bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Behavioral Improvement with Haloperidol or Trazodone Treatment Depend on Psychosis or Mood Symptoms in Patients with Dementia?
Authors: Sultzer David L. , Gray Kevin F. , Gunay Ibrahim , Wheatley Muriel V. , Mahler Michael E.
Published: March 2003

OBJECTIVES:

Several previous studies have examined the effects of pharmacological interventions for agitated behavior in patients with dementia. However, the choice of medication in clinical practice continues to be directed largely by local pharmacotherapy culture rather than empirical treatment guidelines. We examined the relationship between behavioral improvement and co‐occurring delusions and mood symptoms in patients with dementia who were treated with haloperidol, an antipsychotic medication, or trazodone, a serotonergic antidepressant.

DESIGN:

Randomized, double‐blind, parallel‐group, 9‐week treatment trial.

SETTING:

Inpatient geropsychiatry unit.

PARTICIPANTS:

Twenty‐eight patients with dementia and agitated or aggressive behaviors.

INTERVENTION:

Haloperidol 1 to 5 mg/day or trazodone 50 to 250 mg/day.

MEASUREMENTS:

Cohen‐Mansfield Agitation Inventory (CMAI), Hamilton Depression Rating Scale (Ham‐D), and delusional thoughts subscale and hallucinations subscale of the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE‐AD).

RESULTS:

CMAI scores improved in each treatment group over the 9 weeks of treatment (P < .001 in each group). Within the haloperidol treatment group, CMAI improvement was not associated with baseline delusional thoughts score or with change in delusional thoughts score over the course of treatment. Within the trazodone treatment group, CMAI improvement was associated with baseline score on total Ham‐D (r = −0.60, P = .02), Ham‐D items measuring subjective mood symptoms (r = −0.50, P = .07), and Ham‐D items measuring neurovegetative signs (r = −0.49, P = .08). CMAI improvement was also associated with improvement in Ham‐D total score over the course of treatment (r = 0.62, P = .02).

CONCLUSIONS:

Mild depressive symptoms in patients with dementia and agitated behavior are associated with greater behavioral improvement by trazodone‐treated patients. In contrast, the presence of delusions in concert with behavioral disturbance does not necessarily predict greater behavioral improvement with haloperidol treatment than in subjects without signs of psychosis. J Am Geriatr Soc 49:1294–1300, 2001.
Racial and State Differences in the Designation of Advance Directives in Nursing Home Residents
Authors: Kiely Dan K. , Mitchell Susan L. , Marlow Aimee , Murphy Katharine M. , Morris John N.
Published: March 2003

OBJECTIVES:

To examine racial and state differences in the use of advance directives and surrogate decision‐making in a nursing home population.

DESIGN:

A retrospective cohort study.

SETTING:

Nursing homes in the states of California (CA), Massachusetts (MA), New York (NY), and Ohio (OH).

PARTICIPANTS:

Nursing home residents: 130,308 in CA, 59,691 in MA, 112,080 in NY, and 98,954 in OH.

MEASUREMENTS:

Minimum Data Set information concerning resident race and whether or not residents have a living will (LW), a do not resuscitate (DNR) order, or a surrogate decision‐maker (SDM).

RESULTS:

The proportion of LWs, DNR orders, and SDMs varied significantly (P < .0001) by racial categories in each state. In general, whites were distinctly different from other racial categories. Whites were significantly more likely to have a LW (odds ratio (OR) = 1.9 (CA), OR = 2.2 (NY), OR = 4.9 (OH)), a DNR order (OR = 2.4 (CA), OR = 2.4 (MA), OR = 3.3 (NY), OR = 3.2 (OH)), and a SDM (OR = 1.1 (CA), OR = 1.2 (NY), OR = 1.6 (OH)) than were nonwhites, after adjusting for potentially confounding factors. Significant state differences (P < .0001) were observed in LWs, DNR orders, and SDMs and were most pronounced in residents of Ohio, who were significantly more likely to have a LW than were residents in other states (OR = 9.3).

CONCLUSIONS:

Various resident characteristics explain some of the racial differences, although whites are still more likely to have a LW, a DNR order, or an SDM independent of various resident characteristics included in the adjusted analyses. This pattern is observed in all states, although the ORs varied by state. Some of these differences may be due to distinct cultural approaches to end‐of‐life care and lack of knowledge and understanding of advance directives. The distinctly higher rates of LWs among all racial groups in Ohio than in other states suggest that states can potentially increase the use of advance directives through intervention. J Am Geriatr Soc 49:1346–1352, 2001.
Impact of Geographic Barriers on the Utilization of Mammograms by Older Rural Women
Authors: Engelman Kimberly K. , Hawley Daniel B. , Gazaway Rona , Mosier Michael C. , Ahluwalia Jasjit S. , Ellerbeck Edward F.
Published: March 2003

OBJECTIVES: To examine whether geographic proximity to mammography facilities influences mammogram utilization.

DESIGN: Retrospective cohort analysis.

SETTING: Rural state.

PARTICIPANTS: Female Kansas Medicare beneficiaries aged 65 to 79 (N = 117,901).

MEASUREMENTS: Using Medicare claims data, we measured county‐level mammography rates for beneficiaries in Kansas. We calculated mammography rate differences for beneficiaries according to age, race, distance from permanent and mobile mammography sites, and county characteristics including county mammography service availability.

RESULTS: Of 105 counties, 37% had only permanent mammography facilities, 22% had both permanent and mobile sites, 29% had only mobile facilities, and 11% had neither, representing 44%, 44%, 9%, and 3% of the 117,901 beneficiaries, respectively. Of the beneficiaries, 91% lived less than 20 miles from a permanent facility; of the remaining 9%, 67% lived less than 20 miles from a mobile site. In 30 counties with only mobile sites, 90% of the 10,439 beneficiaries residing in the counties had access to the sites fewer than 2 days per month. County‐level mammography rates ranged from 37% to 72%. Mammography utilization was 57% in counties with permanent facilities only, 55% in counties with both permanent and mobile sites, 53% in counties with only mobile sites, and 53% in counties with neither (P = 0.12). After adjusting for age, race, and county education level, the odds of receiving a mammogram was slightly lower for persons residing longer distances from a permanent facility (odds ratio = 0.97 for each 5‐mile increase in distance, 95% confidence interval = 0.95–0.99).

CONCLUSION: The majority of Kansans live near a mammography facility. Although there is a large variation in county‐level mammography rates across Kansas, this disparity is not well explained by proximity to mammography facilities.
Distal Radius Fractures in Older Women: A 10‐Year Follow‐Up Study of Descriptive Characteristics and Risk Factors. The Study of Osteoporotic Fractures
Authors: Vogt Molly T. , Cauley Jane A. , Tomaino Matthew M. , Stone Katie , Williams James R. , Herndon James H.
Published: March 2003

OBJECTIVES: To determine the incidence of distal radius fractures and the characteristics of those fractures and to identify the key risk factors.

DESIGN: Prospective cohort study, mean follow‐up of 9.8 years.

SETTING: Four clinical centers, one each in Baltimore, Maryland; Minneapolis, Minnesota; Pittsburgh, Pennsylvania; and Portland, Oregon.

PARTICIPANTS: Nine thousand seven hundred four white women aged 65 and older, enrolled in the multicenter Study of Osteoporotic Fractures.

METHODS: Five hundred twenty‐seven distal radius fractures were confirmed by physician review of radiology reports; characteristics of the fractures were noted. Information was also collected on lifestyle, demographics, bone mineral density (BMD), and clinical and performance measures.

RESULTS: The overall incidence of fracture was 7.3/1,000 person‐years. Twenty‐seven percent of the fractures were intra‐articular; 73% were extra‐articular. The independent predictors of fracture were decreased BMD (per 0.1 g/cm2) at the distal radius (

relative risk (

RR) = 1.8, 95%confidence interval (

CI) = 1.6–2.1), a history of recurrent falls (

RR = 1.6, 95%CI = 1.2–2.0), and having had a previous fracture since age 50 (

RR = 1.3, 95%CI = 1.1–1.6). Current use of oral estrogen was protective (

RR = 0.6, 95%CI = 0.4–0.8). For women aged 75 and older, poor cognitive status was also a predictor of wrist fracture. Intra‐articular fractures occurred more than twice as frequently in women with diabetes mellitus.

CONCLUSIONS: This is the first large long‐term comprehensive study of distal radius fractures in older people. The results indicate that factors predictive of distal radius fractures can easily be assessed in routine clinical practice and can identify women at high risk for fracture. Selected preventive strategies could be designed to reduce the incidence of these fractures.
Barriers to Optimum End‐of‐life Care for Minority Patients
Authors: Krakauer Eric L. , Crenner Christopher , Fox Ken
Published: March 2003

Although major efforts are underway to improve end‐of‐life care, there is growing evidence that improvements are not being experienced by those at particularly high risk for inadequate care: minority patients. Ethnic disparities in access to end‐of‐life care have been found that reflect disparities in access to many other kinds of care. Additional barriers to optimum end‐of‐life care for minority patients include insensitivity to cultural differences in attitudes toward death and end‐of‐life care and understandable mistrust of the healthcare system due to the history of racism in medicine. These barriers can be categorized as institutional, cultural, and individual. Efforts to better understand and remove each type of barrier are needed. Such efforts should include quality assurance programs to better assess inequalities in access to end‐of‐life care, political action to address inadequate health insurance and access to medical school for minorities, and undergraduate and continuing medical education in cultural sensitivity.
Reduced Mortality in Treating Acutely Sick, Frail Older Patients in a Geriatric Evaluation and Management Unit. A Prospective Randomized Trial
Authors: Saltvedt Ingvild , Mo Ellen‐Sofie Opdahl , Fayers Peter , Kaasa Stein , Sletvold Olav
Published: March 2003

OBJECTIVES: Documentation of treatment effects in acutely sick frail older patients in geriatric evaluation and management units (GEMUs) is scarce. The present study evaluated whether treatment in a GEMU would reduce mortality as compared to traditional treatment delivered in the Department of Internal Medicine.

DESIGN: Prospective randomized trial.

SETTING: GEMU or general medical ward

PARTICIPANTS: Acutely sick frail patients aged 75 and older who had been admitted to the Department of Internal Medicine were randomly assigned to treatment in the GEMU (n = 127) or to the general medical wards (n = 127). The following inclusion criteria were used to target frail patients: chronic disability, acute impairment of single activity of daily living, mild/moderate dementia, confusion, depression, imbalance/dizziness, falls, impaired mobility, urinary incontinence, malnutrition, polypharmacy, vision or hearing impairment, social problems, or prolonged bedrest.

INTERVENTION: In the GEMU, the treatment strategy emphasized interdisciplinary assessment of all relevant disorders, prevention of complications and iatrogenic conditions, early mobilization/rehabilitation, and comprehensive discharge planning. The control group received treatment as usual from the Department of Internal Medicine. After discharge neither group received specific follow‐up.

MEASUREMENTS: Mortality and causes of death.

RESULTS: Mortality in the intervention and control groups, respectively, was 12% and 27% at 3 months (P = .004), 16% and 29% (P = .02) at 6 months, and 28% and 34% (P = .06) at 12 months. The hazard ratio was 0.39 (95% confidence interval = 0.21–0.72) at 3 months. The main cause of death was cardiovascular disease.

CONCLUSION: Treatment of acutely sick, frail, older patients in a GEMU substantially reduced mortality.
The Current State of Geriatric Medicine: A National Survey of Fellowship‐Trained Geriatricians, 1990 to 1998
Authors: Medina‐Walpole Annette , Barker William H. , Katz Paul R. , Karuza Jurgis , Williams T. Franklin , Hall William J.
Published: March 2003

The rapid growth of the older population has focused national attention on the need for physicians trained in geriatric medicine. To gain insight into the evolving status of the field, with particular focus on career decision‐making and academic career development of trainees, we conducted a survey of physicians recently completing geriatric fellowships. The 107 accredited extant geriatric fellowship programs in the United States and Puerto Rico were contacted to identify trainees from 1990 to 1998. A mailed survey addressed relevant career development and training issues. Four hundred ninety out of 787 (62%) physicians responded; 20% completed 1 year and 80% 2 or more years of training. Half made the decision to pursue a career in geriatrics during residency, 27% decided before/during medical school, and a mentor influenced 48%. Currently, 80% have a Certificate of Added Qualifications in geriatric medicine, 69% hold academic appointments, 78% teach, 39% participate in research, and 44% author publications. Most are doing predominantly clinical work in multiple settings. Further analysis of the 1996‐to‐1998 cohort revealed that those completing fellowships of 2 or more years are more likely to identify all geriatrics as their professional focus, conduct and author research, work with multidisciplinary teams, and participate in professional geriatric societies. This national survey documents career decision‐making and the academic and clinical profiles of physicians completing geriatric fellowship training in the past decade. Longer fellowship training is associated with academic career development. Although there is a national need to train clinical geriatricians, the additional need to train and fund future geriatric academic leaders requires increased attention.
Tai Chi Chuan Training is Associated with Enhanced Endothelium‐Dependent Dilation in Skin Vasculature of Healthy Older Men
Authors: Wang Jong‐Shyan , Lan Ching , Chen Ssu‐Yuan , Wong May‐Kuen
Published: March 2003

OBJECTIVES: The vascular endothelium modulates vascular tone by synthesizing and metabolizing vasoactive substances. Endothelium‐dependent vasodilation declines with age. This study investigated whether Tai Chi Chuan (TCC) training could enhance endothelial function in the skin vasculature of older men.

SETTING: Community setting.

DESIGN: Basic hemodynamic characteristics and skin vascular response to endothelium‐dependent and ‐independent vasodilators were studied.

PARTICIPANTS: Ten older men who practiced TCC, 10 older healthy sedentary men, and 12 younger healthy sedentary men. The older TCC subjects had practiced classical Yang TCC for a mean ± standard deviation of 11.2 ± 3.4 years; mean attendance was 5.1 ± 1.8 times weekly. Sedentary subjects had not participated in any regular exercise training for at least 5 years.

MEASUREMENTS: Different doses of 1% acetylcholine (ACh) and 1% sodium nitroprusside (SNP) were iontophoretically applied to the skin of subjects' lower legs, and cutaneous microvascular perfusion responses were determined by laser doppler measurements. Additionally, arterial and venous hemodynamic variables were measured by impedance plethysmograph.

RESULTS: The older TCC group had higher lower leg arterial blood flow (LABF); LABF in response to reactive hyperemia; and lower leg venous capacity, tone and blood flow than their sedentary counterparts, but the older TCC group displayed similar arterial and venous hemodynamic variables to the younger sedentary group. The younger sedentary group had a higher ACh‐induced cutaneous perfusion and a higher ratio of ACh‐ to SNP‐induced cutaneous perfusion than the two older groups. The older TCC group showed a higher ACh‐induced cutaneous perfusion and a higher ratio of ACh‐ to SNP‐induced cutaneous perfusion than the older sedentary group. Skin vascular responses to SNP did not differ significantly between the three groups.

CONCLUSIONS: Regular practice of TCC is associated with enhanced endothelium‐dependent dilation in skin vasculature of older individuals. Moreover, TCC training may delay the age‐related decline of venous compliance and hyperemic arterial response.
Does Aspirin Attenuate the Effect of Angiotensin‐Converting Enzyme Inhibitors on Health Outcomes of Very Old Patients with Heart Failure?
Authors: L Lapane Kate , L Hume Anne , M Barbour Marilyn , Lipsitz Lewis A.
Published: March 2003

OBJECTIVES: Concomitant ischemic heart disease (IHD) is common in older individuals with heart failure (HF). We estimated the effect of aspirin use on the rate of mortality, morbidity, and decline in physical functioning in nursing home residents with HF taking angiotensin‐converting enzyme (ACE) inhibitors.

DESIGN: We conducted a retrospective cohort study using a nursing home database linking resident information collected via the Minimum Data Set (MDS) with drug utilization data.

SETTING: Nursing homes in four states (1992–1995).

PARTICIPANTS: Of 49,779 residents with HF admitted to these homes, 12,703 residents were taking an ACE inhibitor; 2,046 of these took aspirin.

MEASUREMENTS: Medicare enrollment files provided the date of death, and we used the Part A Medicare files to identify hospital admissions. The activity of daily living scale from repeat MDS assessments allowed us to evaluate decline in physical function. Cox proportional hazards models provided adjusted estimates of the aspirin effect, with nonusers as the reference group.

RESULTS: The overall mortality rate, hospitalization rate, and rate of decline in physical function of aspirin users were not different from those of nonusers (e.g., hospitalization rate ratio = 0.99, 95% confidence interval = 0.92–1.07). This effect did not vary by presence of concomitant IHD or by dose or type of ACE inhibitor.

CONCLUSION: In a cohort of older HF residents receiving ACE inhibitors in nursing homes, we found that treatment with aspirin did not appear to affect outcomes negatively.
Unrecognized Tuberculosis in a Nursing Home Causing Death with Spread of Tuberculosis to the Community
Authors: Ijaz Kashef , Dillaha Jennifer A. , Yang Zhenhua , Cave M. Donald , Bates Joseph H.
Published: March 2003

OBJECTIVES: To determine the reason for an increase in tuberculin skin test (TST) conversion in employees in a nursing home and to determine the source case responsible for spread of tuberculosis (TB) in two nursing homes and a hospital in a rural part of Arkansas using molecular and traditional epidemiological methods.

DESIGN: TB contact investigation of residents and employees of two nursing homes and a hospital.

SETTING: Two nursing homes and a hospital in rural part of Arkansas.

PARTICIPANTS: One hundred fifty‐seven employees and 117 residents of two nursing homes and 211 employees of a hospital in rural part of Arkansas

MEASUREMENTS: Tuberculin skin test.

RESULTS: Analysis of room and work assignments of residents and employees who converted their TSTs in Nursing Home A showed that residents and employees in the same wing as the suspect source case were significantly more likely to have converted their TST than residents and employees in other wings (P = .01). A nurse from the local hospital where the suspected source case had been sent developed a tuberculous cervical abscess, and one employee in Nursing Home A developed pulmonary TB. A visitor to Nursing Home A was diagnosed with culture‐positive pulmonary TB 2 years later. Genotyping of the Mycobacterium tuberculosis isolates from the four secondary cases showed identical patterns.

CONCLUSION: Molecular and traditional epidemiological studies revealed an outbreak of TB that began in a nursing home and spread to a second nursing home, a local hospital, and the community.
Translating Clinical Research into Practice: A Randomized Controlled Trial of Exercise and Incontinence Care with Nursing Home Residents
Authors: Schnelle John F. , Alessi Cathy A. , Simmons Sandra F. , Al‐Samarrai Nahla R. , Beck John C. , Ouslander Joseph G.
Published: March 2003

OBJECTIVES: To examine clinical outcomes and describe the staffing requirements of an incontinence and exercise intervention.

DESIGN: Randomized controlled trial with blinded assessments of outcomes at three points over 8 months.

SETTING: Four nursing homes.

PARTICIPANTS: Two hundred fifty‐six incontinent residents.

INTERVENTION: Research staff provided the intervention, which integrated incontinence care and exercise every 2 hours from 8:00 a.m. to 4:00 p.m. 5 days a week.

MEASUREMENTS: Average and maximum distance walked or wheeled, level of assistance required to stand, maximum pounds lifted by arms, fecal and urinary incontinence frequency, and time required to implement intervention.

RESULTS: Intervention residents maintained or improved performance whereas the control group's performance declined on 14 of 15 outcome measures. Repeated measures analysis of variance group‐by‐time significance levels ranged from P < .0001 to .05. The mean time required to implement the intervention each time care was provided was 20.7 ± 7.2 minutes. We estimate that a work assignment of approximately five residents to one aide would be necessary to provide this intervention.

CONCLUSIONS: The incontinence care and exercise intervention resulted in significant improvement for most residents, and most who could be reliably interviewed expressed a preference for such care. Fundamental changes in the staffing of most nursing homes will be necessary to translate efficacious clinical interventions into everyday practice.
Factors Associated With Falls in Older Patients With Diffuse Polyneuropathy
Authors: Richardson James K.
Published: March 2003

OBJECTIVES: To identify clinical factors associated with falls by older persons with polyneuropathy (PN).

DESIGN: A cross‐sectional study of 82 subjects aged 50 to 85 with clinical and electrodiagnostic evidence of PN.

SETTING: Electrodiagnostic and biomechanical research laboratories.

PARTICIPANTS: Patients referred to the electrodiagnostic laboratory.

MEASUREMENTS: History and physical examination, including semiquantitative methods of peripheral nerve function, and clinical balance testing. Falls were defined by retrospective self‐report over a 2‐year period.

RESULTS: Forty (48.8%), 28 (34.1%), and 18 (22.0%) subjects reported a history of at least one fall, multiple falls, and injurious falls, respectively. Factors associated with single and multiple falls were similar, so only results for multiple and injurious falls are reported. Bivariate analysis showed that an increased body mass index (BMI) and more severe PN (as determined by the Michigan Diabetes Neuropathy Score) were associated with both fall categories. Men reporting falls also demonstrated a decreased unipedal stance time. Age, sex, nerve conduction study parameters, Romberg testing, medications, and comorbidities were not consistently associated with either fall category. Logistic regression demonstrated that multiple and injurious falls were associated with an increased BMI and more severe PN, controlling for age, sex, medications, and comorbidities (pseudo R2 = 0.458 and 0.484, respectively).

CONCLUSIONS: Although previous work has demonstrated that all older persons with PN are at increased risk for falls, patients with increased BMI and more severe PN are at particularly high risk and should be targeted for intervention.
Radiofrequency Treatment of Peripheral Nerves
Authors: Rohof O.J.J.M.
Published: March 2003

Abstract: Treatment of chronic refractory pain in which peripheral nerves are involved has proven to be difficult. Neurolysis by surgical, chemical, cryogenic, or thermal means may be considered as an option on seldom occasions, because of the risk of neuritis and deafferentation pain, motor deficit, and potential unintentional damage to nontargeted tissue. To our knowledge, there is only 1 report concerning selective radiofrequency (RF) treatment of the obturator and femoral nerves that was published. The introduction of the non‐neurodestructive pulsed radiofrequency technique has provided new possibilities for the treatment of peripheral nerves. Today there is some experience with the management of chronic shoulder pain and additional case reports on other indications.
Simple and rapid preparation of granulocytes for the treatment of neonatal septicemia
Authors: Rock G. , Zurakowski S. , Baxter A. , Adams G.
Published: March 2003

Recent reports have documented benefit from the infusion of granulocytes into septic neonatal patients. However, while the requirement of 1 × 10(9) per kg of granulocytes is easily met by apheresis procedures, treatment of neonatal septicemia requires immediate response 24 hours a day. Unfortunately, this rapid response is beyond the capability of most apheresis units. Therefore, we developed a method for obtaining granulocytes from whole blood collected by routine blood donation. Hydroxyethyl starch (60 ml of a 6% solution) is introduced into a unit of whole blood within 24 hours of collection. Following sedimentation and subsequent centrifugation, a buffy coat is obtained which contains more than 75 percent of the granulocytes; an average of 1.62 × 10(9) WBC, of which 1.25 × 10(9) were granulocytes that were recovered in an average 17‐ml final volume with a hematocrit of 4 percent. Granulocyte morphology and function as measured by chemiluminescence indicated good maintenance of function. Total processing time was short, requiring less than 2 hours, and the procedure was performed easily in a routine blood bank. The recovery of 1.25 × 10(9) granulocytes from a single, routine blood donation without steroid treatment of the donor makes this product ideal for use in the treatment of neonatal septicemia.
Anti‐Dob implicated as the cause of a delayed hemolytic transfusion reaction
Authors: Moheng M. C. , McCarthy P. , Pierce S. R.
Published: March 2003

A 27‐year‐old, gravida 3, para 2 woman experienced a delayed hemolytic transfusion reaction. She had anti‐Dob in both serum and eluate 8 days after infusion of 6 units of Do(b+) red cells. No antibody had been detected prior to transfusion. By the 15th day after transfusion, there was no evidence of survival of red cells from any of the 6 units. Anti‐ C and anti‐M were demonstrated later, but 29 months after transfusion, no atypical antibodies were detectable. The evidence suggests anti‐Dob should be considered an antibody of potential clinical significance until contrary evidence becomes available.
Elution of anti‐Cra
Authors: Reid M. E. , Dean William D. , Ellisor Sandra S.
Published: March 2003

Six examples of IgG anti‐Cra were absorbed onto group O, Cr(a+) red cells and subsequently eluted by five elution methods. Five of the anti‐ Cra antibodies were eluted only by the digitonin‐acid method. The sixth example was recovered by all elution methods; however, the digitonin‐ acid and Lui freeze‐thaw methods recovered more antibody activity than did the dichloromethane, ether, or 56 degrees C heat methods. This is the first report of multiple examples of antibodies with the same specificity demonstrated preferentially by a single elution technique.
Anti‐EnaFS detected in the serum of an MiVII homozygote
Authors: Laird‐Fryer B. , Moulds J. J. , Dahr W. , Min Y. O. , Chandanayingyong D.
Published: March 2003

Anti‐EnaFS was detected in the serum of a Caucasian woman, K.T., during her third pregnancy. She had not been transfused. At delivery, the infant's red cells (RBCs) had a negative direct antiglobulin test. The antibody was inhibited by isolated MN sialoglycoprotein (SGP). Unlike other En(a—) cells, K.T.'s EnaFS‐negative RBCs were found to demonstrate normal sialic acid levels, and an MN SGP exhibiting normal sodium dodecylsulphate electrophoretic mobility and periodic acid‐Schiff staining intensity. K.T., whose parents were consanguineous, appears to be the first known MiVII homozygote. In a three‐generation family study, MiVII was shown to travel with MS.

The Anek receptor of K.T.'s RBCs was found to be located on the trypsin‐resistant and V8 protease‐sensitive portion of the MN SGP (residues 40 to 57), whereas the Anek receptor of MiVI RBCs was shown to be associated with their abnormal Ss SGP. K.T.'s MN SGP appears to exhibit an amino acid sequence alteration in the region of the EnaFS determinant, which is located within the residues 46 to 56 of the normal MN SGP. These findings suggest that the MiVII and EnaFS receptors are the products of allelic genes.
An anti‐i biphasic hemolysin in chronic paroxysmal cold hemoglobinuria
Authors: Shirey R.S. , Park K. , Ness P. M. , Kickler T. S. , Rones J. , Dawson R. B. , Jiji R.
Published: March 2003

Paroxysmal cold hemoglobinuria (PCH) was diagnosed in an elderly patient with a history of chronic lymphocytic leukemia. In this case, the Donath‐Landsteiner antibody demonstrated anti‐i specificity rather than the more commonly reported anti‐P specificity. This unusual case of a biphasic hemolysin with anti‐i specificity emphasizes the importance of performing a Donath‐Landsteiner test when presented with serological or clinical findings that are suggestive of PCH.
Accelerated destruction of radiolabeled red cells due to anti‐Coltonb
Authors: Dzik W. H. , Blank J.
Published: March 2003

A patient who developed anti‐Cob in response to transfusion was studied. The antibody was a warm‐reactive, high‐titered, IgG alloantibody that did not fix complement, and reacted strongly in the antiglobulin phase. During a period of transfusion the patient developed a positive direct immunoglobulin test with anti‐Cob recoverable in the eluate. Reactions were stronger with enzyme‐treated red cells. Survival studies with 51Chromium‐labeled red cells showed: 1) normal survival of Co(b‐) red cells, and 2) accelerated destruction of Co(b+) red cells; initially, cells were destroyed with a one‐half disappearance time of 4 days, but after about 4 days, the rate of destruction increased. This study, together with reported suspected transfusion reactions attributed to anti‐Cob, suggest that anti‐Cob should be considered a clinically significant antibody.
Evaluation of a volumetric intravenous fluid infusion pump for transfusion of blood components containing red cells
Authors: Thompson H. W. , Lasky L. C. , Polesky H. F.
Published: March 2003

A method was devised to evaluate the suitability of an infusion pump for transfusing components containing red cells. With simulated transfusions of units of whole blood tested before or after the expiration date there was no increase in the plasma hemoglobin level in pumped blood compared with blood that was put through a standard blood transfusion set. With outdated units of red cells there was an increased level of plasma hemoglobin after pumping. The increases were greatest at maximum pump rates, but were not statistically or clinically significant. The authors' evaluation indicates that this pump causes minimal damage to the red cells, although care should be exercised when rapidly transfusing red cells with high hematocrit values.
Broadening the base of a rare donor program by targeting minority populations
Authors: Beattie K. M. , Shafer A. W.
Published: March 2003

Some red cell phenotypes are found exclusively in one race and may be of low frequency. Finding compatible blood for patients needing one of these rare types has been extremely difficult. A program was implemented to screen large numbers of donors for blood types found solely in their racial group. Implementation steps included obtaining broad community endorsement of the concept, educating blood service personnel, developing educational materials, enlisting the support of a knowledgeable physician from a minority group, developing a computer program to facilitate selection of donors to be tested, beginning the program and making the necessary adjustments, doing the laboratory testing to identify rare bloods, notifying the rare donors, and maintaining the enthusiasm of the entire blood service for the rare donor screening program. After 7706 black donors were typed, 1 Cr—, 5 Hy—, 24 U—, and 20 Js(b—) persons were found; one U— donor was also Js(b—).
The M1 and Tm antigens require M and N gene‐specified amino acids for expression
Authors: Issitt P. D. , Wren M. R. , Moore R. E. , Roy R. B.
Published: March 2003

It is known that the major red ceil sialoglycoprotein (SGP) of M1 + red cells has the same amino acid sequence as M SGP, whereas that of Tm+ cells has the same sequence as N SGP. M1 and Tm are serologically demonstrable when a substitution of N‐acetyl‐D‐glucosamine for N‐acetyl‐neuraminic acid occurs in one or more of the alkali‐labile tetrasaccharides bound at positions 2, 3, and/or 4 of M or N SGP, respectively. The authors used two serums containing anti‐M and potent anti‐M1 and two containing anti‐Tm in tests for antibody crossreactivity and cross adsorption and in antibody inhibition studies. The distinct specificities of anti‐M1 and anti‐Tm, as determined by these studies, show that the M and N gene‐specified amino acids are more important than the glycosylation change in the fine structure of M1 and Tm antigens.
The B3 phenotype in Chinese
Authors: Lin‐Chu M. , Broadberry R. E. , Chiou P. W.
Published: March 2003

Sixteen cases of subgroup B3 and two cases of subgroup A1B3 were found among donated blood processed in Taipei Blood Donation Center. The frequencies of B3 and of A1B3 among group AB Chinese in Taiwan are about 1 in 900, and about 1 in 1800, respectively. The B3 red cells showed 1 to 2+ mixed field agglutination with anti‐B, 2 to 3+ mixed field agglutination with anti‐A,B, and 4+ agglutination with anti‐H. Reverse grouping showed anti‐A but no anti‐B activity; saliva of secretors contained B and H substances. The significant low avidity of subgroup B3 and subgroup A1B3 red cells with both polyclonal and monoclonal antiserums, as compared with normal group B cells, coupled with the difference in the avidity of the reaction between monoclonal and polyclonal antisera with B3 and A1B3 red cells, suggest the possibility of a qualitative as well as a quantitative difference in the B antigen of B3 red cells.
Immunoadsorption of human plasma with protein A‐sepharose columns
Authors: Branda R. F. , Miller W. J. , Soltis R. D. , McCullough J. J.
Published: March 2003

Four patients with refractory acute leukemia were treated a total of 31 times with an immunoadsorption system consisting of protein A‐sepharose columns, a cell separator, and an eiution monitor to test its safety and capacity to remove immunoglobulins. The procedure was tolerated well, and acutely reduced plasma IgG levels by approximately 18 percent. When the procedure was repeated two to three times per week for 3 weeks, IgG levels dropped by 30 to 40 percent, but they gradually returned to pretreatment levels after completion of the course of treatment. Single columns became saturated with IgG after approximately 1500 ml of plasma had passed through the columns. The use of multiple columns sequentially provided continuous extraction of immunoglobulin. One patient regained responsiveness to platelet transfusions after removal of platelet antibodies. These preliminary studies suggest that this immunoadsorption system is effective for specifically removing IgG and that it merits further clinical testing.
Evidence suggesting the occurrence of C3‐independent intravascular immune hemolysis: Reactive hemolysis in vivo
Authors: Salama A. , Bhakdi S. , Mueller‐Eckhardt C.
Published: March 2003

The authors present circumstantial evidence for the involvement of reactive hemolysis, i.e., C3‐independent binding of the cytolytic C5b‐9 complement complex to bystander red cells (RBC), in a case of intravascular immune hemolysis. Fresh serum obtained from a 6‐year‐old patient during the hemolytic episode, but not obtained thereafter, induced C5b‐9‐dependent hemolysis of human RBCs but the indirect C3 antiglobulin test remained negative. Particles (presumably RBC ghosts) isolated from the patient's plasma anticoagulated with EDTA at the peak of hemolysis were coated with C5b‐9 complexes, whereas the direct antiglobulin test was strongly positive for IgA, only weakly positive for IgG, and negative for C3. Moreover, neither the autoantibodies isolated by elution (IgG plus IgA), nor free serum autoantibodies (IgA alone) activated complement in vitro. Additionally, serum samples collected later during the 12‐month period of observation contained normal levels of C3, C4, C8, and C9, but markedly reduced levels of C7. These serums all produced strong reactive lysis in agarose plates, but not in test tubes. These results appear compatible with the working hypothesis that the intravascular hemolytic episode in this patient might have arisen through a local initiation of complement activation with subsequent C3‐independent binding of C5b‐9 to and hemolysis of bystander RBCs.
Computerized selection of donors for inclusion in red cell antibody panels
Authors: AuBuchon J.P. , Roberts G.C.
Published: March 2003

This study evaluated various algorithms for the generation of a red cell antibody identification panel by computer. The algorithms depended on schemes that optimized Fisher's exact p value for each specificity in the panel rather than using predetermined formulations of desired phenotypic combinations. Panels produced by these computer‐driven algorithms offered the distinction of a greater number of antibody specificities than manually created panels. They were also evaluated by a group of technologists to be more useful for general serologic work than panels created manually. Although the panels were created from a database of only 252 donors, an objective numeric evaluation showed that the panels were more useful than commercial panels. The computer approach used in this study may offer means of efficiently creating panels for general use as well as creating panels for resolution of particular serologic problems. They may also facilitate and encourage the construction of panels from small donor databases.
The manual hexadimethrine bromide (Polybrene) test
Authors: Lalezari Parviz
Published: March 2003

Serum proteins affect the performance of the manual hexadimethrine bromide (Polybrene) test. Red cells suspended in the low‐ionic medium adhere to the surface of test tubes when centrifuged. This adherence is prevented by serum components apoprotein B, fibronectin, von Willebrand factor, or serum diluted less than 75‐fold, but not by serum albumin or immunoglobulin fractions. A high concentration of serum reduces the sensitivity of the test and destabilizes antibody‐dependent aggregation. Disaggregation time (DT), defined as the time required for antibody‐dependent aggregates to disperse, was used as an indicator of agglutination stability. DT was often shortened when antibodies were in native serums, but could be prolonged if serums were diluted with 0.85 percent saline. Other factors that influenced DT included antibody concentration, temperature, specificity, and sources of antibodies within specificities. When antibodies were present in a mixture, they produced various DTs related to individual specificities. Determination of these differences allowed the successful identification of multiple antibodies. The procedure, called differential disaggregation time, was also used for typing red cells coated by autoantibodies. Additional modifications improved the performance of the antiglobulin phase.
Plasma free fatty acid metabolism during storage of platelet concentrates for transfusion
Authors: Cesar J. , DiMinno G. , Alam I. , Silver M. , Murphy S.
Published: March 2003

New containers allow storage of platelet concentrates (PC) at 22 degrees C for up to 7 days, during which glycolytic and oxidative metabolism is vigorous. Recent evidence suggests that 85 percent of adenosine triphosphate regeneration is based on oxidative metabolism and that substrates other than glucose may be used. Because platelets can oxidize free fatty acids (FFA) as a possible source of energy during storage, the authors studied their availability, distribution, and turnover. Plasma FFA concentration was unchanged after 1 day of PC storage but significantly increased on Days 3, 5, and 7. Platelet‐free plasma (PFP) stored under the same conditions as PC demonstrated a progressive increase in FFA, suggesting that some of the FFA accumulating in PC were derived from plasma rather than platelets. Indeed, during PC storage, plasma triglycerides decreased significantly, suggesting that they are a possible source of the increased levels of FFA found on Day 3 and thereafter. Thus, PC have a plasma FFA pool available continuously for oxidation during storage. Studies with radiolabeled palmitate suggested that FFA oxidation by platelets occurs during storage. The current findings show that plasma FFA could be a significant substrate for oxidative metabolism during storage of PC and that the oxidized FFA are replenished at least in part from plasma. These results may allow platelet storage to be improved, particularly in synthetic media.
Changes in hospital component therapy in response to reduced availability of whole blood
Authors: Crowley J.P. , Guadagnoli E. , Pezzullo J. , Fuller J. , Yankee R.
Published: March 2003

The effects of a systematic reduction of whole blood (WB) availability on transfusion practice were studied at a large university‐affiliated community hospital from 1978 through 1985. The reduction in WB availability was part of a planned statewide shift in blood procurement and processing from hospitals' individual blood banks to a new statewide blood center. Hospital WB use declined 96 percent, from 3400 to 109 units annually, with a net addition of more than 3000 units of plasma to the statewide stocks. A large increase in the use of other blood components occurred when WB was withdrawn, but this use fell sharply in 1984 and 1985, despite the continued relative unavailability of WB. Analysis of individual hospitals' services showed that increases in the use of packed red cells were distributed across all the services that frequently use red cell transfusions. However, a disproportionate rise and then fall in the use of fresh‐frozen plasma and platelets for cardiovascular operations were observed. The data suggest that education and more conservative transfusion practices are reducing the use of blood components despite continued restricted availability of WB.
Evidence that Wra and Wrb are antithetical
Authors: Wren M.R , Issitt P.D
Published: March 2003

Studies on 24 Wr(a+b+) and 23 Wr(a−b+) blood samples, using anti‐Wrb in the enzyme‐linked antiglobulin test (ELAT), have shown that Wr(a+b+) red cells bind, on average, a little over half the amount of anti‐Wrb bound by Wr(a−b+) red cells. Similarly, ELAT studies using six different anti‐Wra and 10 Wr(a+b+) samples, as well as red cells from the original Wr(a+b−) proposita, have shown that Wr(a+b+) red cells bind about half the amount of anti‐Wra bound by Wr(a+b−) red cells. Various pitfalls that can arise when the ELAT is used to measure antigen ratios on red cells have been avoided but are described. This conclusive evidence that Wra and Wrb have an antithetical relationship is discussed in light of the knowledge that a ficin‐resistant portion of MN sialoglycoprotein (SGP), when carried in liposomes, can inhibit anti‐Wrb. It is possible that Wra, Wrb, or both may encode a post‐ translational change in MN SGP, or production of transferases that glycosylate membrane lipids that affect in situ orientation of MN SGP, or production of protein band 3 that then forms a complex with MN SGP at the red cell membrane surface.
Life‐threatening autoimmune hemolytic anemia in a patient with the acquired immune deficiency syndrome
Authors: RAPOPORT AARON P. , ROUE JACOB M. , McMICAN ANN
Published: March 2003

Increasing numbers of patients are being seen with the acquired immune deficiency syndrome (AIDS). An abnormal serology with a positive direct antiglobulin test has been observed in these patients and is usually not thought to contribute to significant clinical morbidity. We describe a patient with AIDS who presented with a severe hemolytic anemia which was not distinguishable clinically and serologically from the idiopathic form of autoimmune hemolytic anemia.
Evaluation of the optimal incubation temperature for detecting certain IgG antibodies with potential clinical significance
Authors: Arndt P. , Garratty G.
Published: March 2003

It is commonly believed that IgG antibodies react optimally at 37°C, but there are few published data supporting this. In this study, 140 antibodies from the Rh, Kell, Duffy, Kidd, and SsU blood groups were studied by a low‐ionic‐strength solution indirect antiglobulin technique at four different temperatures of incubation: 10, 22, 30, and 37°C. Only titration score differences of greater than 10 were considered significant. None of the 140 antibodies sensitized red cells (RBC) significantly better at 10, 22, or 30 than at 37°C. All antibodies, except one example of anti‐c, sensitized RBCs as well at 30 as at 37°C. At 22°C, 100 percent of Kidd and SsU, 94 percent of Kell, and 82 percent of Duffy, but only 49 percent of Rh antibodies sensitized RBCs as well as they did at 37°C. It is possible that these differences reflect the influence of antigenic structures and/or topography on the thermal dynamics of the antigen‐antibody bond.
Clinical significance of anti‐Ytb
Authors: Levy G.J. , Selset G. , McQuiston D. , Nance S.J. , Garratty G. , Smith L.E. , Goldfinger D.
Published: March 2003

Several published reports have documented the variable survival of Yt(a+) red cells (RBC) in patients with anti‐Yta as measured by 51Chromium (Cr)‐labeled RBC survival studies. Similar studies with anti‐Ytb have not been reported. A 51Cr‐labeled RBC survival study was performed using Yt(b+) RBCs and a monocyte monolayer assay in a young hemodialysis patient who required chronic transfusion therapy and who had developed anti‐Ytb. The survival of the transfused RBCs was 100 and 93 percent at 1 and 24 hours, respectively, with a half life of 21 days at termination of the study (normal, 28 to 32 days). These results showed no evidence of rapid destruction of the Yt(b+) RBCs, indicating that this patient could be transfused safely with blood from Yt(b+) donors. Long‐term survival of the 51Cr‐labeled Yt(b+) RBCs was shortened moderately, however, a finding that correlated with a slightly abnormal monocyte monolayer assay test.