bluuebunny/crossref_metadata_2025 huggingface dataset:
Resistance Exercise and Physical Performance in Adults Aged 60 to 83
Authors: Vincent Kevin R. , Braith Randy W. , Feldman Ross A. , Magyari Pete M. , Cutler Rachel B. , Persin Stephanie A. , Lennon Shannon L. , Md Abdel H. Gabr , Lowenthal David T.
Published: March 2003

OBJECTIVES: This investigation examined the effect of 6 months of high‐ or low‐intensity resistance exercise on muscular strength and endurance and stair climbing ability in adults aged 60 to 83.

DESIGN: A randomized controlled trial.

SETTING: University of Florida Center for Exercise Science

PARTICIPANTS: Sixty‐two men and women completed the study protocol. Subjects were matched for strength and randomly assigned to a control (n = 16), low‐intensity (LEX, n = 24), or high‐intensity (HEX, n = 22) group.

INTERVENTION: Six months of progressive, whole‐body resistance training. Subjects trained at 50% of their one‐repetition maximum (1RM) for 13 repetitions (LEX) or 80% of 1RM for eight repetitions (HEX) three times per week for 24 weeks using resistance machines. One set each of 12 exercises was performed.

MEASUREMENTS: One‐repetition maximum was measured for eight different exercises. Muscular endurance was measured using leg press and chest press machines. Low back strength was measured using a lumbar extension machine. Stair climbing ability was assessed as the time to ascend one flight of stairs.

RESULTS: 1RM significantly increased for all exercises tested for the HEX and LEX groups (P≤ .050). The increases in total strength (sum of all eight 1RMs) were 17.2% and 17.8% for the LEX and HEX groups, respectively. Muscular endurance improved by 79.2% and 105.0% for the leg press, and 75.5% and 68.0% for the chest press for the LEX and HEX groups, respectively. The time to ascend one flight of stairs significantly decreased for both the LEX and HEX groups (P≤ .050). Lumbar extension strength increased by 62.6% and 39.5% for the LEX and HEX groups, respectively.

CONCLUSIONS: These data indicate that significant and similar improvements in strength, endurance, and stair climbing time can be obtained in older adults as a consequence of high‐ or low‐intensity resistance exercise training. These findings may have an effect on how resistance exercise is prescribed to older adults.
The Prevalence of Dementia in Older People in an Urban Population of Korea: The Seoul Study
Authors: Lee Dong Young , Lee Jung Hie , Ju Young‐Su , Kang Uk Lee MD , Kim Ki Woong , Jhoo Jin Hyeong , Yoon Jong Choul , Ha Jin , Woo Jong Inn
Published: March 2003

OBJECTIVES: To estimate prevalence of dementia and its subtypes in older people in Seoul, a metropolitan area of Korea, and compare these findings with estimates reported for other populations.

DESIGN: The study employed a two‐stage design for case identification. Initially, the Mini‐Mental State Examination in the Korean version (MMSE‐KC) of the Consortium to Establish a Registry for Alzeheimer's Disease (CERAD) assessment packet was administered to all participants. Two hundred seventeen persons sampled from three levels of performance on MMSE‐KC underwent the second‐stage clinical evaluation based on the Korean Version of the CERAD assessment packet.

SETTING: The study was conducted in an urban community setting.

PARTICIPANTS: Six hundred forty‐three persons aged 65 and over participated in the study.

MEASUREMENTS: Dementia was defined using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic features of dementia.

RESULTS: Dementia prevalence ranged from 2.6% in persons aged 65 to 69 to 32.6% in persons aged 85 and older. Age‐standardized prevalence was 8.2% for dementia, 5.4% for Alzheimer's disease, and 2.0% for vascular dementia. The prevalence estimates, which excluded very mild cases (clinical dementia rating index 0.5), were approximately 5.3% for dementia and 4.3% for Alzheimer's disease.

CONCLUSION: The prevalence of dementia in older people in Seoul appears to be somewhat lower than in rural areas of Korea. Considering the difficulties involved in establishing a diagnostic threshold for dementia, actual differences in dementia prevalence between Asian populations are probably minimal.
Quality of Care of Nursing Home Residents Hospitalized With Heart Failure
Authors: Ahmed Ali , Weaver Michael T. , Allman Richard M. , DeLong James F. , Aronow Wilbert S. , Cmd
Published: March 2003

OBJECTIVES: To determine whether the quality of heart failure (HF) care of hospitalized nursing home (NH) residents is different from that of patients admitted from other locations.

DESIGN: Retrospective chart review.

SETTING: Nursing home residents discharged from hospitals.

PARTICIPANTS: Medicare beneficiaries aged 65 and older.

MEASUREMENTS: Subjects were discharged with a primary discharge diagnosis of HF in Alabama in 1994. They were categorized as having been admitted from a NH or other locations. Bivariate logistic regression analysis was used to estimate crude odds ratios (ORs) and 95% confidence intervals (CIs) for left ventricular function (LVF) evaluation and angiotensin‐converting enzyme (ACE) inhibitor use for NH residents relative to nonresidents. Multivariate generalized linear models were developed to determine independence of associations.

RESULTS: Subjects (N = 1,067 years) had a mean age ± standard deviation of 79 ± 7.4, 60% were female, and 18% were African Americans. Fewer NH residents (n = 95) received LVF evaluation (39% vs 60%, P < .001) and ACE inhibitors (50% vs 72%, P = .111). NH residents had lower odds for LVF evaluation (OR = 0.42, 95% CI = 0.27–0.64). The odds for ACE inhibitor use, although of similar magnitude, did not reach statistical significance (OR = 0.40, 95% CI = 0.12–1.28). After adjustment of patient and care characteristics, admission from a NH was significantly associated with lower LVF evaluation (adjusted OR = 0.64, 95% CI = 0.49–0.82) but not with ACE inhibitor use (adjusted OR = 0.59, 95% CI = 0.16–2.14).

CONCLUSIONS: Quality of HF care received by hospitalized NH residents was lower than that received by others. Further studies are needed to determine reasons for the lack of appropriate evaluation and treatment of NH patients with HF who are admitted to hospitals.
Survival to Late Dementia in Dutch Nursing Home Patients
Authors: Koopmans Raymond T. C. M. , Ekkerink John L. P. , Van Weel Chris
Published: March 2003

OBJECTIVES:To investigate the determinants of survival to late dementia in Dutch nursing home patients.

DESIGN:Observational analysis of a cohort of patients with a prospective follow‐up.

SETTING:Psychogeriatric nursing home “Joachim en Anna” in Nijmegen, the Netherlands.

PARTICIPANTS:Dementia patients from a psychogeriatric nursing home admitted between 1980 and 1989.

MEASUREMENTS:All patients were followed until death. Age, sex, severity of dementia on admission, and type of dementia were analyzed as determinants of survival to late dementia. Late dementia was operationally defined as total impairment on 20 items of the functional status questionnaire.

RESULTS:The mean disease duration of the study population was 7.0 years, with a wide range. Some died soon after dementia was diagnosed, whereas others lived for more than 25 years after onset of the disease. One hundred twenty‐six patients (14.2%) reached the phase of late dementia, most of whom were women (90%) with Alzheimer's disease (60%). For most of the patients, this phase lasted 1 year or less. Age, sex, type of dementia, and severity of dementia on admission all contributed significantly to predicting survival to late dementia.

CONCLUSION:One of seven nursing home patients with dementia survived to late dementia. Nursing home physicians can use these findings to inform relatives about the prognosis. J Am Geriatr Soc 51:184–187, 2003.
Development and Validation of an Instrument to Predict Probability of Home Discharge from a Geriatric Convalescence Unit in Spain
Authors: Miralles Ramón , Sabartés Olga , Ferrer Montse , Esperanza Ascensión , Llorach Imma , García‐Palleiro Pedro , Cervera Antoni‐María
Published: March 2003

OBJECTIVES: To develop and validate an instrument to predict probability of home discharge upon hospital admission.

DESIGN: Prospective cohort study.

SETTING: Geriatric convalescence unit (GCU) in Spain.

PARTICIPANTS: Seven hundred eighty‐one patients aged 65 and older consecutively admitted to a GCU over a 4‐year period. The total sample was randomized and divided into two subgroups; the first (n = 575) was used to construct the predictive instrument (development subgroup) and the second (n = 206) for the validation process (validation subgroup).

MEASUREMENTS: All patients were evaluated within the first 72 hours after admission. Age, sex, functional status before admission, diagnostic categories, functional status on admission, comorbidity, cognitive function, and social support were assessed.

RESULTS: Logistic regression analysis identified three patient characteristics as independent predictors of home discharge in the development subgroup: higher scores on functional status at admission (Barthel index), normal Mini‐Mental State Examination scores, and lower scores on Social Familial Evaluation Scale. A scoring system ranging from 0 to 5 was constructed using these variables to predict probability of home discharge (PHD). Different PHD scores (0–1, 2, 3, 4, and 5) identified patients with different probabilities of returning home on discharge in the validation subgroup (36.5%, 53.6%, 60.8%, 83.3%, and 100%, respectively). PHD scores of 4 and 5 demonstrated substantially higher posttest than pretest probability, with moderate and high clinical effect value. Scores of 0 or 1 demonstrated substantially lower posttest than pretest probability.

CONCLUSION: A PHD instrument may be useful in identifying patients most likely to be discharged to home from the GCU. Patients with low probability of home discharge may also be identified early.
Differential Diagnosis and Management of Spinal Nerve Root‐related Pain
Authors: Sizer Phillip S. , Phelps Valerie , Dedrick Greg , Matthijs Omer
Published: March 2003

Abstract: Pain originating from spinal nerve roots demonstrates multiple pathogeneses. Distinctions in the patho‐anatomy, biomechanics, and pathophysiology of spinal nerve roots contribute to pathology, diagnosis, and management of root‐related pain. Root‐related pain can emerge from the tension events in the dura mater and nerve tissue associated with primary disc related disorders. Conversely, secondary disc‐related degeneration can produce compression on the nerve roots. This compression can result in chemical and mechanical consequences imposed on the nervous tissue within the spinal canal, lateral recess, intervertebral foramina, and extraforminal regions. Differences in root‐related pathology can be observed between lumbar, thoracic, and cervical spinal levels, meriting the implementation of different diagnostic tools and management strategies.
The role of glutamate, calcium and magnesium in secondary brain injury
Authors: Leonard Susan E. , Kirby Rebecca
Published: March 2003

Objective:To review the roles that glutamate, calcium and magnesium play in both normal brain function and in the events following traumatic brain injury.

Human data synthesis:Elevated extracellular brain glutamate levels have been well documented in humans following traumatic brain injury. Therapies focusing on glutamate receptor antagonists have not yet been shown to have clinical effectiveness significant enough to outweigh the side effects. Newer strategies are currently being explored focusing on the many secondary cellular cascades interacting to culminate in cell injury and death.

Veterinary data synthesis:Derangements in glutamate, calcium and magnesium have been well documented in animals following traumatic brain injury. Research studies using animal models other than small laboratory animals such as rats, mice and rabbits are very limited. Prospective veterinary clinical trials in dogs and cats are needed to determine the potential success that various therapeutic strategies might have in the field of small animal emergency and critical care medicine.

Conclusions:Alterations in the levels of glutamate, calcium and magnesium play a critical role in secondary brain injury. The future development of clinically‐tolerated and effective antagonists of glutamate, glutamate receptors, and other downstream mediators has the potential to revolutionize the therapy of traumatic brain injured patients.
Fibronectin in liquid and frozen stored blood components
Authors: SNYDER E.L. , FERRI P.M. , MOSHER D.F.
Published: March 2003

To quantitate the concentration of fibronectin in blood components to determine if the fibronectin present in liquid and frozen stored blood products deteriorates in vitro, we measured the concentration of this opsonic protein at the beginning and at the end of storage. In addition, electroblotting studies were performed to ascertain if aggregation or degradation of fibronectin occurred during component preparation or storage. Results showed that fibronectin concentration was stable in whole blood, single donor plasma, platelet concentrates, fresh‐frozen plasma, and cryoprecipitate. By electroblotting, aggregated or degraded fibronectin was found in some components, especially cryoprecipitate. Most of the fibronectin, however, appeared to be unaffected by component preparation or storage.
Rheological properties of antibody‐coated red cells
Authors: Ballas S.K. , Mohandas N. , Clark M.R. , Shohet S.B.
Published: March 2003

In vivo and in vitro antibody‐coated nonspherocytic red cells have normal deformability in iso‐osmolar media, and their isolated membranes have normal mechanical stability as measured in the ektacytometer, a laser visco‐diffractometer. The deformability of red cells from patients with hemolytic anemia was proportionately reduced with the degree of spherocytosis irrespective of whether the direct antiglobulin test was positive. However, when antibody‐sensitized nonspherocytic cells were suspended in hyperosmolar media and exposed to constant shear stress in the ektacytometer, they showed reduction of their deformability index in the presence of polyvinylpyrrolidone (PVP; 360,000 Daltons) but not dextran. This reduction was not due to alterations in cell water or cation content. Also, when incubated at 37 degrees C, sensitized red cells reacted specifically with PVP, and underwent a decrease in cell deformability. This appears to be the result of changes either in red cell membrane rigidity or membrane viscosity. The PVP effect was reproducible, time‐ and temperature‐ dependent, and predicted reliably the Rh phenotype. These observations were used to develop a novel approach to the antiglobulin test in the blood bank.
Characterization of various anti‐Pr cold agglutinins
Authors: Roelcke D. , Kreft H.
Published: March 2003

Forty ‐one samples of anti‐Pr cold agglutinins (CA) were studied. The titers ranged from 4 to 32,000. As is the case with cold agglutinins of other specificities, immunoglobulin class M and k‐type light chains predominated with anti‐Pr CA. On the other hand, the few IgM lambda, IgG, and IgA found were associated preferentially with anti‐Pr specificity. All anti‐Pr CA were inhibited by human red cell membrane sialoglycoproteins. On the basis of an increased inhibition by sialoglycoproteins after periodate oxidation and carbodiimide treatment, respectively, three anti‐ Pr2 and five anti‐Pr3 were found. Among 24 anti‐Pr1 CA subclassified on the basis of agglutination with dog red cells, six were anti‐ Pr1h, 16 were anti‐ Pr1d, and two did not fit into the subclassification. Similar to the anti‐ Pr1h, ‐ Pr1d subclassification, anti‐Pr3 CA could be subclassified into anti‐ Pr3h, ‐ Pr3d. Three anti‐Pra examples were found. None of the anti‐Pr CA was inhibited by N‐acetylneuraminic acid; some (5/35) were inhibited by sialyllactose, NeuAc alpha 2–3 2–6 Gal beta 1–4Glc, in high doses (5.0‐ 20.0 mM).
A microtiter plate technique for the detection of platelet antibodies and platelet antigen typing
Authors: Kickler T.S. , Salamon J. , Welsh F. , Ness P.M. , Braine H.
Published: March 2003

A microtiter plate assay is described for platelet serologic studies. The assay is based on an indirect radiolabeled antiglobulin test. The test was performed in microtiter wells of 400 microliter capacity manufactured to form strips that fit into a standard 96‐well carrier. The strips were broken apart and placed into tubes for counting in a gamma counter. The technique does not require fixation of the platelets to the wells. Freshly collected platelets or platelets that have been stored frozen in 5 percent dimethylsulfoxide can be used. Results are presented using the technique for platelet alloantibody identification, platelet antigen typing, and platelet crossmatching.
The 24‐hour posttransfusion survival, oxygen transport function, and residual hemolysis of human outdated‐rejuvenated red cell concentrates after washing and storage at 4 degrees C for 24 to 72 hours
Authors: Valeri CR , Gray AD , Cassidy GP , Riordan W , Pivacek LE
Published: March 2003

Red cell concentrates with hematocrit values of 80 +/− 5 percent were stored at 4 degrees C either in citrate‐phosphate‐dextrose for 22 to 28 days or in citrate‐phosphate‐dextrose‐adenine‐one for 35 to 39 days. After storage, the red cells had reduced 2,3‐diphosphoglycerate and adenosine triphosphate levels, and biochemical treatment with a solution called PIPA was used to restore these levels. The red cells were not preserved further, but instead were washed after rejuvenation with an unbuffered sodium chloride‐glucose solution, pH 5.0, for in vivo studies, and with a buffered sodium chloride‐glucose‐phosphate solution, pH 6.8, for comparative in vitro studies. The red cells were stored in the wash solution at 4 degrees C for 72 hours after washing. Red cell recovery after washing was about 95 percent. Twenty‐four‐hour posttransfusion survival value was about 80 percent, and the index of therapeutic effectiveness was greater than 75 percent. These biochemically modified washed red cells exhibited higher than normal P50 values, even after 3 days of postwash storage at 4 degrees C. The units that were washed with the sodium chloride‐glucose solution with a pH of 5.0 exhibited a greater degree of hemolysis after 3 days of postwash storage at 4 degrees C than did the units that were washed with the sodium chloride‐glucose‐phosphate solution with a pH of 6.8.(ABSTRACT TRUNCATED AT 250 WORDS)
The clinical significance of HLA antigens on red cells. Survival studies in HLA‐sensitized individuals
Authors: Panzer S. , Mueller‐Eckhardt G. , Salama A. , Strauss B. E. , Kiefel V. , Mueller‐Eckhardt C.
Published: March 2003

To investigate the clinical significance of HLA determinants expressed on red cells (RBCs), 51Cr survival studies were carried out in six women (four healthy individuals, two patients with solid carcinoma) immunized against HLA antigens by pregnancy or blood transfusions, respectively. Donors were selected who were compatible in typical RBC antigen systems assayed by conventional techniques but were mismatched for the HLA antigens in question. Crossmatches also were performed with RBC, as well as with lymphocytes, by means of a radioimmune anti‐IgG test (RIAT). We found that RBC survival was shortened in all cases. The mean life‐span of RBCs depended on antigen specificity rather than on the antibody strength. HLA incompatibility of RBCs could be monitored by the RIAT in all donor/recipient pairs. We conclude that a shortened mean life‐span of RBC is to be expected by HLA antibodies, especially when HLA‐B7 is involved, but the severity of an in vivo immune reaction in HLA incompatible transfusions cannot be predicted from the in vitro tests used.
Improved detection of hepatitis B surface antigen (HBsAg) in blood donors by monoclonal radioimmunoassay
Authors: Ben‐Porath E. , Wands J. R. , Bar‐Shany S. , Huggins C. , Isselbacher K.
Published: March 2003

We evaluated the performance of a monoclonal radioimmunoassay (M‐RIA) with enhanced sensitivity and high specificity for hepatitis B surface antigen (HBsAg) in blood donors. The results were compared to a conventional RIA that used polyvalent antibodies (P‐RIA). Analysis of 6409 American blood donors not reactive by P‐RIA revealed an additional 1.4 HBsAg‐positive donors per 1000 by M‐RIA, or an approximate 60 percent, improvement in HBsAg detection rate. Furthermore, in 995 Israeli blood donors negative by P‐RIA, 11 additional HbsAg‐positive donors were identified. The 55 percent improvement in detection rate was similar to that observed with American blood donors. Since several of the newly identified HBsAg‐positive blood donors had antibodies to the core antigen (anti‐HBc) as the only serologic evidence of recent or past hepatitis B exposure, we studied an additional 68 anti‐HBc‐ positive individuals with the M‐RIA. It was found that 26 percent (18/68) reacted only by M‐RIA and not by P‐RIA. These findings suggest that there are blood donors with HBsAg undetectable by P‐RIA.
Enhancement of the indirect anti‐platelet antibody test and its application to platelet immunology
Authors: Orsini F. , O'Donnell A. , Fitzpatrick J. , Birl T. , Mink I. , Dozier A.
Published: March 2003

Comparisons in the same patients of platelet‐bound anti‐platelet antibody (APA) levels (direct test) with serum APA levels (indirect test) frequently do not give the same results. Indirect test results frequently are negative or marginally elevated even though platelet‐ bound antibody is greatly increased on direct testing. The most likely cause for these differences between the two tests is insufficient binding of serum antibody to test platelets in vitro. In an effort to enhance in vitro antibody binding, we examined four test modifications affecting platelet attachment. Rabbit anti‐human platelet antisera (absorbed with their specific human donor leukocytes to remove HLA‐ and granulocyte‐specific antibodies) were combined under various conditions with human platelets and tested in a modified antiglobulin consumption test utilizing rabbit IgG. The test conditions varied: incubation time of the serum APA‐platelet mixture at 37°C; age of the test platelet pool; ionic strength of the mixture (varied through incorporation of a low‐ionic‐strength solution (LISS); and vortex agitation for 30 seconds prior to the addition of sera. Optimal attachment in standard phosphate‐buffered saline took place in 60 minutes using test platelets stored for either 3 or 30 days, and yielded mean values for rabbit immune sera of 9.9 fg of IgG per platelet. Preincubation controls yielded a mean of 0.7 to 1.5 fg per platelet. Incorporation of LISS or vortexing of test platelets did not affect the results of control, but both modifications substantially increased test values of immune sera to 15.8 and 17.3 fg of IgG per platelet, respectively. Combining LISS with vortexing did not further increase values.
Separation of large quantities of mononuclear cells from human blood using a blood processor
Authors: Beaujean Françoise , Gourdin Marie‐Françoise , Farcet Jean‐Pierre , Forestier Chantal Le , Bouguet Jacqueline , Reyes Felix , Duedari Najib
Published: March 2003

A blood processor (IBM 2991) was used to separate lymphocytes from large volumes of blood. The procedure included the centrifugation of 200 ml whole blood on a density gradient. The results of this procedure were compared with those obtained with a manual procedure. Mononuclear cell (MNC) viability was preserved well in the two methods. But with the processor, recovery of MNC was better (63.5 +/− 2.5%) than with manual separation (26.5 +/− 4.1%). Monoclonal antibodies were used to identify the various cell subsets in the MNC fractions. No particular cell selection was observed when MNC fractions were obtained by the separator. In conclusion, the use of a cell separator provided an efficient technique for rapid isolation of large quantities of lymphocytes.
Kinetics and mobilization from the spleen of indium‐111‐labeled platelets during platelet apheresis
Authors: Heyns A du P. , Badenhorst P. N. , Lötter M. G. , Pieters H. , Wessels P.
Published: March 2003

The rate and extent of platelet mobilization from the spleen were measured, and their relationship to the removal of platelets from the peripheral blood during discontinuous flow platelet apheresis was determined in four normal volunteers. Autologous platelets were labeled with Indium‐111‐oxine and in vivo whole body and organ In‐111 radioactivity quantitated with a scintillation camera and a computer‐ assisted imaging system. Dynamic changes in splenic radioactivity were monitored during 12 cycles of platelet apheresis. The number of platelets harvested and changes in whole body and blood In‐111 activity were determined during the procedure. The platelet life‐span was estimated, and the sites of sequestration of labeled platelets was measured. Platelet apheresis removed a mean of 64 percent of platelets in the circulation; i.e., 48 percent of all platelets in the body. During the procedures, 28.0 ± 9.4 percent In‐111‐labeled platelets in the body were removed, splenic radioactivity decreased by 36.5 ± 13.2 percent, and whole body activity decreased by 34.5 ± 9.7 percent. In‐ 111 activity in the spleen and whole body decreased in parallel, indicating a dynamic equilibrium between these pools. The life‐span of the labeled platelets was 226 ± 25 hours, similar to that of normal subjects. The major sites of sequestration of senescent platelets were the spleen (37.9 ± 20%) and liver (30.3 ± 5.6%); this is similar to that found in normal subjects. We conclude that as platelets are removed from the peripheral blood, the blood pool is rapidly and effectively replenished from the splenic platelet pool. These two pools are in dynamic equilibrium and permit removal of large numbers of platelets without resultant thrombocytopenia. Platelet apheresis does not adversely effect platelet life‐span, and the sequestration pattern in the reticuloendothelial system is normal.
An approach to determine objectively minimum hemoglobin standards for blood donors
Authors: ALI ANITA M. , McAVOY ANN T. , ALI MAHMOUD A.M. , GOLDSMITH CHARLES H. , BLAJCHMAN MORRIS A.
Published: March 2003

The minimum hemoglobin level for an individual to be accepted as a blood donor in North America is 13.5 g/dl for males and 12.5 g/dl for females. The present study was undertaken to determine the iron status of donors deferred because their hemoglobin did not meet present standards. This was done prospectively by measuring hemoglobin, mean corpuscular volume, ferritin and free erythrocyte protoporphyrin on venous samples of blood. The majority of deferred donors, 85% of males and 83% of females, were found not to be iron deficient. In order to determine objectively minimum hemoglobin standards for blood donors that would include the maximum number of non iron deficient donors while excluding the majority with iron deficiency ROC curves were drawn. This approach demonstrates that minimum hemoglobin levels can be established objectively and from our data indicates that these levels are 12.5 g/dl for males and 12.0 g/dl for females.
Preparation of blood components with saline‐adenine‐glucose‐phosphate‐ maltose quadruple‐pack system
Authors: Uda M. , Ohkuma S. , Ishii A. , Nishizaki T.
Published: March 2003

A saline‐adenine‐glucose‐phosphate‐maltose (SAGP‐maltose) quadruple‐ pack system was devised to improve the conventional method of preparing blood components. One of the features of this method is that high‐speed centrifugation was used as the initial spin in the two‐step centrifugation of whole blood. This feature permitted the removal of the buffy coat from red cells at the same time the platelets were isolated. Since the platelets were concentrated without forming a button, the damage to the platelets due to mechanical stress in preparation was minimized. Another major feature was the use of the SAGP‐maltose solution. Maltose effectively prevented hemolysis during storage in a protein‐poor medium for preserving red cells. Judging from the red cell adenosine triphosphate level and morphology score, it should be possible to store red cells for 35 to 42 days in SAGP‐maltose preservative. In addition, approximately 25 percent more plasma was collected in the present system than in conventional multiple‐pack systems.
Perioperative blood transfusion in patients with colon carcinoma
Authors: Ota D. , Alvarez L. , Lichtiger B. , Giacco G. , Guinee V.
Published: March 2003

The effect of perioperative blood transfusion on 5‐ and 10‐year survival following curative resection for intra‐abdominal colon carcinoma was investigated retrospectively. Two hundred and seven patients with Dukes' stages A, B, and C carcinoma were divided into two groups: those who received perioperative blood transfusion and those who did not. The data indicated that survival was not altered by blood transfusion during primary surgical tumor resection. Location of tumor in intra‐abdominal colon, size of tumor, units of blood received, and stage of disease also were considered in our analysis but did not change this conclusion.
Exposure of newborn infants to plasticizers: Plasma levels of di‐(2‐ ethylhexyl) phthalate and mono‐(2‐ethylhexyl) phthalate during exchange transfusion
Authors: Sjoberg P. O. , Bondesson U. G. , Sedin E. G. , Gustafsson J. P.
Published: March 2003

The exposure of newborn infants to the plasticizer di‐(2‐ethylhexyl) phthalate (DEHP) and its primary metabolite mono‐(2‐ethylhexyl) phthalate (MEHP) was studied during exchange transfusions by measuring their contents in the infused blood. Plasma concentrations of DEHP and MEHP in the blood withdrawn from the infants during the transfusions also were determined. The amounts of DEHP and MEHP inadvertently infused varied from 1.7 to 4.2 and 0.2 to 0.7 mg per kg body weight, respectively. Immediately after the transfusions, the plasma levels of DEHP in the individual infants varied between 3.4 and 11.1 micrograms per ml. MEHP in the corresponding samples ranged from 2.4 to 15.1 micrograms per ml. Judging from plasma concentrations of DEHP and MEHP during and after transfusion, there was no gradual accumulation of these substances in the plasma during the course of the transfusion. In the two infants who underwent a second exchange transfusion, significant levels of phthalates were found at 16 and 23 hours, respectively, after the first transfusion. Plasma concentrations of DEHP in these infants declined at a faster rate than those of MEHP, thus pointing to the importance of examining the pharmacokinetics of this potentially toxic metabolite.
Evaluation of two viral inactivation methods for the preparation of safer factor VIII and factor IX concentrates
Authors: Heldebrant C. M. , Gomperts E. D. , Kasper C. K. , McDougal J. S. , Friedman A. E. , Hwang D. S. , Muchmore E. , Jordan S. , Miller R. , Sergis‐Davenport E. , Law W.
Published: March 2003

We report here the results of our evaluation of two procedures to eliminate viruses in factor VIII and factor IX coagulation factor concentrates. Both procedures were equally effective in the in vitro destruction of marker viruses. However, in a controlled infectivity test in chimpanzees, treatment at 60 degrees C for 20 hours inactivated greater than 500 and less than 10,000 chimpanzee infectious doses (CID) of hepatitis B virus, while treatment at 98 degrees C for 30 minutes inactivated less than 500 CID. Both methods were successful in preventing infection with an undetermined amount of an indeterminate non‐A, non‐B hepatitis agent. The 60 degrees C, 20‐hour treatment method rendered 5.25 logs of the putative acquired immune deficiency syndrome virus, human T‐cell lymphotrophic virus III/lymphadenopathy virus, added to factor VIII or factor IX concentrates, undetectable. Heat‐treated factor VIII and factor IX complex concentrates prepared by these methods were tested against corresponding untreated control lots. There was no significant difference in the plasma recovery or plasma half‐life of the factor (p greater than 0.05). The treated concentrates were equivalent to the control concentrates with respect to vital signs, clinical laboratory studies, and adverse reactions. The heat‐ treated concentrates appeared bioequivalent to the untreated concentrates with the additional benefit of inactivation of potentially present infectious viruses.
Ingestion of hydroxyethyl starch by human leukocytes
Authors: Strauss R. G. , Snyder E. L. , Stuber J. , Fick B.
Published: March 2003

Following infusion into animals, hydroxyethyl starch (HES) can be found in nearly all tissues, including phagocytic leukocytes (WBCs) of the reticuloendothelial system (RES). Conceivably, the ingestion of HES molecules by these cells might lead to RES blockade. We studied the ability of WBCs obtained from human blood (neutrophils, mononuclear leukocytes, and mixtures of these cells) and from the RES (alveolar macrophages) to interact with radioactive HES in vitro in the presence of normal serum. In general, 14C‐HES failed to associate with blood WBCs (i.e., the cells did not acquire significant amounts of radioactivity). Generally, less than 0.1 percent of radioactivity available in the reaction mixtures became cell associated. Moreover, when used as a phagocytic stimulus, HES elicited practically no superoxide anion production from blood WBCs. Alveolar macrophages acquired significant amounts of 14C‐HES (presumably by ingestion). However, only tiny quantities (0.09%) of the total amount of radioactivity available in the reaction mixture became cell associated. Despite this slight interaction with alveolar macrophages, it seems unlikely that the internalization of HES by WBCs will lead to phagocytic dysfunction (such as RES blockade) in humans since human WBCs seem quite limited in their ability to interact with this drug.
Harvesting of committed hematopoietic progenitor cells (CFU‐GM) by hemapheresis
Authors: Heal J. M. , West B. L. , Brightman A.
Published: March 2003

In order to investigate collection of committed hematopoietic progenitor cells (CFU‐GM) by hemapheresis, four protocols using a discontinuous cell separator (Haemonetics) were evaluated. The combined platelet and granulocytapheresis procedure using hydroxyethyl starch (HES) but no steroids was significantly more efficient (75%) than a standard plateletapheresis (40%, p < 0.001) or a plateletapheresis modified by either using HES during the collection (49%, p < 0.05) or pretreating the donors with steroids in an attempt to raise circulating stem cell levels prior to harvesting (46%, p < 0.001). Donor basal CFU‐GM levels were very variable but could be predicted by the circulating lymphocyte levels. In all four protocols, there was a direct correlation between the number of stem cells circulating at the start of the procedure and the final harvest. With this equipment, an appropriate transplant dose of CFU‐GM could be provided for a child under 30 kg with less than seven procedures.
Results of nationwide screening of blood and plasma for antibodies to human T‐cell lymphotrophic III virus, type III
Authors: KURITSKY J.N. , RASTOGI S.C. , FAICH G.A. , SCHORR J.B. , MENITOVE J.E. , REILLY R.W. , BOVE J.R.
Published: March 2003

Abstract: From April 22 to July 28, and from October 7 to November 3, 1985 the American Red Cross, the Council of Community Blood Centers, the American Association of Blood Banks, and the American Blood Resources Association provided the Food and Drug Administration with data at 2‐week intervals on human T‐lymphotropic virus type III (HTLY‐III) test kit results at blood and plasma collection centers. Reports were received from over 150 blood collection centers that screened 2,502,829 units of blood for antibody to HTLY‐III by enzyme‐linked immunosorbent assay (ELISA) during nine 2‐week surveillance intervals. Of these, 25,324 or 1.01 percent were initially reactive and 8443 or 0.34 percent were repeatedly reactive. The repeatedly reactive rate for women was 0.33 percent and for men 0.30 percent. Data for source plasma was collected at 275 locations and tested at eight central laboratories showed that for 2,603,652 units screened (which may represent multiple collections from the same donor) 3978 or 0.15 percent were repeatedly reactive. Screening results from both blood and plasma collection centers varied over time and among kits.
Cost analysis of routine laboratory testing in blood centers
Authors: Kline L. M. , Friedman L. I. , Severns M. L.
Published: March 2003

The direct costs of ABO, Rh, Du, syphilis, and antibody screening tests were investigated. Questionnaires from 58 blood centers were analyzed to compare cost‐effectiveness among methods of testing and annual collection volume as well as differences in cost of the various methods of testing within the same‐size center. We found that “expensive” automated equipment cannot be justified on the basis of direct costs in centers processing less than 100,000 units of blood per year and that there is a wide variation in costs among centers using the same equipment.
Plasma collection using an automated membrane device
Authors: Rock G. , Tittley P. , McCombie N.
Published: March 2003

A plasmapheresis device with both membrane filtration and centrifugation features was tested. The device permits the collection of 500 ml of plasma within 30 minutes; when run at a 1:12.5 ratio with acid‐citrate‐dextrose (ACD‐A) the resultant plasma factor VIII levels were 1.05 units per ml and the albumin was 41 g per I. Free hemoglobin was not detected, and there was no evidence of fibrinopeptide A, prekallikrein, or activation of complement. The plasma had a zero hematocrit value and contained few platelets and white cells. Before and after the procedure, donors and aliquots from the return line did not show any significant effect on cell count or function. This device functioned well to collect plasma for infusion or fractionation and was accepted well by donors. A major advantage is the relatively low cost for the software package ($15.00, US, 1985), which should make plasmapheresis with this device economically feasible.
Immune anti‐A1 in A2 recipients of kidneys from group O donors
Authors: Bracey A. W. , Van Buren C.
Published: March 2003

Antibodies specific for recipient red cell antigens have been demonstrated in patients who receive organs from ABO unmatched donors. In some cases, severe but self‐limited hemolysis has been associated with the development of posttransplantation antibodies. We report a case in which an A2 recipient of a kidney from a group O donor formed anti‐A1 antibody which reacted with homologous red cells. The patient developed a delayed hemolytic transfusion reaction. A radiochromium survival study revealed decreased survival of A1 red cells. A broader specificity of the antibody was not shown during follow‐up. The anti‐A1 was not detected in a sample tested 6 months after the initial study. It is probable that the anti‐A1 noted in this case was formed by passenger lymphocytes. A2 patients who develop anti‐A1 after renal transplantation should be transfused with red cells negative for A1.
Detection of acquired Immunodeficiency syndrome (AIDS) retrovirus antibody by lymphadenopathy‐associated virus (LAV) enzyme Immunoassay In low‐ and high‐risk populations
Authors: RAGNI MARGARET V. , LEWIS JESSICA H. , BRACKEN MELINDA , TOTH ROBERTA , STOKES JOHN , STEFFENSEN DAVID O.
Published: March 2003

Abstract: Antibody to the acquired immunodeficiency syndrome (AIDS) retrovirus was evaluated by an lymphadenopathy‐associated (LAV) enzyme immunosorbent assay (EIA) and compared with the standard human T‐cell lymphotropic virus, Type III (HTLV‐III) screening test in two groups of people. The first group consisted of those at low risk for AIDS, including 1352 random volunteer donors, 1140 of whom were prospective donors and 212 of whom were retrospective donors, repeatedly reactive by HTLV‐III EIA. The second group was composed of those at high risk for AIDS, including 54 hemophiliacs, one of whom had AIDS, seven AIDS‐related complex (ARC), and one immune thrombocytopenia (ITP). Of the 1140 prospective donors, one was repeatedly reactive by LAV EIA and four by HTLV‐III EIA; none was positive by Western blot. Of the 212 retrospective donors, six were repeatedly reactive by LAV EIA and 212 by HTLV‐III EIA; only six (the six LAV EIA positive) were positive by Western blot. Of the 54 hemophiliacs, 46 were repeatedly reactive by both LAV EIA and HTLV‐III EIA, and all 46 were positive by Western blot. Both LAV EIA and HTLV‐III EIA were positive in all hemophiliacs with AIDS, ARC, and ITP. The marked reduction in HTLV‐III EIA repeatedly reactive, Western blot nonreactive samples by the LAV EIA system suggests that this assay may be as sensitive but more specific than the standard HTLV‐III EIA in low‐risk populations. The strong correlation between the LAV EIA and the Western blot assay further suggests that this assay may provide an efficient screening test for AIDS antibody in the donor population.
Use of PGE1 for preparation of platelet concentrates
Authors: Menitove J. E. , Frenzke M. , Aster R. H.
Published: March 2003

Platelets stored as platelet concentrates (PCs) undergo biochemical, functional, and morphological changes that may inhibit their hemostatic effectiveness. Prostaglandin E1 (PGE1 (5.9 × 10−8 M) added to platelet‐rich plasma (PRP) immediately before PC preparation reduced platelet activation during PC preparation and storage as determined by inhibition of β‐thromboglobulin release and thromboxane B2 production. However, PCs prepared with PGE1 contained less glycogen after storage than PCs prepared by standard methods. All PC platelets lost their ability to aggregate in response to adenosine diphosphate (ADP) during storage, but sensitivity to dual stimulation with epinephrine and ADP was retained. These findings suggest that addition of PGE1 to PRP may permit production of platelets that are hemostatically superior to conventional PCs. In vivo studies to evaluate this possibility are indicated.
Anti‐Lsa. Case study of an antibody to a low‐incidence antigen
Authors: Clark A. L. , Dorman S. A.
Published: March 2003

An antibody to the low‐incidence antigen Lsa (Lewis II) was discovered during routine pre‐operative antibody screening of an 87‐year‐old white man. This example of anti‐Lsa reacted only in the indirect antiglobulin test. The antibody did not react with Ls(a+) red cells treated with either ficin or papain. Treatment of the serum with 2‐mercaptoethanol did not reduce the reactivity of the antibody. No antibody activity had been detected during previous hospital admissions.
Concentrations of factor VIII‐related antigen and factor XIII during open heart surgery
Authors: Brody J. I. , Pickering N. J. , Fink G. B.
Published: March 2003

Plasma levels of factor VIII‐related antigen (fVIIIRA) and factor XIII S and A subunits (fXIIIS, fXIIIA) were assayed by counterimmunoelectrophoresis before, during, and after cardiopulmonary bypass (CPB) in patients with coronary artery and valvular heart disease to define the basis for clinical and laboratory abnormalities of hemostasis occurring in this form of surgery. During CPB, concentrations of fXIIIA dropped in both patient groups but returned to preoperative levels promptly after pump removal. In contrast, fVIIIRA and fXIIIS, which are not incorporated into the clot, remained unchanged even during fluid administration. These data provide evidence of a transient consumption coagulopathy as a feature of CPB. Hemodilution probably plays a secondary role in these changes.
The status of automation and data processing in the United States blood banking community
Authors: Friedman L. I. , Severns M. L. , Goodkofsky I. , Holland N.
Published: March 2003

A survey of the extent of automation and data processing in the blood banking community was conducted by questionnaire. The likelihood that a facility had some type of automation was related to the volume of blood products produced or transfused. Facilitates that collected blood or collected and transfused blood were more likely to have automation for ABO and Rh testing than those that only transfused blood. Automation for many other blood bank tests is unavailable. Many facilities had data processing capability, which is used primarily for accounting.
Granulocyte transfusion kinetics measured by chemiluminescence, nitroblue tetrazolium reduction, and recovery of indium‐111‐labeled granulocytes
Authors: Elliott G.R. , Clay M.E. , Mills E.L. , Abramson J.S. , McCullough J. , Quie P.G.
Published: March 2003

A 20‐year‐old man with chronic granulomatous disease (CGD) and who was receiving granulocyte transfusions for a refractory liver abscess was studied to compare the kinetics of 111In‐labeled granulocytes with those of two functional granulocyte assays, nitroblue tetrazolium reduction and chemiluminescence. Transfused granulocytes were eliminated in both rapid and slow phases. Peak recovery was noted in the first sample, which was obtained 10 minutes after transfusion for each assay. The elimination kinetics were similar over 24 hours. These results confirm the value of using 111In‐labeled granulocytes as a marker of transfused granulocytes. These data also confirm that the oxidative metabolic function of granulocytes prepared by continuous‐ flow leukapheresis remains intact while in the recipient's circulation. The response of the patient adds support for the use of granulocyte transfusions in certain patients with CGD.
Comparison of a manual hexadimethrine bromide‐antiglobulin test with saline‐ and albumin‐antiglobulin tests for pretransfusion testing
Authors: Anderson G. , Mintz P. D.
Published: March 2003

A prospective double‐blind study compared a manual hexadimethrine bromide (Polybrene) antiglobulin antibody detection test (P‐AHG) and crossmatch with the albumin‐antiglobulin antibody detection test and saline‐antiglobulin crossmatch routinely used in our laboratory. A total of 10,084 pretransfusion blood samples from approximately 6000 patients were tested. The P‐AHG method detected 153 of 157 alloantibodies for which antigen‐negative, crossmatch‐compatible blood is routinely provided. All four antibodies not detected were anti‐K. The routine techniques detected 147 of the 157 alloantibodies. The P‐ AHG method detected only 36 percent of the alloantibodies for which crossmatch‐compatible blood is routinely provided without determination of the antigen status of the donor unit's red cells (e.g., anti‐Lea), whereas the routine method detected 91 percent of such antibodies. Eighty‐six percent of the 189 alloantibodies detected by the Polybrene technique were found before the addition of antiglobulin. The manual Polybrene test is a rapid and sensitive technique; it may be used without an antiglobulin phase as a routine crossmatch procedure when accompanied by a sensitive antibody detection test that includes antiglobulin and an additional test to ensure ABO compatibility.