bluuebunny/crossref_metadata_2025 huggingface dataset:
The Incremental Effect of Dementia‐Related Problem Behaviors on the Time to Nursing Home Placement in Poor, Frail, Demented Older People
Authors: Phillips Victoria L. , Diwan Sadhna
Published: March 2003

OBJECTIVES: To examine the incremental effect of dementia‐related problem behaviors (DRPBs) on the risk of and time to nursing home placement (NHP) in poor, frail, demented older people.

DESIGN: Client assessments were reviewed retrospectively for clinical, functional, and cognitive information, particularly the presence of DRPBs and the time during enrollment at which they occurred.

SETTING: The Georgia Community Care Services Program (CCSP), a Medicaid 1915‐C home and community‐based services program (HCBS).

PARTICIPANTS: A random sample of demented clients (n = 204) discharged during fiscal year 1996 from four CCSP regions.

MEASUREMENTS: The risk of and time to nursing home placement. Cox proportional hazards models and an extended Cox model with a time‐varying covariate for the presence of DRPBs were used to evaluate the risk factors associated with NHP in demented older people. Kaplan‐Meier survival curves were used to estimate the time to NHP for several risk groups.

RESULTS: In demented older people in a HCBS program, having a DRPB was found to increase the hazard rate of NHP. Having a problem behavior shortened average median survival in the community by approximately 2 years.

CONCLUSIONS: DRPBs in demented older people shorten the time to NHP. Exploration of effective interventions is warranted.
Epidemiology of Anemia in the Elderly: Information on Diagnostic Evaluation
Authors: Balducci Lodovico
Published: March 2003

A rise in the aging population has been predicted, and, as a result, it is expected that the incidence of age‐related health conditions will also increase. Although common in the elderly, anemia is often mild and asymptomatic and rarely requires hospitalization. However, untreated anemia can be detrimental, because it is associated with increased mortality, poor health, fatigue, and functional dependence and can lead to cardiovascular and neurological complications. Several factors have been suggested to cause anemia in this population, for example, blood loss or chronic disease. In some cases, the cause is unknown. It has been suggested that this is a result of the presence of comorbid conditions that can mask the symptoms of anemia. Therefore, appropriate diagnosis and management strategies of anemia in the elderly need to be identified, particularly because anemia may indicate the presence of other serious diseases.
Predictive Value of Intrathecal Narcotic Trials for Long‐Term Therapy with Implantable Drug Administration Systems in Chronic Non‐Cancer Pain Patients
Authors: Dominguez Eric , Sahinler Bolkar , Bassam Deeni , Day Miles , Lou Leland , Racz Gabor , Raj Prithvi
Published: March 2003

Abstract: This study retrospectively investigated the predictive value of intrathecal narcotic trials for long‐term drug utilization via implantable pumps in chronic non‐cancer patients. Data were derived from 86 patients who were categorized according to the intrathecal narcotic dose that resulted in the optimal trial response. The response during the trial period and the pattern of long‐term utilization of morphine was studied, as was the impact of age, gender and diagnosis. The analysis revealed that low dose responders had lower daily dose requirements at 18 months than standard dose and high dose responders. It also showed that women had lower total daily dose requirements at 18 and 24 months and that individuals over 65 years of age had lower total daily dose requirements at 18 months. A trend toward a disproportionately higher use of adjuvant drugs and narcotic substitutions was found among high dose responders, while a trend toward a disproportionately higher total daily dose was found among cervicalgia patients. The findings indicate that the responsiveness to an intrathecal narcotic during a trial, along with the diagnosis at the time of implantation, and the patient's age and gender can shed light on the long‐term utilization of intrathecal analgesics in chronic non‐cancer patients. This information may be used to better select patients and design trials that more closely reflect long‐term drug utilization.
Acquired alteration in the expression of blood groups in a patient with sideroblastic anemia and chronic renal failure
Authors: LEVINE M. N. , KUHNS W. K. , BOLK T. A. , BEYER T. A. , ROSE W. F.
Published: March 2003

A patient with well‐differentiated lymphocytic lymphoma in remission presented with renal failure, sideroblastic anemia, and an acquired diminution in the expression of A antigen on his red cells. Other red cell antigens (H, M, i, and I) also were expressed weakly. Lewis antigen was expressed only in secretions. The diminished expression of the A antigen could not be accounted for by diminution in the specific glycosyl transferases responsible for its expression, since the activity in the serum of both the H enzyme (alpha 1 leads to 2 fucosyltransferase) and the A enzyme (alpha 1 leads to 3 N‐ acetylgalactosaminyltransferase) was not diminished. When sialic acid was removed by enzymatic treatment, the expression of the A and i antigens was augmented markedly, suggesting that the sialic acid may have altered the expression or detection of the antigens. This abnormality was probably related to dysplasia of the bone marrow which was otherwise manifest by ringed sideroblasts, unsegmented megakaryocytes, and diminished growth in vitro.
Isolation and serological characterization of a monoclonal antibody recognizing the N blood group antigen
Authors: Allen R.W. , Nunley N. , Kimmeth M.E. , Wallhermfechtel M. , Vengelen‐Tyler V.
Published: March 2003

A mouse hybridoma has been isolated which secretes a hemagglutinating monoclonal antibody (MoAb) recognizing the N and ‘N’ blood group antigens. This conclusion is based upon the following observations. First, all red cells expressing either N or one of the alleles of Ss (ie, ‘N’ were strongly agglutinated by the MoAb diluted fourfold. The only cells not reactive were of the M+N‐S‐s‐(U‐) and M+N‐S‐s‐(U+) phenotype and cells (J.R. and A.G.) expressing Lepore‐type hybrids of the MN and Ss sialoglycoproteins, which do not express N or ‘N’. Secondly, red cells of the N+S‐s‐(U‐) phenotype were rendered unreactive to MoAb following treatment of the cells with trypsin, which is known to destroy N antigen activity. Conversely, cells expressing S and/or s maintained their reactivity with MoAb following trypsin treatment, which does not cleave ‘N’ from the Ss sialoglycoprotein. When spent culture medium containing MoAb was diluted and tested against a panel of red cells, the antibody titer fell into two distinct categories depending upon the MNSs phenotype of the target. Red cells expressing either homozygous or heterozygous N‐sialoglycoprotein (N‐ SGP) were agglutinated by 128‐fold diluted MoAb. In contrast, a 16‐fold dilution of MoAb was the endpoint for agglutination of cells lacking N‐ SGP, but expressing S and/or s.
Resolution of red cell compatibility testing problems in patients receiving anti‐lymphoblast or anti‐thymocyte globulin
Authors: Swanson J.L. , Issitt C.H. , Mann E.W. , Condie R.M. , Simmons R.L. , McCullough J.
Published: March 2003

Passively acquired hemagglutinating antibodies may be detected in the serum of patients receiving horse anti‐lymphoblast globulin (ALG) or anti‐thymocyte globulin (ATG). Thirty‐seven patients receiving ALG following renal transplantation were studied. Eight patients monitored daily all developed positive direct antiglobulin tests (DAT) and positive red cell antibody screening tests. Fifteen of 32 recipients developed red cell antibodies reactive at room temperature in saline, 4 of 32 in albumin at 37 degrees C, and 33 of 37 in the antiglobulin test. Horse globulin was detected on the red cells of all six recipients tested with rabbit anti‐horse globulin. Ether eluates prepared from the red cells of 20 patients showed no specificity for common red cell antigens. Anti‐human globulin (AHG), absorbed with ALG‐ coated red cells to remove the component in the AHG which was crossreacting with horse globulin, was used successfully for antibody screening and identification, direct antiglobulin testing, and/or the antiglobulin crossmatching of 27 ALG and ATG recipients, including five with red cell alloantibodies.
Thimerosal‐dependent agglutination complicating the serologic evaluation for unexpected antibodies
Authors: Shulman IA , Simpson RB , Farmer CF , Lam HT
Published: March 2003

Thimerosal (merthiolate) is a preservative present in several low‐ionic‐ strength blood bank reagents. Thimerosal‐dependent panagglutinins were found in the serum of a hospitalized patient during serologic testing for unexpected red cell antibodies. The agglutinins behaved like a mixture of IgG and IgM and reacted with all red cells tested. Once the true nature of the serum panagglutinins was determined, blood bank reagents free of thimerosol were used, and no further serologic problems were encountered. Agglutination of this type should be considered whenever sera appear to contain panagglutinins and thimerosal is present in the test system.
CFU‐GM and T cell subsets in young red cell collections
Authors: Marcus R.E. , Knott L.J.
Published: March 2003

Young red cells (YRBCs) prepared using cell separators contain large numbers of white cells. The absolute numbers and percentages of different lymphocyte subsets and progenitor cells in YRBC collections were assessed before and after filtration through two white cell filters. It was found that the filters do not take up or selectively allow through any one lymphocyte subset and that the absolute number of T cells and progenitor cells in YRBC collections after filtration is less than that in normal donor blood.
The use of hepatitis B marker prevalences in regional blood center employees as a guide to vaccination policy
Authors: Borek DA , Tegtmeier GE , Blosser JK , Jenkins DC , Parks LH , Plapp FV , Bayer WL
Published: March 2003

ABSTRACT: Hepatitis B vaccination has been recommended for health care personnel having frequent contact with blood. Serologic markers of hepatitis B infection were studied in employees of this regional blood center to determine the prevalence of infection in our population.
Hepatitis B surveillance in employees of a community blood center
Authors: Hanson M. R. , Polesky H. F.
Published: March 2003

Over a period of 10 years, 185 employees of a community blood center were screened for evidence of hepatitis B virus (HBV) infection. Included were laboratory personnel (64%), phlebotomists (27%), and administrative employees (9%). HBV markers were detected in 5.8 percent of the individuals at the time of enrollment in the study. During the study period, seven clinical cases of HBV occurred, all in laboratory personnel. Four of the infections were in personnel involved primarily in donor processing. The other three were in individuals working in research areas. In addition, four asymptomatic HBV infections were identified on the basis of seroconversion from anti‐HBs negative to positive. The annual incidence of HBV infection per 100 tested employees at risk (1.6%) indicates that blood bank personnel, despite their frequent exposure to blood, are not at high risk of developing HBV infection.
Long‐term in vivo survival of Rh(D)‐negative donor red cells in a patient with anti‐LW
Authors: Chaplin H. , Hunter V. L. , Rosche M. E. , Shirey R. S.
Published: March 2003

The present study documents immediate and long‐term survival of crossmatch‐incompatible Rh(D)‐negative donor red cells in a patient with anti‐LW. A 67‐year‐old group A Rh(D)‐positive man was admitted for urgent coronary artery bypass surgery. The direct antiglobulin test (DAT) was weakly positive in two of five laboratories. His serum contained anti‐LW (two laboratories); his red cells were LW negative (three antisera). Two siblings were LW‐positive. Surgery was delayed, and 3 ml Rh(D)‐negative crossmatch‐incompatible red cells stored in citrate‐phosphate‐dextrose‐adenine‐one were labeled with 25 μCi of 51Cr and injected. Immediate survival was approximately 100 percent with 92 percent survival at 20 hours. Six daily blood samples showed a decreased red cell lifespan, (T ½ = 14 days). Because of medical complications, 4 units of Rh(D)‐negative crossmatch‐incompatible blood were then transfused without clinical or hemolytic reaction. The anti‐ IgG DAT became stronger. In vivo survival of the remaining 51Cr‐RBCs became normal (T ½ 28 days over the succeeding 20 days). Following transfusion, no change in serum antibody strength was demonstrated by double‐blind titration of seven coded samples. The observations support modest reduction of lifespan for 3 ml of LW‐positive red cells, but normal survival following subsequent transfusion of approximately 700 ml of LW‐positive red cells.
Transfusion problems in renal allograft recipients
Authors: Anderson H. J. , Aubuchon J. P. , Draper E. K. , Balls S. K.
Published: March 2003

Heterologous anti‐lymphocyte globulin (ALG) is known to contain panagglutination activity and may cause a positive direct antiglobulin test in a renal allograft recipient. Three patients are reported in whom the passively acquired antibody showed apparent specificity in the Lutheran blood group system. The sera of these patients and eluates from their red cells displayed reactivity consistent with a Lutheran‐ related antibody. While the neat ALG acted as a panagglutinin, the Lutheran system specificity appeared only following dilution of the ALG. This specificity did not appear to represent a separate, distinguishable antibody in the ALG product. Before considering the utilization of units of the rare Lu(a‐b‐) phenotype for transfusing a renal allograft patient who has a Lutheran‐related antibody, investigation of ALG as a source of that antibody should be conducted.
Lymphocytaplasmapheresis in Devic's syndrome
Authors: Aguilera A. J. , Carlow T. J. , Smith K. J. , Simon T. L.
Published: March 2003

A pregnant 26‐year‐old woman with Devic's syndrome manifesting as paraplegia and visual loss was treated with multiple courses of lymphocytaplasmapheresis. Clinical improvement was temporally related to the lymphocytaplasmapheresis. She relapsed when treatment was stopped and improved with reinstitution of therapy. Thereafter, further treatments were not required and she delivered a normal infant.
Changes in human cultured cells exposed to a perfluorocarbon emulsion
Authors: Wake E. J. , Studzinski G. P. , Bhandal A.
Published: March 2003

A perfluorocarbon emulsion (Fluosol‐DA, 20%) produced persistent cytotoxic changes and growth inhibition in fibroblast‐like human cells. After 18 hours of exposure to culture medium containing 4 percent of this perfluorochemical emulsion, normal embryonic lung fibroblasts (IMR 90 cells) and their SV40 virus‐transformed counterparts (AG 2804 cells) ceased proliferation and showed degenerative changes, even if Fluosol was washed off the cell monolayer and replaced with normal medium. The morphological manifestations of Fluosol cytotoxicity included cytoplasmic vacuolation of varying but frequently marked degree. These findings raised concerns about the use of perfluorochemicals in patients until safe dose limits can be established.
A delayed hemolytic transfusion reaction due to anti‐Cob
Authors: Squires Jerry E. , Larison P. Joyce , Charles William T. , Milner Paul F.
Published: March 2003

A delayed hemolytic transfusion reaction precipitated by anti‐Cob is described in a multiple transfused primigravida woman with sickle‐cell disease. Sixteen days after the prophylactic transfusion of the first of 4 units of red cells, she experienced a fall in hemoglobin concentration accompanied by a newly positive antibody screen and direct antiglobulin test. Anti‐Cob was identified both in the patient's serum and in an eluate prepared from her red cells.
Neutrophil collection using modified fluid gelatin
Authors: Price T. H. , Glasser L.
Published: March 2003

Modified fluid gelatin (MFG) is a possible alternative to hydroxyethyl starch (HES) for use as a red cell sedimenting agent in neutrophil collection procedures. Since the efficacy of neutrophil transfusion therapy depends upon the integrity of the infused cells, we examined the in vitro and in vivo function of neutrophils collecting using MFG. Neutrophils were collected from 17 normal subjects by continuous flow centrifugation using MFG in place of HES. In vitro measurement of neutrophil function included dye exclusion, phagocytosis, candidacidal activity, staphylococcal killing, chemotaxis, and random migration. For in vivo studies, neutrophils were labeled with 3H‐ diisopropylfluorophosphate, reinfused into the donor, and blood kinetics and skin chamber accumulation of the labeled cells were measured. In vivo results were compared with results from previous studies using neutrophils collected with HES or by phlebotomy. MFG neutrophils were normal by all in vitro functional criteria and localized normally at an in vivo inflammatory site. Intravascular survival (T ½ = 3.3 ± 0.9 hours) was significantly shorter than normal (T ½ = 7.3 ± 2.3 hours) but was identical to that of cells collected using HES. Thus, on the basis of neutrophil functional capabilities, MFG appears to be an acceptable alternative to HES in collection of neutrophils for transfusion.
Tolmetin‐induced hemolysis
Authors: Squires J. E. , Mintz P. D. , Clark S.
Published: March 2003

A case of drug‐associated immune hemolysis in a patient taking tolmetin for arthritic pain is described. Serologic tests showed that in the absence of tolmetin, the patient had a negative antibody screening test but a strongly positive direct antiglobulin test. An eluate prepared from the patient's red cells caused agglutination of all cells tested. However, addition of tolmetin revealed a high‐titered tolmetin‐ dependent antibody in the patient's serum; the addition of tolmetin did not affect the results obtained with the eluate. within 3 months after the patient discontinued tolmetin, his hematocrit had increased to 45 percent, and his jaundice and bilirubinuria had disappeared. These results are similar to those described for zomepirac, another of the group of nonsteroidal anti‐inflammatory medications.
Inactivation of viruses in labile blood derivatives. II. Physical methods
Authors: Horowitz B. , Wiebe M. E. , Lippin A. , Vandersande J. , Stryker M. H.
Published: March 2003

The thermal inactivation of viruses in labile blood derivatives was evaluated by addition of marker viruses (VSV, Sindbis, Sendai, EMC) to anti‐hemophilic factor (AHF) concentrates. The rate of virus inactivation at 60 degrees C was decreased by at least 100‐ to 700‐fold by inclusion of 2.75 M glycine and 50 percent sucrose, or 3.0 M potassium citrate, additives which contribute to retention of protein biologic activity. Nonetheless, at least 10(4) infectious units of each virus was inactivated within 10 hours. Increasing the temperature from 60 to 70 or 80 degrees C caused a 90 percent or greater loss in AHF activity. An even greater decline in the rate of virus inactivation was observed on heating AHF in the lyophilized state, although no loss in AHF activity was observed after 72 hours of heating at 60 degrees C. Several of the proteins present in lyophilized AHF concentrates displayed an altered electrophoretic mobility as a result of exposure to 60 degrees C for 24 hours. Exposure to lyophilized AHF to irradiation from a cobalt 60 source resulted in an acceptable yield of AHF at 1.0, but not at 2.0, megarads. At 1 megarad, greater than or equal to 6.0 logs of VSV and 3.3 logs of Sindbis virus were inactivated.
Stability of platelet surface antigens during storage
Authors: Dunstan R. A. , Simpson M. B.
Published: March 2003

We measured changes in A, B, 2H, PlA1, and HLA Class I antigens on human platelets stored as routine platelet concentrates (PCs) in 50 to 60 ml of citrate‐phosphate‐dextrose‐adenine (CPDA‐1) plasma in polyolefin (PL 732) bags at 22 degrees C with continuous cartwheel rotation. Samples were obtained at 1, 3, 5, and 10 days of storage; incubated with human IgG anti‐A, ‐B, ‐HLA and ‐PlA1; incubated with mouse monoclonal 125I‐labeled anti‐human IgG; centrifuged through phthalate ester oils; and assayed in a gamma scintillation counter. Additionally, group O platelets were analyzed using 125I‐labeled IgM mouse monoclonal anti‐Type 2H. Mean values for molecules of Ig bound per platelet showed that platelet surface antigens A, B, 2H, PlA1, and HLA Class I showed no significant change during 10‐day storage as routine PCs in CPD‐A1 in PL 732 bags. Identical radioassays were performed with platelets incubated at 22 degrees C in plastic test tubes for 24 hours in homologous plasma from donors negative for the respective antigens and in a variety of artificial media with albumin and lipids. No significant changes occurred in any of the surface antigens, except for the loss of approximately 50 percent of the blood group A antigen from platelets stored in O plasma or in albumin media. These data indicate that HLA, PlA1, and type 2H structures do not readily dissociate from the platelet membrane during storage, while some blood group A antigens, presumably acquired passively from the plasma, will elute from the platelet under certain conditions. Routine storage conditions are unlikely to alter the immunogenicity of platelets due to a loss of antigen expression.
The effect of capillary tube diameter on microhematocrit value
Authors: Solomon H. M. , Grindon A. J.
Published: March 2003

Changes in percentages of donor deferrals associated with changes in the capillary tube size used for microhematocrit determinations led us to study the variables which influence microhematocrit values. Duplicate microhematocrit determinations were performed on a normal donor population with capillary tubes of different diameter, as well as with different anticoagulants, sample sites, centrifugation times, and degrees of operator skill. Microhematocrit values varied directly with capillary tube diameter over the range of diameters tested, and varied independently of sample site, centrifugation time, anticoagulant, and operator. The magnitude of the difference in microhematocrit values between small and large capillary tubes was approximately one volume percent in the normal microhematocrit range. Although differences of this magnitude are without clinical significance, they can be of substantial importance in attempts to minimize donor deferrals in a blood center. In our center, increasing the diameter of the capillary tube used for the microhematocrit determination allowed the collection of 6500 additional units of blood annually, or an approximate 3.5 percent increase in total collections.
Studies of the Diego blood group among Mexican‐Americans
Authors: Edwards‐Moulds J. M. , Alperin J. B.
Published: March 2003

Dia occurs with a frequency of 8.2 to 14.7 percent in Mexican‐Americans living in three Texas communities. Of 4225 blood samples tested, only six (0.14%) were Di(a+b‐), and none of 2540 samples was Di(a‐b‐). In other studies, 1 of 525 random white blood donors was Di(a+), and Dib was well developed in 100 random umbilical cord blood samples.
Red cell autoantibodies in patients with acquired immune deficiency syndrome
Authors: McGinniss M. H. , Macher A. M. , Rook A. H. , Alter H. J.
Published: March 2003

Mild‐to‐profound anemia, thrombocytopenia, and rarely neutropenia have been observed in patients with the acquired immune deficiency syndrome (AIDS). To investigate a possible immune mechanism, blood samples from 28 hospitalized AIDS patients, four asymptomatic homosexual men, four homosexual men with the AIDS‐related lymphadenopathy syndrome, 30 hospitalized patients with diseases other than AIDS, and 60 blood donors were tested for the presence of atypical red cell antibodies. Eighteen AIDS patients (64%) had anti‐i, nine (32%) had autoanti‐U, and 12 (43%) had a positive direct antiglobulin test. One asymptomatic homosexual man and three homosexual men with lymphadenopathy also had anti‐i. In contrast, of the 30 patients with diseases other than AIDS and 60 donors, none had anti‐U or a positive direct antiglobulin test. One patient with sickle cell disease had anti‐i. The mean hemoglobin level of AIDS patients with anti‐i or anti‐U was significantly lower than the mean hemoglobin level of patients who did not have those antibodies.
Multiple transfusions fail to provoke antibodies against blood cell antigens in human infants
Authors: Floss A. M. , Strauss R. G. , Goeken N. , Knox L.
Published: March 2003

We conducted studies of both red cell (RBC) and leukocyte (WBC) antibody formation in infants following multiple transfusions given during the first weeks of life. Fifty‐three infants received 683 RBC transfusions from 503 different donors, plus 62 platelet, 4 granulocyte, and 53 fresh‐frozen plasma units during the first 4 months of life. Three hundred fifty serum samples were obtained before, during, and after the transfusions. None of the infants formed unexpected RBC antibodies when tested at 37°C by a two‐cell low‐ionic‐strength solution antibody screen that included an anti‐globulin phase. Twenty posttransfusion serums were negative when tested at room temperature. Lymphocytotoxic and granulocytotoxic WBC antibodies were measured in posttransfusion serums from 13 infants, and none were found. Despite exposure to many RBC and WBC antigens, no infants produced alloantibodies against blood cell antigens. Thus, immunologically mediated transfusion reactions should be quite rare in young infants, and this study supports recommendations of the American Association of Blood Banks Standards to omit repeat RBC compatibility testing during the first 4 months of life in infants whose initial RBC antibody screens reveal no unexpected antibodies.
Positive antiglobulin tests due to intravenous immunoglobulin in patients who received bone marrow transplant
Authors: Robertson V.M. , Dickson L.G. , Romond E.H. , Ash R.C.
Published: March 2003

To investigate an increased frequency of positive direct (DAT) and indirect (IAT) antiglobulin tests in bone marrow transplant (BMT) patients who received intravenous immunoglobulin (IVIG), serologic testing was performed weekly on blood samples from 94 consecutive BMT patients. Group 1 (47 patients) did not receive IVIG. Group II (47 patients) received high‐dose IVIG as prophylaxis for cytomegalovirus infections. Before transplantation no alloantibodies were found in the serums of 92 patients and anti‐E was found in the serums of two patients. DATs were negative in all patients before BMT. Four percent of Group I had a positive IAT and 13 percent had a positive DAT. In contrast, 25.5 percent of Group II patients had a positive IAT and 49 percent had a positive DAT, usually within 1 week after initiation of IVIG therapy (p < 0.001). Antibodies identified in serums and eluates of patients in Group I were anti‐A and anti‐B. Antibodies identified in serums and eluates of patients in Group II were anti‐A, ‐ B, ‐D, and ‐K. Twenty‐one lots of IVIG were tested and antibodies identified were anti‐A, ‐B, ‐D, and ‐K. The data suggest that the higher frequency of positive serologic tests in Group II was due to passively acquired antibodies from high‐dose IVIG.
Anti‐Jka autoimmune hemolytic anemia in an infant
Authors: Sander R.P. , Hardy N.M. , Van Meter S.A
Published: March 2003

Anti‐Jka was identified in the serum and on the red cells of an 8‐month‐ old infant with anemia, splenomegaly, and symptoms of an upper respiratory infection. The anemia improved after transfusion and treatment with prednisone.
Evaluation and comparison of four reticulocyte enrichment procedures
Authors: Rushing D. , Vengelen‐Tyler V.
Published: March 2003

Four reticulocyte enrichment techniques were compared: differential centrifugation, and density gradient centrifugation with phthalate esters, Percoll‐Renografin (PR), and silicone oil. The reticulocyte yields were 2.6, 7.4, 13.5, and 13.1 percent, respectively. The differential centrifugation procedure did not separate a statistically significant higher number of reticulocytes than were counted in an unseparated sample. The PR density gradient procedure was the best for our needs because it yielded the highest number of reticulocytes and was the easiest and quickest of the four procedures to perform; however, the method requires a high‐speed centrifuge.
Sensitization of repeat plasmapheresis donors to ethylene oxide gas
Authors: Dolovich J. , Sagona M. , Pearson F. , Buccholz D. , Hiner E. , Marshall C.
Published: March 2003

Repeat plasma donors were studied to determine whether there was a relationship between allergic‐type reactions during plasmapheresis and IgE‐dependent sensitization to ethylene oxide gas used for sterilization of disposable fluid administration sets. Serums from 32 donors with allergic‐type reactions and 84 donors who had no reactions but were exposed to the same materials and served as controls were tested for IgE‐antibodies to ethylene oxide. The results, expressed as an IgE ethylene oxide index, were greater than 2 in 78 percent of serums from donors with allergic reactions and 12 percent of serums from controls. This association was significant (p < 0.0001). Reactivity of the antibodies was directed against an ethylene oxide‐ human serum albumin conjugate and not against human serum albumin carrier protein. IgG antibodies with ethylene oxide specificity also were present in the serums of repeat plasmapheresis donors. Each of seven rabbits immunized with an ethylene oxide‐protein conjugate responded with a high serum level of antibody with ethylene oxide specificity. It was concluded that the residual ethylene oxide in fluid administration sets is immunogenic and may cause allergic reactions in plasma donors.
Positive direct antiglobulin test results after intravenous immune globulin administration
Authors: Moscow J. A. , Casper A. J. , Kodis C. , Fricke W.
Published: March 2003

The authors report a case of passive red cell sensitization caused by antibodies received during an infusion of intravenous immune globulin. The patient had a positive direct antiglobulin test but showed no signs of hemolysis. The intravenous immune globulin product contained antibodies against four red cell antigens. These adverse reactions should be considered in the laboratory evaluation and clinical care of patients who receive intravenous immune globulin.
Fibrinogen content of low‐volume cryoprecipitate
Authors: Hoffman M. , Koepke J.A. , Widmann F.K.
Published: March 2003

Single‐donor cryoprecipitate is the most convenient and reliable source of fibrinogen. A change by the regional Red Cross Blood Service to the production of low‐volume cryoprecipitate led the authors to reexamine the fibrinogen content of cryoprecipitate units. The average fibrinogen content of individual low‐volume (4 ml) units (n = 23) was 101 ±/− 48 mg; in the 10‐unit pools (n = 9 pools), content was 89 ±/− 13 mg. Both measurements were considerably lower than previously published. By contrast, the mean fibrinogen content of regular‐volume (15 ml) cryoprecipitate units (n = 8) was 142 ±/− 50 mg. The fibrinogen was stable for at least 4 hours after thawing, and it survived refreezing and thawing.
Estimating the risks of transfusion‐associated acquired immune deficiency syndrome and human immunodeficiency virus infection
Authors: Peterman T.A. , Lui K.J. , Lawrence D.N. , Allen J.R.
Published: March 2003

The risk of transfusion‐associated acquired immunodeficiency syndrome (AIDS) has been difficult to estimate because of the long and variable incubation period. Mathematical modeling suggests there may eventually be 2100 cases among persons aged 13 to 65 who received transfusions between 1978 and 1984. An estimated 12,000 living transfusion recipients of all ages from these years are infected with the human immunodeficiency virus, the virus that causes AIDS. Secondary transmission might be prevented by testing and counseling recipients, but the likelihood of infection in any single recipient is small.
Characterization of antibody and selection of alternative drug therapy in hydrochlorothiazide‐induced immune hemolytic anemia
Authors: Shirey R.S. , Bartholomew J. , Bell W. , Pollack B. , Kickler T.S. , Ness P.M.
Published: March 2003

The authors report the clinical and laboratory findings of a patient who had severe immune hemolytic anemia due to hydrochlorothiazide (HCTZ). In this case, the HCTZ antibody reacted not only with other thiazide and thiazide‐like drugs, but also with a chemically unrelated diuretic, ethacrynic acid. These results indicate that HCTZ antibody activity is not restricted solely to the thiazides and imply that therapy with any of the reactive drugs would be contraindicated for this patient. The serologic screening for drug reactivity may be useful for selecting alternative therapy for patients with drug‐induced immune hemolytic anemia.
Pentastarch may cause fewer effects on coagulation than hetastarch
Authors: Strauss R. G. , Stansfield C. , Henriksen R. A. , Villhauer P. J.
Published: March 2003

Hetastarch, the currently marketed preparation of hydroxyethyl starch, affects coagulation by prolonging partial thromboplastin, prothrombin, and bleeding times; by lowering clotting proteins such as fibrinogen via hemodilution; by lowering clotting factor VIII (coagulant, von Willebrand antigen, and von Willebrand activity) to a greater degree than can be explained simply by hemodilution (i.e., presumably factor VIII affected by both hemodilutional plus additional, independent effects); and, finally, by shortening thrombin, reptilase, and urokinase‐activated clot lysis times. Pentastarch, a new analog of hetastarch, was found to exert lesser effects on blood coagulation, despite its greater hemodiluting properties. When compared with hetastarch, pentastarch had little effect on factor VIII (except that due to hemodilution), shortened thrombin times to a significantly lesser degree, exerted no effect on the urokinase‐activated clot lysis time, and did not prolong the bleeding time. Even when plasma hydroxyethyl starch levels were similar, pentastarch seemed to alter the results of coagulation assays to lesser degree than did hetastarch, which suggests the possibility of greater safety. Therefore, pentastarch may be a desirable drug, not only for leukapheresis, but also for plasma volume expansion in trauma and surgical patients who often have additional hemostatic abnormalities that place them at increased risk of hemorrhage.
Paternity probabilities of biologic fathers and unexcluded, falsely accused men using blood group markers
Authors: Wenk R. , Houtz T. , Brooks M.
Published: March 2003

A frequent legal argument raised in defense of men accused of paternity, but not excluded by genetic tests, is that the probabilities of paternity of falsely accused men are similar to those of biologic fathers. This assertion was tested in a computer simulation experiment that used a database of 15,000 actual paternity cases to provide red cell and HLA phenotypes of mothers, children, and putative fathers. Tests had a combined probability of exclusion of 97.3 percent. Equal numbers of true and false fathers were generated from the data by computer to achieve a prior probability of paternity of 0.5. True fathers' phenotypes were those of unexcluded men from actual cases (Group A) or of mothers from actual cases (Group B) in which paternity was not excluded. The false father group was created by assigning the phenotypes of racially identical men who were selected at random from among cases other than their own. Probabilities of paternity were calculated for the men in each group and were classified into descriptive intervals. The frequency of men in each group was compared in each interval. The frequency distributions of probabilities of paternity for true fathers and unexcluded, falsely accused men (false fathers) were markedly dissimilar.
Discrepancies in reverse ABO typing due to prozone
Authors: Judd W.J. , Steiner E.A. , O'Donnell D.B. , Oberman H.A.
Published: March 2003

Three group O sera manifesting prozone in reverse ABO tests are reported. All were implicated in erroneous blood typing results. One sample failed to react with A1 red cells (RBCs) in immediate‐spin (IS) tests, had anti‐A and ‐B titers of 8192 and 2048, respectively, by indirect antiglobulin technique (IAT), and was from a diabetic patient; the parenteral administration of A substance present in porcine insulin is a possible cause of hyperimmunity in this case. The second sample was from the recipient of a single unit of group B fresh‐frozen plasma; the serum anti‐A and ‐B titers were 10,240 by IAT, but only weak reactions with A1 and B RBCs were noted in routine IS reverse typing tests; the hyperimmunity in the patient concerned was likely due to crossreacting anti‐A, B stimulated by B‐active glycoproteins and/or glycolipids in the transfused plasma. The third serum also had anti‐A and anti‐B IAT titers of 10,240 but did not react with A1 and B RBCs by IS; the hyperimmunity in this case may be related to sepsis from intestinal flora carrying A‐ and/or B‐like antigens. These antibodies lysed A1 and/or B RBCs in tests incubated at room temperature (RT) and strongly agglutinated those RBCs by IS when diluted 10‐fold with saline. The absence of the prozone phenomenon in tests with RBCs suspended in diluents containing EDTA is consistent with the previously published mechanism for anti‐A prozone: namely, the steric hindrance of agglutination by the C1 component of human complement. In addition, weak (≤ 1+) anti‐A/‐B agglutination without lysis was also seen with 5 of 231 other sera in 2‐minute RT tests, but all five reached ≥3+ by IS and lysed A1 and/or B RBCs in 5‐minute RT tests. These findings raise concerns regarding the ability of the IS crossmatch to detect ABO errors, particularly if tests are not centrifuged immediately. While prozones in true IS tests are rare, failure to detect anti‐A/‐B due to C1 blocking occurs more frequently in tests left briefly at RT. Accordingly, use of EDTA is indicated when IS crossmatches are performed to demonstrate ABO incompatibility.
Comparison of assays for anti‐HBc in blood donors
Authors: Schmidt Paul J. , Leparc German F. , Samia Concepcion T.
Published: March 2003

ABSTRACT: Testing for anti‐HBc has been recommended for use as a paradoxical or surrogate marker of carriers of non‐A, non‐B hepatitis. Serial sampling on a pool of 35,600 donors was done and those donors found to be repeatedly reactive by EIA method were rested using RIA methodology. Of 1367 donors found to be repeatedly reactive by EIA method, only 984 were confirmed by RIA. Those found to be reactive by EIA only were allowed to donate blood again, with only three of them becoming positive by both EIA and RIA on subsequent donations. The majority of these donors (107 out of 151) reverted to EIA negative status. Therefore, the finding of a positive anti‐HBc by EIA method that could not be repeated by RIA method is not an early reproducible sign of anti‐HBc reactive status.
Enhanced reaction with Vicia graminea lectin and exposed terminal N− acetyl‐D‐glucosaminyl residues on a sample of human red cells with Hb M− Hyde Park
Authors: King M. J. , Liew Y. W. , Moores P. P. , Bird G. W.
Published: March 2003

A sample of polyagglutinable red cells was obtained from a healthy individual (group O, N) possessing a hemoglobin (Hb) variant called Hb M‐Hyde Park. The sialic acid content of the individual's red cells is 90 percent of normal, and his cells are agglutinated by monoclonal but not lectin anti‐Tn, a panel of lectins specific for N‐ acetylgalactosamine (or galactose), and N‐acetylglucosamine. Enhanced agglutination reactions were obtained with Vicia graminea, Ulex europaeus, and human anti‐I and ‐i. Using various enzyme treatments and different methods of labeling cell surface components, two defective cell membrane sites have been identified: one associated with the O‐ linked oligosaccharides on sialoglycoproteins and the other associated with exposed N‐acetylglucosaminyl residues located on membrane components of apparent molecular weights 88,000 to 130,000 and 46,000 to 73,000 (probably the Band 3 and Band 4.5 regions, respectively).
Mood states in the volunteer blood donor
Authors: Zillmer E. A. , Glidden R. A. , Honaker L. M. , Meyer J. D.
Published: March 2003

Mood changes across time were evaluated as they applied to the process of volunteer blood donation. Measures of mood (from the Mood Adjective Check List) were taken before and at three different intervals after blood donations by 245 college students. Anxiety scores were significantly higher before blood donation, and elation scores showed a significant increase following donation. Veteran donors experienced significantly less discomfort before donation. These findings imply that blood donations can be viewed as an “opponent‐affective process,” in which initial, mildly aversive feelings lead to positive aftereffects. Current findings suggest that blood donation can be explained, in part, by a self‐serving, addictive process.
Determination of an appropriate size of unrelated donor pool to be registered for HLA‐matched bone marrow transplantation
Authors: Takahashi K. , Juji T. , Miyazaki H.
Published: March 2003

HLA‐matched bone marrow transplantation from related or unrelated donors appears to be effective. To supply HLA‐matched bone marrow for patients who do not have HLA‐matched family donors, registration of unrelated HLA‐typed donors and selection of matched donors will be necessary. In this study, the frequencies of each possible HLA phenotype and of corresponding, potentially matched donors were calculated by a computer from the table of frequencies of HLA‐A, ‐B, and ‐DR haplotypes using data from 300 families in Japan and from the Eighth International Histocompatibility Workshop for European and North American whites. Appropriate sizes of such donor pools were evaluated theoretically in the Japanese population and in European and North American whites. To enable more than 80 percent of patients to have at least one identical donor, only 50,000 potential donors would be necessary for Japanese persons, whereas 1,000,000 and 400,000, respectively, would be required for European and North American whites.
Preparation of white cell‐depleted red cells for 42‐day storage using an integral in‐line filter
Authors: Davey R. J. , Carmen R. A. , Simon T. L. , Nelson E. J. , Leng B. S. , Chong C. , Garcez R. B. , Sohmer P. R.
Published: March 2003

A new blood pack system for the preparation of white cell‐depleted red cells was studied. The system is a modified additive‐solution quadruple‐unit blood pack that incorporates a cellulose‐acetate fiber depth filter in‐line between the AS‐3 additive bag and the CP2D collection bag. Mean ± SD white cell removal from 156 units processed under standard production conditions was 97.7 ± 2.7 percent; residual white cells were 1.1 ± 1.0 × 108 per unit. Red cell loss was 10.0 ± 1.0 percent (n = 43). Mean platelet removal was 80.9 percent from units from which platelet concentrates were not prepared (n = 47). Microaggregates did not form during storage, and hemolysis of filtered red cells was lower than that of unfiltered controls. Filtered AS‐3 red cells stored for 42 days had a 51Cr survival of 80.1 ± 5.7 percent (mean ± SD) as compared with 78.9 ± 6.2 percent for unfiltered controls (n = 17). This in‐line filter system provides white cell‐depleted, microaggregate‐free red cells that can be stored for 42 days.
Th activation of maternal and cord blood
Authors: Wahl C. M. , Herman J. H. , Shirey R. S. , Kickler T. S. , Ness P. M.
Published: March 2003

Th activation of red cells is characterized by agglutination with the peanut lectin from Arachis hypogaea and is diminished by treatment with proteolytic enzymes. The first cases of Th activation were associated with bacterial infections. More recently, a high incidence of Th activation in congenital hypoplastic anemia has been reported, along with the finding that 13.5 percent of cord bloods are Th activated. The incidence of Th reactivity in newborn infants was confirmed by studying 200 paired samples of maternal and cord blood. Twenty‐two (11%) of the cord samples and 13 (6.5%) of the maternal samples were Th activated. In 6 paired samples (6/22), both the mother and child had Th activation, a finding that demonstrates a high degree of concordance. Additionally, 3 (6%) of 50 pregnant women were Th positive. These findings indicate that Th activation is another of the red cell antigen alterations related to pregnancy. TRANSFUSION 1989;29:635–637.
Solid‐phase antiglobulin test for screening and identification of red cell antibodies
Authors: Uthemann H. , Poschmann A.
Published: March 2003

A newly developed automatically readable solid‐phase antiglobulin test is described. The solid‐phase test in comparison with conventional antiglobulin techniques for screening and identification of red cell antibodies showed agreement in 2346 (98.7%) of samples tested. The increased sensitivity of the solid‐phase antiglobulin test is demonstrated by examination of serial twofold dilutions of antibodies.
Blood use during extracorporeal membrane oxygenation
Authors: McCoy‐Pardington D. , Judd W.J. , Knafl P. , Abruzzo L.V. , Coombes K.R. , Butch S.H. , Oberman H.A.
Published: March 2003

An analysis of the transfusion records of 91 neonatal patients subjected to extracorporeal membrane oxygenation (ECMO) is reported. Mean daily blood usage was 250 mL of red cells (RBCs), 80 mL of fresh‐frozen plasma, and 2 units of platelets. Average time on ECMO was 4.6 days. Group O or ABO type‐specific RBCs and group AB or ABO type‐specific plasma products and platelets were transfused. RBCs were not washed, and neither RBCs nor other components were tested for anticytomegalovirus (CMV) or irradiated. No cases of posttransfusion CMV infection or graft‐versus‐host disease were observed. Hemolysis in eight patients was traced to occlusions in the ECMO circuit. All but three patients survived ECMO. Contrary to a previous report, an active ECMO program for neonatal patients imposes a minimal burden on the hospital transfusion service.
Factor IX concentrate versus prothrombin complex concentrate for the treatment of hemophilia B during surgery
Authors: Bardin J.M. , Sultan Y.
Published: March 2003

Hemophilia B patients are usually treated for the prevention and control of bleeding episodes with a plasma derivative containing the four vitamin K‐dependent clotting factors (PPSB). Prothrombin complex concentrate and the French PPSB concentrate are known to be thrombogenic when used in long‐term treatment of surgical patients. The present study reports two cases of thrombotic episodes following surgery in PPSB‐treated hemophilia B patients. Since 1986, there has been available a factor IX (FIX) concentrate depleted of the other vitamin K‐dependent clotting factors and virally inactivated by the solvent‐detergent method. This preparation has been used as replacement therapy in six patients with severe hemophilia B who were to undergo orthopedic surgery. The management of the patients before and after operation was without any thrombotic complication or undesirable side effects. The present study suggests that there is a need for an FIX preparation devoid of the other vitamin K‐dependent clotting factors for long‐term therapy of hemophilia B patients.