoagulated blood drawn directly from anemic patients with mild thrombocytopenia (43,000–58,000 platelets/μliter) before and after RBC transfusion were in agreement with previous experiments that indicated that normalization of both platelet count and hematocrit is required to achieve optimum hemostasis. Our data give experimental support for the transfusional management of patients with anemia and thrombocytopenia.
Complications of plasma exchange
Authors: Sutton D. M. C. , Nair R. C. , Rock G. ,   Canadian Apheresis Study Group
Published: March 2003

For the past few years, the Canadian Apheresis Study Group has collected data on most apheresis procedures carried out throughout the country. The information accumulated during calendar year 1985 has been reviewed, and the complications that occurred as a result of therapeutic plasma exchange (PE) have been assessed. There were side effects during 612 (12%) of the 5235 procedures done, involving 252 (40%) of the 627 patients treated. The most common reactions were fever, chills, urticaria, muscle cramps, or paresthesias; these reactions were encountered more frequently when plasma was used in the replacement fluid. Most reactions had little or no clinical significance. However, there were 28 severe complications, including one cardiac arrest and two respiratory arrests. Five late deaths occurred, but these were not related directly to PE. Although PE is relatively safe, life‐threatening reactions do occur, and patients require careful observation during the procedure.
Peripheral blood stem cell collection and use in Hodgkin's disease. Comparison with marrow in autologous transplantation
Authors: Lasky L. C. , Hurd D. D. , Smith J. A. , Haake R.
Published: March 2003

Hematopoietic progenitor cells can be collected from blood by cytapheresis; the clinical use of these cells may offer such advantages over marrow as the avoidance of general anesthesia, collection on an outpatient basis, and use when marrow is involved with malignancy. Since Hodgkin's disease rarely spreads hematogenously, postchemotherapy marrow transplantation with autologous peripheral blood stem cells (PBSCs) was compared to that with marrow transplantation in patients with this disorder. Seven patients were treated with PBSCs and 19 with marrow. Five to nine collections of PBSC were performed per patient. There was a rebound increase in circulating committed progenitors when PBSC were collected during the marrow rebound after cyclic chemotherapy. After intensification and cellular rescue, quicker recovery of circulating white cells (p<0.05) and a shorter hospital stay (not significant) were seen in the PBSC patients than in those treated with autologous marrow. There was no difference in the duration of red cell or platelet transfusion required after transplant. Of six patients whose marrows were previously involved by Hodgkin's, recurrent or progressive disease has occurred in five. PBSC may be a viable alternative to marrow in selected patients.
Blood transfusion exposure does not influence survival in patients with carcinoma of the breast
Authors: Kieckbusch M. E. , O'Fallon J. R. , Ahmann D. L. , MooreMB S. B.
Published: March 2003

There is abundant evidence of immune modulation induced by exposure to blood transfusions. Some studies have demonstrated a detrimental effect of transfusion on the recurrence of malignant disease and survival. We retrospectively studied the impact of blood transfusion exposure on 229 patients with breast cancer who were seen from July 1973 to September 1980, had at least 5 years' follow‐up and had been randomized by therapy at the time of diagnosis. The patients were divided into four groups according to transfusion history: Group 1 (111 patients), no transfusion; Group 2 (34 patients), first transfusion after mastectomy; Group 3 (41 patients), first transfusion at mastectomy; and Group 4 (43 patients), first transfusion before mastectomy. All transfused patients received red cells or whole blood or both. At the time of analysis, 124 (54%) of the patients had died. Only Group 2 was statistically associated with decreased survival; recurrence of disease was 85 percent in this group, compared with 53 percent to 61 percent in the other three groups (p = 0.006, log‐rank test). In general, Group 2 patients received transfusions because of recurrent disease. We conclude that transfusions before or at mastectomy are not associated with increased recurrence or reduced survival in patients with breast cancer.
A model for estimating incremental benefits and costs of testing donated blood for human immunodeficiency virus antigen (HIV‐Ag)
Authors: MENDELSON DANIEL N. , SANDLER S. GERALD
Published: March 2003

We propose a model for estimating the benefit of adding a test for the human immunodeficiency virus antigen (HIV‐Ag) to current procedures for testing donated blood. Using this model, data on HIV infection from published studies, and certain assumptions about blood donor behavior, we estimate that the probability of detecting an additional HIV‐ infective blood component is approximately 1 in 4,860,000. If this estimate is correct, adding HIV‐Ag testing would prevent approximately 4 cases of primary transfusion‐transmitted HIV infection annually in the United States. After adjustments for the median incubation period for AIDS, and for mortality due to primary illnesses, this estimate represents prevention of approximately 1 case of AIDS per year, within the 4 years after transfusion. A primary advantage of this model is its adaptability for recalculating cost‐benefit analyses if more sensitive tests for HIV infection become available. In addition, we propose that comparing the anticipated costs and benefits of HIV‐Ag testing to other possible uses of these funds should be an important factor in assessing the desirability of HIV‐Ag testing.
Studies of in vitro red cell autoantibody production in normal donors and in patients with autoimmune hemolytic anemia
Authors: Hernandez‐Jodra M. , Hudnall S.D. , Petz L.D.
Published: March 2003

The in vitro production of red cell autoantibodies (RBC AuAbs) has been investigated for better understanding of the pathogenesis of autoimmune hemolytic anemia (AIHA). Peripheral blood mononuclear cells (PBMNCs) were isolated and cultured for 14 days with or without added pokeweed mitogen (PWM), autologous RBCs, methyldopa, procainamide, and alpha‐methylnorepinephrine. Also, isolated B cells were infected with Epstein‐Barr virus (EBV) to produce polyclonal B‐cell lines. Supernatants were tested for IgG and IgM RBC AuAbs by use of 125I‐staphylococcal protein A (SPA). RBC AuAbs were detected in PBMNC cultures without additives to the culture medium of four of eight patients who had warm‐antibody AIHA or a positive direct antiglobulin test (DAT) without hemolytic anemia. In two of these patients, RBC AuAb production was augmented by the addition of PWM, and in two additional patients, RBC AuAbs were detected only after the addition of PWM. Supernatants from PBMNC cultures from three of four normal donors produced RBC AuAbs independent of the presence of PWM; in two of these subjects, PWM augmented production of RBC AuAbs. PBMNC cultures from three DAT‐negative patients with systemic lupus erythematosus produced RBC AuAbs, one in the presence of PWM and two in its absence. With one exception, there was no augmentation of AuAb production by the addition to the culture system of autologous RBCs or drugs. EBV infection of B cells from four patients with AIHA and four normal persons yielded B‐cell lines secreting RBC AuAbs. The quantity of RBC AuAb after a 24‐hour culture of EBV‐transformed B cells was significantly greater in cultures from four patients who had AIHA than in cultures from four normal persons. It is concluded that in vitro cultures of lymphocytes can be used to study the production of RBC AuAbs. The presence of RBC AuAbs in supernatants of normal lymphocyte cultures and their frequent enhancement by a polyclonal activator suggest that the development of pathogenic concentrations of RBC AuAbs may depend on polyclonal stimulation of lymphocytes that are programmed to produce RBC AuAbs.
Evaluation of the transfusion effectiveness of various platelet concentrates by means of an in vitro perfusion technique
Authors: Mazzara R. , Escolar G. , Garrido M. , Pereiray A. , Castillo R. , Ordinas A.
Published: March 2003

An in vitro perfusion technique was used for the assessment of the effectiveness of platelet concentrates (PCs) administered to patients with bone marrow failure. Denuded rabbit arterial segments mounted in annular chambers were exposed to nonanticoagulated blood drawn directly from the antecubital vein. This perfusion system allows the direct visualization of platelet‐subendothelium interactions. The deposition of platelets on exposed subendothelium and the presence of fibrin were evaluated morphometrically. Perfusions were performed before and 10 and 120 minutes after the transfusion of PCs that had been obtained by apheresis and administered immediately after collection (A) or separated by centrifugation of blood units and transfused 24 hours after storage at 22 degrees C (B) or 4 degrees C (C). Bleeding times were also determined systematically. The deposition of platelets on the subendothelium increased significantly (p < 0.01) 10 minutes after transfusions of A and B PCs, but the presence of fibrin did not differ from pretransfusion values. Two hours after the administration of A or B PCs, the improvement of platelet deposition persisted. By then, the presence of fibrin increased markedly (p < 0.01). The deposition of platelets was not modified after the transfusion of C PCs, but the presence of fibrin was augmented significantly at both posttransfusion times. Comparisons between bleeding times and morphometric results pointed to a possible role of fibrin formation in contributing to primary hemostasis.
Blood transfusion costs: a multicenter study
Authors: Forbes J. M. , Anderson M. D. , Anderson G. F. , Bleecker G. C. , Rossi E. C. , Moss G. S.
Published: March 2003

The cost of delivering a unit of blood (whole blood or red cells) to a hospitalized patient was examined in 19 United States teaching hospitals. The average hospital acquisition cost was calculated by using the prices charged by regional blood centers for blood products. To this cost was added an estimate of costs incurred by hospitals for handling, testing, and administering blood. Across study sites, the average hospital cost per unit transfused was $155 and the average charge to the patient was $219. Acquisition cost, the price that hospitals pay for blood, was 37 percent of the total cost to the hospital; the other 63 percent of the hospital cost included costs for blood bank handling (13%), laboratory tests (43%), and blood administration (7%). Significant variations in blood transfusion cost were found within our sample. Most of the variability can be attributed to geographic location of the blood supply source, type of red cell product transfused, prices charged by blood transfusion services, and the frequency of laboratory tests. The results of this transfusion cost study may be helpful in determining the costs of health care delivery, especially when blood transfusions are indicated.
IgA and IgM human immunodeficiency virus antibodies in weakly reactive or false‐negative blood donors
Authors: Weiblen B. J. , Schumacher R. T. , Garrett P. E. , Hoff R.
Published: March 2003

Detection of antibodies to the human immunodeficiency virus (HIV) in recently infected donors is crucial to prevent the transmission of HIV infection via blood products. To determine whether specific antibodies of the IgA or IgM class are present as markers of recent infection in donor specimens that have borderline reactivity on routine enzyme immunoassay (EIA) screening, 15 specimens that were positive by immunoblot were tested for IgA and IgM HIV antibodies. All 15 had detectable IgA HIV antibodies, and 14 had IgM HIV antibodies. The 15 specimens were tested further, each by two independent laboratories, with nine licensed EIAs. Two of the nine EIAs found all 15 units positive in both laboratories; seven EIAs found 1 to 5 of the 15 units negative, for a total of 31 false‐negative results. The results indicated a difference between the sensitivity of EIA kits using only anti‐IgG reagents and of kits using multispecific reagents that react with IgG and other classes of antibody. In a modified procedure, the addition of enzyme‐conjugated anti‐IgA or anti‐IgM to the kit's enzyme‐ conjugated reagent increased the optical density values of most false‐ negative specimens to the positive range. It was concluded that licensed kits vary in reactivity with IgA and IgM HIV antibodies and that sensitivity could be increased by improved detection of these classes of antibody.
Prostate cancer recurrence in radical surgery patients receiving autologous or homologous blood
Authors: Ness P. M. , Walsh P. C. , Zahurak M. , Baldwin M. L. , Piantadosi S.
Published: March 2003

An evaluation of the effects of blood transfusion on recurrence and survival after radical surgery for prostate cancer was performed. Between 1982 and 1986, 315 consecutive patients underwent radical retropubic prostatectomy by a single surgeon; of 309 patients for whom transfusion data were available, 94 received homologous blood (Group I) and 215 received autologous blood or no blood (Group II). At the time of surgery, there were no differences between Group I and Group II with respect to age, preoperative cancer stage, preoperative histologic grade (Gleason grade), prostatic acid phosphatase score, and preoperative potency. At discharge, the groups were similar in the status of neurovascular bundles, capsular involvement, seminal vesicle involvement, lymph node involvement, postoperative Gleason grade, and postoperative potency. No adjuvant hormone therapy or radiation therapy was administered until tumor recurrence. The patients were followed annually by physical examinations and measurements of prostate‐specific antigen. Cancer recurrence was detected in 23 (24.5%) Group I patients and 49 (22.7%) Group II patients. These proportions were not significantly different in univariate or multivariate analysis, and the time to recurrence curves overlapped. It is concluded that homologous blood transfusions are not associated with more rapid tumor recurrence or death after radical surgery for prostate cancer than is seen with autologous transfusions. These results differ from previous reports, which suggested that transfusions may cause recurrence of cancer in patients with colorectal or prostate cancer because of the immunosuppressive effects of blood transfusions.
The effect of ammonium, phosphate, potassium, and hypotonicity on stored red cells
Authors: Kay A. , Beutler E.
Published: March 2003

The use of an experimental solution that maintained high ATP levels and produced > 70 percent viability of stored red cells (RBCs) for up to 18 weeks has been described by other investigators. This solution differed markedly from conventional storage media in that it lacked sodium; contained high concentrations of potassium, ammonium, and phosphate; and was hypotonic. It was not clear which feature or features were responsible for the observed effects. The effects of ammonium, phosphate, potassium, and hypotonicity on stored RBCs have been examined. It was determined that ammonium and phosphate were the important factors in ATP maintenance. The biochemical mechanism by which ammonium acts was studied. In fresh human blood samples, ammonium was found to relieve phosphofructokinase from inhibition by increased ATP concentrations, to have no significant effect on adenine phosphoribosyl transferase activity, and, unexpectedly, to increase the activity of AMP deaminase. Despite prolonged ATP maintenance by ammonium and phosphate‐containing storage media, satisfactory viability of RBCs stored up to 77 days was not demonstrated in the rabbit transfusion model.
Increased tumor necrosis factor alpha (TNF alpha), interleukin 1, and interleukin 6 (IL‐6) levels in the plasma of stored platelet concentrates: relationship between TNF alpha and IL‐6 levels and febrile transfusion reactions
Authors: Muylle L. , Joos M. , Wouters E. , De Bock R. , Peetermans M.E.
Published: March 2003

Increased interleukin 6 (IL‐6) levels were found in 8 of 12 platelet concentrates (PCs) after 3 days of storage and in 10 of 12 PCs after 5 and 7 days of storage. Most of the PCs with an increased IL‐6 level also showed increased tumor necrosis factor alpha (TNF alpha) and interleukin 1 beta (IL‐1 beta) levels. Levels of IL‐6 increased by 3 log10 over the base level during storage. Increased levels were found when the PC white cell count exceeded 3 × 10(9) per L. A linear correlation was found among the levels of TNF alpha, IL‐1 beta, IL‐1 alpha, and IL‐6 in the PCs (r > 0.885). Comparison of the TNF alpha, IL‐ 1 beta, and IL‐6 levels in samples taken at various storage times indicates that the increased levels are the result of an active synthesis and release of interleukins during storage. In a second part of the study, 45 transfusions of white cell‐reduced PCs were studied. Six transfusions were complicated by a febrile reaction. These reactions were related to high levels of IL‐6 and TNF alpha in the PCs (p < 0.0001). These cytokines are known as endogenous pyrogens. These findings indicate that transfusion reactions might be due to the intravenous administration of plasma with high cytokine levels and might not always result from an antigen‐antibody reaction.