bluuebunny/crossref_metadata_2025 huggingface dataset:
Task‐Specific Resistance Training to Improve the Ability of Activities of Daily Living–Impaired Older Adults to Rise from a Bed and from a Chair
Authors: Alexander Neil B. , Galecki Andrzej T. , Grenier Martina L. , Nyquist Linda V. , Hofmeyer Mark R. , Grunawalt Julie C. , Medell Judi L. , Fry‐Welch Donna
Published: March 2003

OBJECTIVES: To determine the effect of a 12‐week intervention to improve the ability of disabled older adults to rise from a bed and from a chair.

DESIGN: Subjects were randomly allocated to either a 12‐week task‐specific resistance‐training intervention (training in bed‐ and chair‐rise subtasks, such as sliding forward to the edge of a chair with the addition of weights) or a control flexibility intervention.

SETTING: Seven congregate housing facilities.

PARTICIPANTS: Congregate housing residents age 65 and older (n = 161, mean age 82) who reported requiring assistance (such as from a person, equipment, or device) in performing at least one of the following mobility‐related activities of daily living: transferring, walking, bathing, and toileting.

MEASUREMENTS: At baseline, 6 weeks, and 12 weeks, subjects performed a series of bed‐ and chair‐rise tasks where the rise task demand varied according to height of the head of the bed, chair seat height, and use of hands. Outcomes were able or unable to rise and, if able, the time taken to rise. Logistic regression for repeated measures was used to test for differences between tasks in the ability to rise. Following log transformation of rise time, a linear effects model was used to compare rise time between tasks.

RESULTS: Regarding the maximum total number of bed‐ and chair‐rise tasks that could be successfully completed, a significant training effect was seen at 12 weeks (P = .03); the training effect decreased as the total number of tasks increased. No statistically significant training effects were noted for rise ability according to individual tasks. Bed‐ and chair‐rise time showed a significant training effect for each rise task, with analytic models suggesting a range of approximately 11% to 20% rise‐time (up to 1.5 seconds) improvement in the training group over controls. Training effects were also noted in musculoskeletal capacities, particularly in trunk range of motion, strength, and balance.

CONCLUSIONS: Task‐specific resistance training increased the overall ability and decreased the rise time required to perform a series of bed‐ and chair‐rise tasks. The actual rise‐time improvement was clinically small but may be useful over the long term. Future studies might consider adapting this exercise program and the focus on trunk function to a frailer cohort, such as in rehabilitation settings. In these settings, the less challenging rise tasks (such as rising from an elevated chair) and the ability to perform intermediate tasks (such as hip bridging) may become important intermediate rehabilitation goals.
The Association of Menopause and Physical Functioning in Women at Midlife
Authors: Sowers MaryFran , Pope Sandra , Welch Gavin , Sternfeld Barbara , Albrecht Gary
Published: March 2003

OBJECTIVES: To determine whether the characteristics of menstrual bleeding and the menopausal transition are associated with physical functioning in women age 40 to 55, after considering ethnicity, ability to pay for basics, body size, and age.

DESIGN: Cross‐sectional study.

SETTING: Seven geographically dispersed community samples in the United States.

PARTICIPANTS: The 14,427 respondents were Caucasians (46.9%), African Americans (28.7%), Chinese (4.0%), Japanese (5.3%), and Hispanics (12.6%) from the Study of Women's Health Across the Nation (SWAN) Cross‐sectional Study, a study of the menopausal transition, including surgical menopause.

MEASUREMENTS: The dependent variable was a three‐category variable based on the physical functioning scale of the Medical Outcomes Study. Explanatory variables included menstrual and menopausal status.

RESULTS: Eighty percent (80.8%) of women reported no limitation in physical functioning, whereas 10% of women had some limitation, and 9.2% of women indicated having substantial limitation. Women with substantial limitation in physical functioning had double the prevalence odds ratio (POR = 2.02; 95% confidence interval (CI) = 1.64–2.49) of having surgical menopause and 76% greater odds (POR = 1.76; 95% CI = 1.38–2.24)) of using hormones, compared with women with no limitation. Compared with those without limitation, women with substantial limitation in physical functioning had 56% greater odds (POR = 1.56; 95% CI = 1.23–1.97)) of being naturally postmenopausal and a 41% greater odds (POR = 1.41; 95% CI = 1.17–1.70) of being perimenopausal, relative to being premenopausal and after adjusting for other variables.

CONCLUSION: Even at the relatively early age of 40 to 55, approximately 20% of women self‐reported limitation in physical functioning. Surgical menopause and the use of hormones were more frequently observed in women with some and substantial physical limitation than in women with no limitation, even after adjusting for economic status, age, body mass index, and race/ethnicity.
Effects of Aging on the Opioid Modulation of Feeding in Humans
Authors: MacIntosh Caroline G. , Sheehan Jessica , Davani Nusha , Morley John E. , Horowitz Michael , Chapman Ian M.
Published: March 2003

OBJECTIVES: To determine whether aging is associated with a reduction in the opioid modulation of feeding, which may be important in the pathogenesis of the “anorexia of aging.”

DESIGN: Three studies on separate days, in randomized order and double‐blind fashion.

SETTING: Clinical Human Research Laboratory, Department of Medicine, RAH, Adelaide, Australia.

PARTICIPANTS: Twelve older (5 male/7 female) (age 65–84) and 12 young (5 male/7 female) (age 20–26) healthy subjects.

INTERVENTION: Subjects received in double‐blinded random order, intravenous bolus (10 minutes) and then continuous (140 minutes) infusions of saline (control), naloxone low dose (LD) (bolus 27 μg/kg; continuous 50 μg/kg/hr), or naloxone high dose (HD) (bolus 54.5 μg/kg; continuous 100 μg/kg/hr).

MEASUREMENTS: After 120 minutes, subjects were offered a buffet meal, and their energy intake was quantified. Hunger, fullness, nausea, and drowsiness were assessed using visual analogue scales.

RESULTS: The naloxone LD and HD infusions had no significant effect on ratings of hunger, fullness, or nausea, but increased drowsiness (P < .01) compared with the control infusion in both age groups. Older subjects ate less (P < .001) at the buffet meal than young subjects during all three infusions. Naloxone infusions reduced energy intake compared with control (P < .001), LD by 13.2 ± 5.0% and HD by 10.7 ± 5.0%, with no difference between the doses (P = .71). Overall, naloxone suppressed energy intake in both young and older subjects (P < .01). This suppression was slightly, but not significantly, greater in young than in older subjects (mean of LD and HD 16.4 ± 4.9% vs 7.5 ± 4.9%, P = .42), because of a trend to reduced suppression in older women.

CONCLUSIONS: We conclude that healthy older adults retain their sensitivity to the suppressive effects of naloxone on food intake. Possible gender differences in this sensitivity warrant further investigation. A decline in opioid activity is unlikely to contribute substantially to the physiological anorexia of aging observed in older people.
Ethnicity and Cognitive Performance Among Older African Americans, Japanese Americans, and Caucasians: The Role of Education
Authors: Shadlen Marie‐Florence , Larson Eric B. , Gibbons Laura E. , Rice Madeline Murguia , McCormick Wayne C. , Bowen James , McCurry Susan M. , Graves Amy Borenstein
Published: March 2003

This cross‐sectional analysis evaluated the association between ethnicity and cognitive performance and determined whether education modifies this association for nondemented older people (103 African Americans, 1,388 Japanese Americans, 2,306 Caucasians) in a study of dementia incidence. African Americans scored lower (median 89 out of 100) than Japanese Americans (93) and Caucasians (94) on the Cognitive Abilities Screening Instrument (CASI). Education affected CASI scores differently. The gap decreased between African Americans in high education groups compared with Japanese Americans and Caucasians. Adjustment for gender, depression, and comorbidities did not change this association. The increased ethnic discrepancy in cognitive test scores in low education groups may reflect differential educational quality.
Predicting Stroke Recovery: Three and Six‐Month Rates of Patient‐Centered Functional Outcomes Based on the Orpington Prognostic Scale
Authors: Studenski Stephanie A. , Wallace Dennis , Duncan Pamela Woods , Rymer Marilyn , Lai Sue Min
Published: March 2003

OBJECTIVE: To provide recovery rates after stroke for specific functions using the Orpington Prognostic Scale (OPS).

DESIGN: Prospective cohort.

SETTING: Hospital and community.

PARTICIPANTS: 413 stroke survivors entered the study 3 to 14 days after suffering a stroke.

MEASUREMENTS: A cohort of hospitalized stroke survivors were recruited 3 to 14 days after stroke and assessed at 1, 3, and 6 months poststroke for neurological, functional, and health status. Baseline OPS score was used to predict five functional outcomes at 3 and 6 months using development and validation datasets and receiver operating characteristic (ROC) curves.

RESULTS: In 413 stroke survivors, functional recovery rates at 3 and 6 months were similar. Baseline OPS predicted significant differences in recovery rates for all five outcomes (P < .0001 for all five outcomes at 3 and 6 months). Personal care dependence was present at 3 months in only 3% of persons with baseline OPS scores of 3.2 or less compared with over 50% with OPS of 4.8 or higher. Independent personal care, meal preparation, and self administration of medication were achieved by 80% who had baseline OPS scores of 2.4 or lower compared with less than 20% when OPS scores were 4.4 or higher. Independent community mobility was achieved in 50% of those who had OPS scores of 2.4 or lower but only 3% of those with OPS scores of 4.4 or higher. The area under ROC curves assessing OPS scores against each of the five outcomes ranged from 0.805 to 0.863 at 3 months and 0.74 to 0.806 at 6 months.

CONCLUSION: OPS scores can predict widely differing rates of functional recovery in five important functional abilities. These estimates can be useful to survivors, families, providers, and healthcare systems who need to plan for the future.
Efficacy, Safety, and Tolerability of Extended‐Release Once‐Daily Tolterodine Treatment for Overactive Bladder in Older versus Younger Patients
Authors: Zinner Norman R. , Mattiasson Anders , Stanton Stuart L.
Published: March 2003

OBJECTIVES: To evaluate the efficacy, safety, and tolerability of a new, once‐daily extended‐release (ER) formulation of tolterodine in treating overactive bladder in older (≥65) and younger (<65) patients.

DESIGN: A 12‐week double‐blind, placebo‐controlled clinical trial.

SETTING: An international study conducted at 167 medical centers.

PARTICIPANTS: One thousand fifteen patients (43.1% aged ≥65) with urge incontinence and urinary frequency.

INTERVENTION: Patients were randomized to treatment with tolterodine ER 4 mg once daily (qd) (n = 507) or placebo (n = 508) for 12 weeks.

MEASUREMENTS: Efficacy, measured with micturition charts (incontinence episodes, micturitions, volume voided per micturition) and subjective patient assessments, safety, and tolerability endpoints were evaluated, relative to placebo, according to two age cohorts: younger than 65 and 65 and older.

RESULTS: Mean age in the older and younger patient cohorts was 74 (range 65–93) and 51 (range 20–64), respectively. Compared with placebo, significant improvements in micturition chart variables with tolterodine ER showed no age‐related differences. Irrespective of age, significantly more tolterodine ER recipients than placebo recipients reported an improvement in urgency symptoms. After 12 weeks of treatment with tolterodine ER, a fivefold increase in the percentage of patients able to finish tasks before voiding in response to urgency was noted in both age groups (<65: from 6.5–32.8%, ≥65: from 5.1–26.2%). Tolterodine ER recipients, irrespective of age, also had significant improvements in their bladder condition than did placebo recipients. Overall, a greater percentage of patients, irrespective of age, perceived any benefit with tolterodine ER than with placebo (P < .001). Dry mouth (of any severity) was the most common adverse event in both the tolterodine ER and placebo treatment arms, irrespective of age (<65: ER 22.7%, placebo 8.1%; ≥65: ER 24.3%, placebo 7.2%). Few patients (<2%) experienced severe dry mouth. No central nervous system, visual, cardiac (per electrocardiogram), or laboratory safety concerns were noted. Withdrawal rates due to adverse events on tolterodine ER 4 mg qd were comparable in the two age cohorts (<65: 5.5%; ≥65: 5.1%; P = .87).

CONCLUSIONS: The new, once‐daily ER formulation of tolterodine is efficacious, safe, and well tolerated in the treatment of patients with symptoms of overactive bladder, irrespective of age.
Are There Differences Between Older Persons Who Screen Positive on the CAGE Questionnaire and the Short Michigan Alcoholism Screening Test—Geriatric Version?
Authors: Moore Alison A. , Seeman Teresa , Morgenstern Hal , Beck John C. , Reuben David B.
Published: March 2003

OBJECTIVES: To determine (1) the extent of agreement between the CAGE (acronym for cut down, annoyed by criticism, guilty about drinking, eye‐opener drinks) and the Short Michigan Alcoholism Screening Test—Geriatric Version (SMAST‐G) in identifying older persons who may have possible alcohol use disorders (AUDs) and (2) whether persons identified as having possible AUDs by each of these screening measures differ in their drinking, demographic, or health‐related characteristics.

DESIGN: Secondary analysis of a cross‐sectional study using data from a self‐administered mailed survey sample.

SETTING: Three organizations were surveyed: (1) members of the American Association of Retired Persons and, in southern California, (2) managed care enrollees in a large medical group and (3) attendees of a community‐based senior health center.

PARTICIPANTS: One thousand eight hundred eighty‐nine persons aged 55 and older completing a health risk appraisal for older persons (Health Risk Appraisal for the Elderly (HRA‐E)).

MEASUREMENTS: The HRA‐E included items on drinking behaviors (including amount of alcohol use, the CAGE, and the SMAST‐G) and health and demographic characteristics.

RESULTS: Twenty‐six percent of all persons screened positive on the CAGE or the SMAST‐G. Fewer than half of all persons screening positive on either the CAGE or the SMAST‐G, screened positive on both measures. Among current drinkers, persons screening positive on the SMAST‐G alone drank less than persons screening positive on the CAGE alone, and these persons drank less than those screening positive on both the SMAST‐G and the CAGE. More men screened positive on the CAGE alone than on the SMAST‐G alone.

CONCLUSION: Fewer than half of persons screening positive on either the CAGE or the SMAST‐G screened positive on both measures, suggesting that these instruments may be capturing different aspects of unsafe drinking. A screening strategy employing both brief measures may identify more AUDs among older persons having differing demographic and health characteristics.
Caregiver Attitudes and Hospitalization Risk in Michigan Residents Receiving Home‐ and Community‐Based Care
Authors: Shugarman Lisa R. , Buttar Amna , Fries Brant E. , Moore Tisha , Blaum Caroline S.
Published: March 2003

OBJECTIVES: To study a cohort of participants in home‐ and community‐based services (HCBS) in Michigan to evaluate the relationship between (1) caregiver attitudes and participant characteristics and (2) the risk of hospitalization.

SETTING: HCBS programs funded by Medicaid or state/local funds in Michigan.

PARTICIPANTS: Five hundred twenty‐seven individuals eligible for HCBS in Michigan were studied. These HCBS participants were randomly selected clients of all agencies providing publicly funded HCBS in Michigan from November 1996 to October 1997.

MEASUREMENTS: Data for this study were collected using the Minimum Data Set for Home Care. Assessments were collected longitudinally, and the baseline (initial admission assessment) and 90‐day follow‐up assessments were used. Key measures were caregiver attitudes (distress, dissatisfaction, and decreased caregiving ability) and HCBS participant characteristics (cognition, functioning, diseases, symptoms, nutritional status, medications, and disease stability). Multinomial logistic regression was used to evaluate how these characteristics were associated with the competing risks of hospitalization and death within 90 days of admission to HCBS.

RESULTS: We found a strong association between caregiver dissatisfaction (caregiver dissatisfied with the level of care the home care participant was currently receiving) and an increased likelihood of hospitalization. HCBS participant cancer, chronic obstructive pulmonary disease, pain, and flare‐up of a chronic condition were also associated with increased hospitalization. Poor food intake and prior hospitalization were associated with hospitalization and death.

CONCLUSIONS: We conclude that, within a cohort of people receiving HCBS who are chronically ill, highly disabled, and at high risk for hospitalization and death, interventions addressing caregiver dissatisfaction, pain control, and medical monitoring should be evaluated for their potential to decrease hospitalization.
Plasma Homocysteine and Cognitive Impairment in an Older British African‐Caribbean Population
Authors: Stewart Robert , Asonganyi Belinda , Sherwood Roy
Published: March 2003

OBJECTIVES: To investigate the association between homocysteine concentrations and cognitive impairment in an older African‐Caribbean population. To investigate other measures of risk for vascular disease and nutritional status as potential confounding factors.

DESIGN: A secondary analysis from a cross‐sectional community study.

SETTING: The sample was drawn from registration lists for seven primary care services in south London, United Kingdom.

PARTICIPANTS: Two hundred forty‐eight individuals aged 55 to 75 who were born in a Caribbean nation and for whom homocysteine concentrations had been ascertained.

MEASUREMENTS: Plasma homocysteine and serum folate were assayed from frozen samples. Cognitive impairment as a composite measure was derived from 11 psychometric tests. Other measures of risk for vascular disease were considered as potential confounding factors: diagnosed hypertension/diabetes mellitus; physical exercise; and concentrations of cholesterol, triglycerides, and fibrinogen.

RESULTS: Cognitive impairment was classified in 68 (27%) participants. Raised homocysteine (highest quartile: >13.85 μmol/L) was significantly associated with cognitive impairment (odds ratio (OR) = 2.50, 95% confidence interval (CI) = 1.33–4.69). This association persisted after adjustment for age, occupation, other measures of vascular risk, folate, body mass index, and waist:hip ratio (OR = 3.00, 95% CI = 1.35–6.69). As with other risk factors for vascular disease in this sample, the association was significant only in those with less education (P‐value for interaction = .049).

CONCLUSION: Raised homocysteine was associated with cognitive impairment in this sample, but this was modified by previous educational attainment. This association was independent of other measures of vascular risk and was not explained by folate concentrations.
Patients with Hip Fracture: Subgroups and Their Outcomes
Authors: Eastwood Elizabeth A. , Magaziner Jay , Wang Jason , Silberzweig Stacey B. , Hannan Edward L. , Strauss Elton , Siu Albert L.
Published: March 2003

OBJECTIVES: To present several alternative approaches to describing the range and functional outcomes of patients with hip fracture.

DESIGN: Prospective study with concurrent medical records data collection and patient and proxy interviews at the time of hospitalization and 6 months later.

SETTING: Four hospitals in the New York metropolitan area.

PARTICIPANTS: Five hundred seventy‐one hospitalized adults aged 50 and older with hip fracture between July 1997 and August 1998.

MEASUREMENTS: Rates of return to function in four physical domains, mortality, and nursing home residence at 6 months. Cluster analysis was used to describe the heterogeneity among the sample and identify variations in 6‐month mortality, nursing home residence, and level of functioning and to develop a patient classification tree with associated patient outcomes at 6 months postfracture.

RESULTS: In locomotion, transfers, and self‐care, 33% to 37% of patients returned to their prior level of function by 6 months, including those needing assistance, but only 24% were independent in locomotion at 6 months. Cluster analysis identified eight patient subgroups that had distinct baseline features and variable outcomes at 6 months. The patient classification tree used four variables: atypical functional status (independent in locomotion but dependent in other domains); nursing home residence; independence/dependence in self‐care; and age younger than 85 or 85 and older that identified five subgroups with variable 6‐month outcomes that clinicians may use to predict likely outcomes for their patients.

CONCLUSION: Patients with hip fracture are heterogeneous with respect to baseline and outcome characteristics. Clinicians may be better able to give patients and caregivers information on expected outcomes based on presenting characteristics used in the classification tree.
Dying of Old Age: An Examination of Death Certificates of Minnesota Centenarians
Authors: Gessert Charles E. , Elliott Barbara A. , Haller Irina V.
Published: March 2003

OBJECTIVES: To compare how causes of death are recorded on the death certificates of centenarians with those who die in their 70s, 80s, and 90s. We also examined direct and indirect acknowledgment of age as a cause of death.

DESIGN: Retrospective review of death certificates.

SETTING: State of Minnesota.

PARTICIPANTS: The death certificates of 26,415 individuals aged 70 and over who died in Minnesota in 1998 were examined for underlying causes of death. Of these, 449 were for individuals who were aged 100 and older at the time of their death.

MEASUREMENTS: Causes of death.

RESULTS: Diabetes mellitus, chronic obstructive pulmonary disease, cirrhosis, myocardial infarction, and most cancers decreased in frequency as reported causes of death with advancing age. Conversely, congestive heart failure, atherosclerosis, and neurological/mental and poorly defined conditions increased in frequency with age.

CONCLUSIONS: Centenarians appear to “outlive” the risks for many of the conditions that are common causes of death for those who die in their 70s, 80s, and 90s, such as cancer and myocardial infarction. Conditions associated with aging, such as congestive heart failure and degenerative neurological conditions become more prominent as reported causes of death in the oldest individuals. The guidelines for the completion of death certificates should be modified to facilitate direct acknowledgment of age‐related frailty as a contributing cause of death.
Paired comparison of the in vivo and in vitro results of storage of platelet concentrates in two containers
Authors: MURPHY S. , HOLME S. , NELSON E. , CARMEN R.
Published: March 2003

Both in vitro and in vivo methods are used to test the validity of techniques for storing platelet concentrates for transfusion. In this study, the characteristics of platelet concentrates stored for 5 days at 22 degrees C in two different containers were evaluated by paired comparison using two in vitro measurements and two in vivo measurements. On two occasions, 10 normal subjects donated concentrates that were stored in containers of either the CLX system or the PL‐146 system. The first plastic used was chosen at random. If necessary, a concentrate platelet count was reduced to 1,200,000 per microliters by addition of plasma to avoid pH fall. Mean recoveries were 48.2 +/− 10.6 percent (mean +/− 1 SD) and 42.4 +/− 7.8 percent for platelets stored in containers of the CLX and PL‐146 systems, respectively. Similarly, survivals (T 1/2 in days) were 3.4 +/− 0.8 and 3.0 +/− 0.7, respectively. Since a paired design was used, the superiority of the CLX system was demonstrable with a one‐tailed paired t test. If a paired design had not been used, a pooled t test would have been appropriate and the differences would not have been significant. This result emphasizes the value of the paired design. Furthermore, two in vitro measurements that reflect platelet morphology, dispersion of the size distribution and extent of shape change with adenosine diphosphate, were superior for platelets stored in CLX containers as well, suggesting a relationship between these measurements and in vivo viability.(ABSTRACT TRUNCATED AT 250 WORDS)
Blood usage in transfusion‐dependent patients
Authors: MARCUS R.E. , JOHNSON E.R. , THOMAS M.J.G. , PARRY E.S.
Published: March 2003

A model for blood requirements of transfusion‐dependent patients is presented to relate the transfusion interval in days (I), the percentage fall in hemoglobin (F), and the time in days after a transfusion during which no red cell loss occurs (S). The model applies to both normal blood (S = 0) and to young red cell (YRBC) transfusions, giving I = (S + 120)/(200/F ‐ 1) The model predicts prolongation of transfusion interval by use of YRBCs, and is also of use in establishing whether excess red cell destruction or significant red cell production is present in a transfusion‐dependent patient receiving either normal blood or YRBCs.
Red cell alloantibodies in thalassemia major
Authors: Sirchia Girolamo , Zanella Alberto , Parravicini Anna , Rebulla Paolo , Morelati Ferdinanda , Masera Giuseppe
Published: March 2003

Clinical and serological data on 1435 Italian thalassemia major patients were collected during a cooperative study involving 19 centers in 10 regions. The main findings were as follows: 18 percent of the patients were under 6 years of age, 63 percent between 6 and 15, and 19 percent over 15. Forty‐one percent had undergone splenectomy. Sixty‐two percent of the patients were maintained at pretransfusion hemoglobin levels higher than 10 g per dl, 36 percent between 8 and 10 g per dl, and 2 percent below 8 g per dl. Overall, 5.2 percent of the patients had clinically significant red cell alloantibodies (136 alloantibodies in 74 patients). One‐half of the immunized patients had more than one and one‐fourth had more than two alloantibodies. The specificities of the 136 alloantibodies were almost exclusively confined to the common antigens of the Rh, Kell, Kidd, and Duffy systems, in that decreasing order of frequency. The antibody screening procedure, using a low‐ionic‐ strength solution antiglobulin test against a three‐red‐cell panel and the patient's own red cells (autocontrol) with a serum to cell ratio of 100 to 1 was shown to be an adequate technique for red cell antibody detection.
Blood transfusion in liver transplantation
Authors: Butler Patricia , Israel Linda , Nusbacher Jacob , Jenkins David E. , Starzl Thomas E.
Published: March 2003

Liver transplantation is a relatively new procedure in which unusually large quantities of blood are used. Blood use in 68 adult and 49 pediatric liver transplants was reviewed. The median (range) intraoperative red cell use for adults and children was 28.5 (3‐251) and 11 (2‐55), respectively. Blood use closely correlated with the patient's primary diagnosis. Adult patients with primary biliary cirrhosis and carcinoma used about one‐half as much blood as those with a diagnosis of sclerosing cholangitis, hepatitis, or cirrhosis. Patients in the former diagnostic groups also had better survival rates. Total red cell use for the patient's entire hospitalization was about twice that used during surgery. Fresh‐frozen plasma use paralleled red cell transfusions, but platelet use was modest. These data can serve as a baseline in helping other hospital transfusion services prepare for the advent of liver transplantation in their institutions.
Anti‐HTLV‐III testing of blood donors: reproducibility and confirmability of commercial test kits
Authors: Holland P. V. , Richards C. A. , Teghtmeyer J. R. , Douville C. M. , Carlson J. R. , Hinrichs S. H. , Pedersen N. C.
Published: March 2003

Since 2% of the cases of Acquired Immune Deficiency Syndrome (AIDS) have been attributed to transfusions of blood and blood products, licensed tests to detect antibody to the human T‐lymphotropic virus type III (anti‐HTLV‐III) have been put into practice to reduce the risk of transfusion associated AIDS. Two commercial ELISA kits (Abbott and ENI) were used to test for anti‐HTLV‐III in 100 coded samples from individuals with AIDS, at high risk for AIDS, or with low risk for AIDS and in 1280 unlinked blood donor serums. From the 100 coded samples, both Abbott and ENI tests identified 51 of 52 coded samples with anti‐ HTLV‐III which were confirmable with Western blot analysis. Initial testing of the donor serums by Abbott's test revealed 20 reactives, of which 5 were repeatably reactive; initial testing by ENI's test revealed 25 reactives, of which 14 were repeatably reactive. However, only 3 donor serums were repeatably reactive by both test kits, out of 17 repeatable reactive by either, and no ELISA positive samples were confirmed by Western blot or IFA. Before a blood donor is notified of “anti‐HTLV‐III reactivity”, tests demonstrating this should be both reproducible and confirmable by at least one additional test.
Alternate dosage regimens for high‐molecular‐weight hydroxyethyl starch
Authors: Rock G. , McCombie N.
Published: March 2003

Six percent high‐molecular‐weight hydroxyethyl starch (HES) was used in the standard 500‐ml dose and in various decreased doses to assess the efficacy of alternate dosage regimens for granulocyte procurement. When used in full strength, yields of 0.57 +/− 0.15 × 1010 per 1 of blood processed (LBP) were obtained. When HES was used in only the first three passes, the subsequent three passes, done with acid‐citrate‐ dextrose, Formula‐A (ACD‐A, Fenwal Laboratories, Deerfield, IL), reduced the yield to 0.14 +/− 0.06 (mean +/− SD) × 1010 per LBP. Reversing this procedure gave yields of 0.06 +/− 0.05 × 1010 per LBP (without HES) and 0.49 +/− 0.36 × 1010 per LBP when HES was added during the next three passes. When the HES dose was reduced to one‐half strength on the second consecutive day of leukacytapheresis, the granulocyte yields were reduced from 0.57 +/− 0.15 × 1010 per LBP to 0.42 +/− 0.07 × 1010 per LBP. Use of one‐half strength HES on first‐ time donors gave yields of only 0.35 +/− 0.39 × 1010 per LBP. Infusion of the entire 500‐ml dose of HES one‐half hour prior to the procedure produced low yields of 0.20 +/− 0.12 × 1010 per LBP, indicating that HES must be present during the centrifugation and separation procedure in order to enhance yields. These data suggest that alternate dosage regimens of this form of HES are not advisable and that optimal yields are produced when 500 ml of the 6 percent solution is used during the collection procedure.
Frequency of alloantibodies accompanying autoantibodies
Authors: Laine M. L. , Beattie K. M.
Published: March 2003

Blood samples of 109 patients with warm autoantibodies were evaluated for the presence of accompanying alloantibody. Clinically significant alloantibodies were present in 41, or 38 percent, of the cases.
Calcium homeostasis during therapeutic plasma exchange
Authors: SILberstein L. E. , Naryshkin S. , Haddad J. J. , Strauss J. F.
Published: March 2003

Because the removal of substantial quantities of plasma calcium during plasma exchange is rarely attended by clinically significant hypocalcemia, we evaluated calcium homeostasis during this procedure. Twenty‐one procedures were performed on 10 patients with various neurological disorders. The reduction by plasma exchange in the serum concentrations of total calcium, ionized calcium, magnesium, and phosphate was significantly less than predicted (p < 0.001) based on plasma volume of the patient and size of the exchange. However, N‐terminal parathomone (PTH) levels increased to 242 ± 120 percent midway into the procedure and were 207 ± 84 percent after plasma exchange; urinary cyclic adenosine monophosphate (cAMP) levels rose by 165 ± 35 percent.

These data demonstrate a rapid compensatory response in N‐terminal PTH and urinary cAMP to the reduction by plasma exchange of serum concentrations of total calcium, ionized calcium, and phosphate. The routine administration of supplemental calcium during plasma exchange may therefore be unnecessary in patients with normal parathyroid function.
Freezing of plasma and recovery of factor VIII
Authors: Carlebjörk G. , Blombäck M. , Pihlstedt P.
Published: March 2003

The freezing procedure and its influence on the plasma quality was studied with a new plasma container and freezing bath and compared with the results from those obtained with commonly used equipment. Cryoprecipitation was performed on plasma pools frozen at three different rates, and quality and recovery of the cryoprecipitates were determined by analysis of factor VIII, factor VIII‐related antigen (vWF:Ag), and fibrinogen. The plasma freezing time was 95 and 65 percent shorter with a new – 40°C freezing bath as compared to –25 and –80°C freezing boxes, respectively. A further 30 percent reduction of the plasma freezing time was gained by the introduction of a new flat 750‐ml plasma container. Rapid plasma freezing prevented substantial loss of factor VIII in frozen plasma. Cryoprecipitate purity measured as factor VIII‐to‐fibrinogen ratio increased from 0.50 to 0.82 (IU/mg) when the freezing time was decreased from 10 hours to 45 minutes, although the recovery of factor VIII increased less.

In summary, freezing of plasma in small flat containers in an effective ethanol bath resulted in rapid freezing with high recovery of factor VIII in plasma, and increased purity and recovery of subsequently processed cryoprecipitate. This freezing concept, adapted at Swedish blood banks, has contributed to higher source plasma quality and increased self‐sufficiency.
An evaluation of 11 red cell elution procedures
Authors: South S. F. , Rea A. E. , Tregellas W. M.
Published: March 2003

Eleven elution procedures were evaluated for their efficacy in recovering antibody from red cells sensitized with immunoglobulin. The procedures evaluated included eight published methods (Lui, heat, digitonin‐acid, ether, chloroform, dichloromethane, xylene, and alcohol freeze‐thaw) and three commercial elution kits (EluAid, Ortho Diagnostic Systems, Inc.; Elution Solution, Biological Corporation of America; and Elu‐Kit II, Gamma Biologicals, Inc.). The xylene elution method proved to be the most effective method, followed by Elu‐ Kit II, chloroform, dichloromethane, and digitonin‐acid. The other six methods evaluated were not optimal based on the suitability of each procedure and the calculated sensitivity.
Development and operation of a program to obtain volunteer bone marrow donors unrelated to the patient
Authors: McCullough J. , Rogers G. , Dahl R. , Therkelsen D. , Kamstra L. , Crisham P. , Kline W. , Bowman R. , Scott E. , Halagan N. , Williams J. , Sandler S. G.
Published: March 2003

Because of recent increases in bone marrow transplantation, the lack of available matched sibling donors has become a problem. This study investigated the feasibility of obtaining volunteer bone marrow donors unrelated to the patient. A program was developed to inform potential donors and obtain their consent for listing in a bone marrow donor registry. Sixty‐six percent of whole blood or apheresis donors agreed to participate in the program. There were no demographic differences between those who accepted or declined to participate. Religion, experiences with medical practices, and the attitude of the potential donor's spouse were important factors in the decision to participate. A search for donors was initiated for 127 patients. Thirty searches were not completed, primarily because of patient‐related problems. A total of 713 HLA‐A and ‐B antigen‐identical donors was located for 63 of the 97 (65%) patients. A total of 40 HLA‐A, ‐B, and ‐DR antigen‐identical donors was located for 18 of these 63 patients. Six of these 18 patients then had one or more donors (total, 9) whose lymphocytes did not react in mixed lymphocyte culture. Thus, using the file of 2147 donors, an HLA‐identical donor was located for 6 percent of the 97 patients. None of these patients has yet received a transplant; in four cases this was due to patient‐related and in two cases donor‐related reasons. The cost to establish the donor program averaged $33.46 (1984) per donor for donors already typed for HLA‐A and ‐B antigens. This experience indicated that, given thorough information about bone marrow donation and transplantation, a majority of blood and apheresis donors will volunteer to donate bone marrow, without feeling pressure to do so. A relatively small donor file provided donors for 6 percent of patients. The long‐term value of bone marrow transplantation using unrelated donors and the optimum size of the donor file remain to be established.
Frozen storage of 11 units of sickle cell red cells for autologous transfusion of a single patient
Authors: Chaplin H. , Mischeaux J. R. , Inkster M. D. , Sherman L. A.
Published: March 2003

A patient with sickle cell disease and multiple alloantibodies required frozen storage of autologous red cells (RBC) to provide the RBC volume equivalent of 6 units of normal donor blood for an orthopedic surgical procedure. Eleven 600‐ml donations were made at 4‐week intervals, without significant change in hemoglobin concentration, hematocrit, or reticulocyte count, and with only small decreases in serum iron and ferritin concentrations. Minor modifications of a glycerolization and deglycerolization procedure described recently were used. We report in vitro recoveries of deglycerolized RBC from the 11 units following frozen storage for 27 to 391 days. Despite use of a single donor and adherence to a standardized processing protocol, considerable variation in the percent in vitro RBC recovery was observed (51–81%). In vivo survival of an aliquot following frozen storage for 27 days was identical with fresh autologous RBC (100% at 1 hr, 88% at 24 hr, one‐half disappearance of 7.5 days). Autologous transfusion of RBC recovered from 7 units after storage for as long as 126 days was uneventful.
Effects of frequent and sustained plateletapheresis on peripheral blood mononuclear cell populations and lymphocyte functions of normal volunteer donors
Authors: Matsui Y. , Martin‐Alosco S. , Doenges E. , Christenson L. , Shapiro H. M. , Yunis E. J. , Page P. L.
Published: March 2003

Per procedure, plateletapheresis may remove 2×109 to 3×109 white cells from the peripheral blood of a normal donor. To investigate the effects of frequent and sustained plateletapheresis, multiple peripheral blood tests were performed on 25 volunteer donors undergoing plateletapheresis an average of 72 times over periods of up to 8 years, and results were compared with 25 age‐ and sex‐matched controls who had not undergone apheresis. In donors, significant decreases were observed in: 1) both absolute number and percentage of T4+ cells; 2) absolute number of both T8+ cells and LeU‐7+ cells; 3) T4/T8 ratio; 4) responses to both pokeweed mitogen and alloantigens; and 5) IgG levels. Significant increases were observed in percentages of both B cells and monocytes, and responses to both phytohemagglutinin and Concanavalin A. Plateletapheresis removes a large number of T4 and T8 cells, a moderate number of B cells, and a smaller number of monocytes and Leu‐7 cells. The results suggest that during vigorous plateletapheresis the replenishment to peripheral blood per month was less than 1.83×109 and 0.93×109 for T4 cells and T8 cells, respectively, greater than 0.27×109 and 0.62×109 for B cells and monocytes, respectively, and approximately 0.39×109 for Leu‐7 cells. Although no clinical effect was noted, these data suggest that frequent and sustained non‐lymphocyte sparing plateletapheresis is associated with changes in laboratory findings related to the immune system.
Studies of the minimum temperature at which human platelets can be stored with full maintenance of viability
Authors: Gottschall J. L. , Rzad L. , Aster R. H.
Published: March 2003

Platelet concentrates from normal donors were stored for 3 days under identical conditions except for the temperature of storage, which was maintained at 21 ± 0.5, 19.5 ± 0.5, or 18 ± 0.5°C. Immediate posttransfusion recovery of the stored platelets determined by 51Cr labeling averaged 47, 47, and 48 percent after storage at 21, 19.5, and 18°C, respectively (differences not significant). Mean life span of the transfused platelets, however, was 8.12, 5.21, and 1.85 days at 21, 19.5, and 18°C, respectively. The difference between mean life span following storage at 21°C was significantly different from that after storage at 18°C (p < 0.03). Reduction in viability after storage at the lower temperature correlated with the reduction in the number of discoid platelets. These findings indicate that platelet viability is compromised after storage for 3 days at 18° C and, possibly, at 19.5° C, and illustrate the need for quality control of temperature in short‐term platelet storage.
Prolonged storage of red cells at 4° C
Authors: Meryman H. T. , Hornblower M. L‐S. , Syring R. L.
Published: March 2003

One of the events associated with red cell storage at 4°C is the development of an increasing proportion of echinocytes. Vesicles also may bud off the spicules, presumably leading to a decreased surface‐to‐volume ratio and decreased deformability. Pursuing the hypothesis that increasing the surface tension of the cells by increasing their volume might reduce the tendency toward echinocytosis and extend refrigerated storage time, packed red cells were resuspended in a solution hypotonic (210 mOsm) with respect to solutes that do not penetrate the cell. Since a reduced ionic concentration results in increased membrane permeability for cations, normal ionic concentration was maintained by the addition of NH4C1, which readily penetrates red cells and therefore contributes no osmotic support. Adenine, glucose, mannitol, citrate, and phosphate also were included. Unexpectedly, the predominant effect of red cell storage in this solution was a remarkable elevation of adenosine triphosphate (ATP). At 4, 8, and 10 weeks, (ATP) levels averaged 165, 135, and 110 percent of initial values, respectively. At 16 weeks, ATP still averaged 50 percent of initial values. Twenty‐four‐hour in vivo survival of red cells measured at 12 to 18 weeks ranged between 70 and 80 percent, and hemolysis ranged from 0.3 to 7.1 percent. Both the hypotonicity and the ammonium salt appear to be necessary for the high ATP.
In vitro characteristics and in vivo viability of platelets contained in granulocyte‐platelet apheresis concentrate
Authors: Snyder E.L. , Ezekowitz M.D. , Malech H.L. , Napychank P.A. , Smith E.O. , Kiraly T. , Gardner J.P. , Kalish R.I.
Published: March 2003

A paired prospective study was performed to compare the in vitro storage characteristics and in vivo kinetics of platelets stored in granulocyte‐platelet concentrates prepared by apheresis with platelets prepared from whole blood. Platelet and granulocyte‐platelet concentrates were collected from five healthy volunteer autologous donors and stored for 16 to 18 hours at 20 to 24°C with and without agitation, respectively. After storage, pH, platelet count, percent release of β‐thromboglobulin, morphologic score, and percent osmotic recovery were measured. In addition, the granulocyte‐platelet concentrates were assayed for total leukocyte count, release of lysozyme, and by several in vitro tests of granulocyte function. The platelets in both products were labeled with 111In oxine and infused into the donors. The pH of both products was above 6.0 at the end of storage. The units stored as platelet concentrates compared with those stored as granulocyte‐platelet concentrates showed a higher percent release of β‐thromboglobulin, 18.4 ± 4.0 percent versus 5.9 ± 3.2 percent (mean ± SD), but significantly better morphologic scores, 676 ± 21 versus 525 ± 56, and better osmotic recovery scores, 72 ± 10 percent versus 40 ± 7 percent, respectively (all p < 0.05). The platelet concentrates (compared with the granulocyte‐ platelet product) had significantly better in vivo recovery, 49.5 ± 15.8 percent versus 38.9 ± 11.5 percent, and survival, 6.1 ± 1.3 days versus 2.4 ± 0.4 days, respectively (p < 0.05). After 16 to 18 hours of storage at 20 to 24°C the platelets in granulocyte‐platelet concentrate show impaired in vitro storage characteristics as well as significantly decreased in vivo recovery and survival especially if agitated during storage, compared with age‐matched random donor platelet concentrates.
Blood use in liver transplantation
Authors: Lewis J. H. , Bontempo F. A. , Cornell F. , Kiss J.E. , Larson P. , Ragni M. V. , Rice E.O. , Spero J. A. , Starzl T.E.
Published: March 2003

During the first 5 years (1981–1985) of the liver transplantation program in Pittsburgh, a total (preoperative, intraoperative, and postoperative) of 18,668 packed red cell units, 23,627 fresh‐frozen plasma units, 20,590 platelet units, and 4241 cryoprecipitate units was transfused for the procedures. This represents 3 to 9 percent of the total of blood products supplied by the Central Blood Bank to its 32 member hospitals. Six hundred thirty‐six (636) transplants were performed on 485 patients in two hospitals: the Presbyterian University Hospital (564 beds) and Children's Hospital of Pittsburgh (236 beds). All of the blood components used in the operations were procured and released by the Central Blood Bank. This report describes some of these findings.
Liquid storage at 4 ° C of previously frozen red cells
Authors: Moore G.L. , Ledford M.E. , Mathewson P.J. , Hankins D.J.
Published: March 2003

Fresh human blood was collected in citrate‐phosphate‐dextrose, frozen by a high‐glycerol technique, and stored at −80 ° C. The red cells were thawed, deglycerolized, and resuspended in a final wash solution, ADSOL (Fenwal Laboratories), or an additive solution (AS) containing glucose, adenine, mannitol, and phosphate. The cells were then stored at 4 to 6 ° C for 21 days and assayed weekly for adenosine triphosphate and 2,3 diphosphoglycerate, pH, glucose use, and lysis. AS and, to a lesser extent, ADSOL produced metabolic profiles similar to or better than profiles of cells not frozen and stored in commercially available additive solutions. AS offers a potential post‐ thaw preservative solution for red cells that would greatly increase the flexibility and reduce the expense of using frozen blood. A sterile post‐thaw storage capability will make the stockpiling of frozen red cells a practical concept for both military and civilian blood banks.
Posttransfusion thrombocytopenia associated with passive transfusion of a platelet‐specific antibody
Authors: Scott E.P. , Moilan‐Bergeland J. , Dalmasso A.P.
Published: March 2003

A transfusion reaction in a 76‐year‐old man was followed by severe but transient thrombocytopenia after infusion of whole blood. A high‐titer platelet‐specific antibody (anti‐PLA) was demonstrated in the plasma of the implicated unit and in the serum of the blood donor. In addition, three previous recipients of blood from the implicated donor had posttransfusion episodes of unexplained thrombocytopenia. These cases represent the first reported clinical examples of posttransfusion thrombocytopenia caused by passively transfused platelet‐specific alloantibodies.