bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Body Mass Index on Complications from Cardiac Surgery in the Oldest Old
Authors: Maurer Mathew S. , Luchsinger Jose A. , Wellner Rachel , Kukuy Eugene , Md Niloo M. Edwards
Published: March 2003

OBJECTIVES: Overweight (body mass index (BMI)>25) and obesity (BMI>30) are associated with adverse outcomes in the general population. In older people, an increased risk of adverse events was observed in leaner and overweight older subjects. We evaluated the association between BMI and cardiac surgery complications in subjects aged 75 and older.

DESIGN: Retrospective review of complication rates compiled as part of the New York State Department of Health Adult Cardiac Surgery Report.

SETTING: Academic tertiary care medical center.

PARTICIPANTS: One thousand four hundred forty‐eight subjects aged 75 and older who underwent cardiac surgery in an academic hospital between 1991 and 1999.

MEASUREMENTS: Subjects were divided into tertiles based on their BMI. Logistic regression was used in multivariate analyses examining the association between tertiles of BMI (<23, 23–26,>26) and complications from cardiac surgery, adjusting for age and gender or using a full model adjusting for history of diabetes mellitus, hypertension, myocardial infarction (MI), congestive heart failure, smoking, chronic obstructive pulmonary disease, peripheral vascular disease, renal disease, surgical priority, age, and gender.

RESULTS: Mean age was 79 (range 75–94); 58% of the subjects were male. The incidence of any postoperative complication, respiratory failure, or death was U‐shaped, with higher incidence in the first tertile of BMI, followed by the last tertile and then the middle tertile. Subjects in the lowest tertile of BMI in the full model had a higher adjusted risk of stroke (odds ratio (OR) = 1.58, 95% confidence interval (CI) = 0.96–2.59), bleeding (OR = 1.71, 95% CI = 0.79–3.67), respiratory failure (OR = 1.65, 95%CI = 0.95–2.87), cardiovascular complications (stroke, MI, arrhythmia) (OR = 1.59, 95% CI = 0.93–2.73), and all complications (OR = 1.45, 95% CI = 1.05–2.00) than subjects in the middle tertile. The risk of most complications in subjects in the highest tertile of BMI was similar to that of subjects in the middle tertile except for wound infections (OR = 3.51, 95% CI = 0.92–13.33). The risk of death was higher in subjects in the lower tertile of BMI (OR = 1.97, 95% CI = 1.12–3.44) than in subjects in the middle tertile. The association between BMI and adverse cardiac surgical outcomes was stronger in men than women and decreased with advancing age.

CONCLUSIONS: In the geriatric population, subjects with lower BMI have a higher risk of complications and death from cardiovascular surgery than subjects with higher BMI. An increased BMI does not increase the risk of complications from cardiovascular surgery, with the exception of wound infections.
Serum Cystatin C Concentration Compared with Other Markers of Glomerular Filtration Rate in the Old Old
Authors: Van Den Noortgate Nele J. , Janssens Wim H. , Delanghe Joris R. , Afschrift Marcel B. , Lameire Norbert H.
Published: March 2003

OBJECTIVES: To assess serum cystatin C, compared with other markers of renal function, as a marker of renal function in the old old (aged 85 and older).

DESIGN: A cross‐sectional analysis of data obtained in medically stable people aged 70 and older in a geriatric ward at a university hospital.

SETTING: University hospital in Belgium.

PARTICIPANTS: Forty‐eight patients (17 men, 31 women) mean age ± standard deviation 84.4 ± 6.3 without acute illness or overt malignancy 7 days after admission were included. Twenty‐five patients were aged 85 and older.

MEASUREMENTS: Blood samples and 24‐hour urine collections were obtained from each patient to determine serum creatinine, serum cystatin C levels, serum albumin, and creatinine clearance. Glomerular filtration rate (GFR) was estimated using the Cockcroft‐Gault formula and the Modification of Diet in Renal Study Group (MDRD) formula. On the same day, clearance of 51chromium ethylenediamine tetraacetic acid was performed in all patients as the criterion standard of GFR.

RESULTS: Serum creatinine (r = 0.68), serum cystatin C (r = 0.62), urinary creatinine clearance (r = 0.57), the Cockcroft‐Gault formula (r = 0.82), and the MDRD‐formula (r = 0.65) correlated significantly with GFR (P < .0001). Regression analysis showed that serum cystatin C and serum creatinine were comparable markers of renal function (Y = 0.442 ± 0.007 × GFR and Y = 0.494 ± 0.01 × GFR respectively). Receiver operating characteristic analysis showed a similar area under the curve for serum cystatin C and serum creatinine (P = .5) in detecting renal impairment (GFR <80 mL/min). The Cockcroft‐Gault formula provides a good estimation of GFR when the GFR is less than 60 mL/min (Y = 1.11 ± 1.04 x GFR). When the GFR is greater than 60 mL/min, the Cockcroft‐Gault formula underestimates GFR (Y = 11.01 ± 0.66 x GFR). In patients aged 85 and older, a slight decrease in GFR (51.8 ± 21.3 mL/min vs 65.2 ± 34.3 mL/min in patients aged 70–84; P = .10) is observed. This is reflected by a nonsignificant increase in serum cystatin C (P = .06), whereas serum creatinine is identical in both groups (P = .88).

CONCLUSION: Serum cystatin C, serum creatinine, the Cockcroft‐Gault formula, the MDRD formula, and urinary creatinine clearance are comparable markers of renal function in the overall older population. The Cockcroft‐Gault formula underestimates renal function in older people with GFR greater than 60 mL/min. In our study, serum cystatin C was not superior to serum creatinine in the detection of renal impairment.
Neurolysis of the Trigeminal and Sphenopalatine Ganglions
Authors: Day Miles
Published: March 2003

Abstract: Facial pain of trigeminal and sphenopalatine ganglion origin is the bain of existence for thousands of people. Treatment protocols typically begin with oral medication, usually anticonvulsants, and may progress to percutaneous and open surgical procedures. Several new medications show promise as alternatives to carbamazepine, which has been the standard first‐line treatment (trigeminal neuralgia), while electromagnetic pulsed radiofrequency and gamma knife surgery are new options when the surgical route is warranted.

This article will examine the anatomy of the trigeminal and sphenopalatine ganglions. Indications for neurolysis and neurolytic options will be discussed. Efficacy of the various neurolytic techniques will be thoroughly reviewed.
Effects of spinally delivered N‐ and P‐type voltage‐dependent calcium channel antagonists on dorsal horn neuronal responses in a rat model for neuropathy. (Department of Pharmacology, University College London, London, United Kingdom) Pain. 2001;92:233–246.
Authors: Matthews Elizabeth A. , Dickenson Anthony H.
Published: March 2003

Neuropathic pain, due to peripheral nerve damage, can include allodynia (perception of innocuous stimuli as being painful), hyperalgesia (increased sensitivity to noxious stimuli) and spontaneous pain, often accompanied by sensory deficits. Plasticity in transmission and modulatory systems are implicated in the underlying mechanisms. The Kin and Chung rodent model of neuropathy employed involved unilateral tight ligation of 2 (L5 and L6) of the 3 (L4, L5, and L6) spinal nerves of the sciatic nerve and reproducibly induced mechanical and cold allodynia in the ipsilateral hindpaw over the 14 day postoperative period. In vivo electrophysiological techniques have then been used to record the response of dorsal horn neurones to innocuous and noxious electrical and natural (mechanical and thermal) stimuli after spinal nerve ligation (SNL). Activation of voltage‐dependent calcium channels (VDCCs) is critical for neurotransmitter release and neuronal excitability, and antagonists can be antinociceptive. Here, for the first time, the effect of N‐type and P‐type VDCC antagonists (ω‐conotoxin‐GVIA and ω‐agatoxin‐IVA, respectively) on the evoked dorsal horn neuronal responses after neuropathy have been investigated. Conclude both presynaptic and postsynaptic VDCCs appear to be important.
Periradicular infiltration for sciatica: a randomized controlled trial. (University Hospital of Oulu, Helsinki, Finland). Spine. 2001;26:1059–1067.
Authors: Karppinen Jaro , Malmivaara Antii , Kurunlahti Mauno , Kyllönen Eero , Pienimäki Tuomo , Nieminen Pentti , Ohinmaa Arto , Tervonen Osmo , Vanharanta Heikki
Published: March 2003

In this study, 160 consecutive, eligible patients with sciatica who had unilateral symptoms of 1 to 6 months duration, and who never underwent surgery were randomized for a double‐blinded injection with methylprednisolone bupivacaine combination or saline. Objective and self‐reported outcome parameters and costs were recorded at baseline, at 2 and 4 weeks, at 3 and 6 months, and at 1 year. Recovery was better in the steroid group at 2 weeks for leg pain, straight leg raising, lumbar flexion, and patient satisfaction. Back pain was significantly lower in the saline group at 3 and 6 months. Sick leave and medical costs were similar for both treatments, except for cost of therapy visits and drugs at 4 weeks, which were in favor of the steroid injection. By 1 year, 18 patients in the steroid group and 15 in the saline group underwent surgery. Conclude improvement during the follow‐up was found in both the methylprednisolone and saline groups. The combination of methylprednisolone and bupivacaine seems to have a short‐term effect, but at 3 and 6 months, the steroid group seems to experience a “re‐bound” phenomenon.
Hydrogen ion maintenance improves the chemotaxis of stored granulocytes
Authors: Lane T.A. , Lamkin G.E.
Published: March 2003

Through technological advances in granulocyte collection, it has become possible to collect neutrophils (PMNs) routinely in high concentration (greater than 5 × 10(7) PMN/ml) for transfusion. Previous studies in this laboratory suggested that storage of neutrophils for transfusion at high PMN concentrations resulted in impaired adenosine triphosphate (ATP) and hydrogen ion maintenance. The studies we report here were designed to assess the effect of PMN storage at concentrations which are usual (2 × 10(7) PMN/ml), intermediate (5 × 10(7) PMN/ml), and high (8 × 10(7) PMN/ml) on chemotactic responses, and to identify variables which are easily measured and might predict the chemotactic function of stored PMNs. Granulocyte concentrates were stored in plastic bags at 2,5, and 8 × 10(7) PMN per ml, with or without 15 mM bicarbonate (HCO3). The random migration (RM) chemotaxis (CTX), ATP, and relative cell size (VOL) of the fresh and stored cells and the pH, glucose, and lactate concentrations in the supernatant medium were measured in the freshly prepared units after 24 and 48 hours storage at room temperature. We found that RM, CTX, ATP, glucose, and pH decreased significantly (p less than .02) following storage for 24 and 48 hours, particularly in units stored at the higher cell concentrations. Cell volume and lactate increased significantly with storage for 24 and 48 hours, and these values were also greater in units stored at the higher cell concentration (p less than .02).(ABSTRACT TRUNCATED AT 250 WORDS)
Platelet transfusion from donors mismatched for crossreactive HLA antigens
Authors: Dahlke MB , Weiss KL
Published: March 2003

Increments in platelet counts following the transfusion of platelets mismatched for crossreactive antigens were evaluated in 67 patients with broad alloimmunization to HLA antigens. The corrected increments following 100 HLA, A‐matched and B1U‐ or B2U‐matched transfusions were compared with the increments following 307 B1X‐ or B2X‐matched transfusions. HLA‐A3 platelets were tolerated poorly by A1 and A11 recipients, as were A1 and A11 by A3 recipients, B17 and BW21 by recipients in the B7 crossreactive group, B5 by B15 and B17 recipients, and B27 by recipients in the B5 crossreactive group. B12 and BW21, and B8 and B14 platelets were not tolerated bidirectionally. Antigens associated with good increments included A28 in A2 recipients, B18 and BW16 (C match) in recipients in the B5 crossreactive group, B5 in B18 recipients, BW22 and B7 in recipients in the B7 crossreactive group. A1 and A11 were transfused successfully bidirectionally. These observations suggest that some private antigens within crossreactive groups are more immunogenic than others and support the observation of others than B17 and BW21 are not in the B5 crossreactive group.
Quantitation of red cell‐associated IgG using an immunoradiometric assay
Authors: Jeje M. O. , Blajchman M. A. , Steeves K. , Horsewood P. , Kelton J. G.
Published: March 2003

In this report, we describe a sensitive immunoradiometric assay (IRMA) for quantitating IgG on the surface of red cells. Washed red cells were prepared to a purity of greater than 99.9 percent. Varying dilutions of these cells were incubated with a fixed concentration of 125I‐anti‐IgG. After equilibrium was achieved, the unbound 125I‐anti‐IgG was measured by the addition of IgG covalently linked to agarose beads. The red cells were lysed by detergent, and the 125I‐anti‐IgG bound to the IgG‐ beads was measured. The amount of IgG on the red cells was determined by relating the concentration of test red cells causing 50 percent inhibition of binding of the 125I‐anti‐IgG to the IgG‐beads to 50 percent inhibition of binding caused by the IgG standard. Using this assay, the red cell‐associated IgG (RCA‐IgG) of 20 healthy male and female controls with normal hemoglobin concentrations was 7.23 +/− 6.11 fg IgG per 10(3) cells (mean +/− 2 SD). The mean RCA‐IgG on washed cells from 34 different tests performed on 19 anemic patients with clinically diagnosed autoimmune hemolytic anemia was 176.1 +/− 375.6 fg IgG per 10(3) cells. There was no correlation between the levels of RCA‐ IgG and the hemoglobin levels or reticulocyte counts in these patients.
Use of prostacyclin to inhibit activation of platelets during preparation of platelet concentrates
Authors: Menitove J. E. , Frenzke M. , Aster R. H.
Published: March 2003

Increased utilization of platelet concentrates (PCs) has created the possibility that demand for this blood component may exceed supply. It seems possible that this problem could be minimized if platelets could be isolated from whole blood and stored with full retention of hemostatic effectiveness. We prepared PCs by adding prostacyclin (PGI2) during the isolation procedure and compared these to PCs prepared without addition of PGI2. At concentration 10(‐7) M, PGI2 inhibited activation of platelets during the process of concentration and resuspension by the criteria of minimal thromboxane production and release of beta thromboglobulin (beta‐TG), in contrast to concentrates prepared by standard methods. These differences persisted throughout 3 days of storage at room temperature. Our findings suggest that further studies are indicated to determine whether the quality (hemostatic effectiveness) of concentrated platelets can be improved by pharmacologic means.
Solid‐phase ABO grouping and Rh typing
Authors: Sinor L. T. , Rachel J. M. , Beck M. L. , Bayer W. L. , Coenen W. M. , Plapp F. V.
Published: March 2003

A solid‐phase adherence method (SPAM) for ABO grouping and Rh typing of red cells (RBCs) has been developed. Adherence reactions were read spectrophotometrically and interpreted by a computer. The SPAM had a 99.6 percent correlation with conventional microplate agglutination methods for ABO grouping and Rh typing. The increased sensitivity of the SPAM was demonstrated because it directly detected Du‐positive RBCs and weak subgroups of A and B.
Replacement therapy for congenital Factor X deficiency
Authors: Knight R. D. , Barr C. F. , Alving B. M.
Published: March 2003

We studied a young woman with severe (< 1%) congenital factor X deficiency during a 2‐year period in order to document the levels of factor X required to provide hemostasis for vaginal bleeding, epistaxis, and hemarthroses, as well as during surgery. Factor X levels of 9 to 17 percent, achieved with fresh‐frozen plasma (FFP) were satisfactory for minor bleeding. Hemostasis was achieved during emergency surgery for hemoperitoneum by increasing the factor X level to 35 percent with a Factor IX concentrate, followed with infusions of FFP to maintain levels between 10 and 20 percent for 6 days postoperatively. These data suggest that factor X levels of 10 to 20 percent are sufficient for hemostasis in factor X‐deficient patients even in the immediate postoperative period.
Clinically significant allo‐anti‐I in an I‐negative patient with massive hemorrhage
Authors: Chaplin H. , Hunter V. L. , Malecek A. C. , Kilzer P. , Rosche M. E.
Published: March 2003

A 37‐year‐old white man who had never been transfused was admitted as an emergency patient with a ruptured spleen and a falling hematocrit (19% on admission). All crossmatches were incompatible. His serum contained anti‐I, and his red cells (RBCs) were I‐negative and strongly i‐positive. Only 4 units of crossmatch‐compatible I‐negative frozen RBCs were available immediately. Because of the likelihood that more than 4 units would be required, chromium survival studies were performed using I‐positive cells. Samples obtained at 15 and 30 minutes after injection revealed less than 1 percent survival of the donor RBCs. He received the 4 units of I‐negative RBCs during the operation in addition to reinfusion of RBCs harvested from 1800 ml of blood aspirated from the abdominal cavity. The postoperative hematocrit remained greater than 30 percent and the bilirubin less than 1.5 mg per dl. Before recommending frozen storage of autologous RBCs, 51Cr labeled I‐positive RBCs from the patient's daughter (obligate li heterozygote) were infused. Survival was 100 percent at 15 and 30 minutes, 90 percent at 3 hours, 85 percent at 26 hours; the remaining RBCs disappeared at a normal rate (T½2 27 days) over the succeeding 2 weeks. A repeat 51Cr‐labeled RBC study with the original I‐positive donor confirmed greater than 92 percent destruction in 90 minutes. The clinical significance of this allo‐anti‐I (apparently primarily against RBCs from homozygous I‐positive donors) is in marked contrast to reported findings with auto‐anti‐I antibodies.
Selective absence of immunoglobulin A1 or A2 among blood donors and hospital patients
Authors: Ozawa N. , Shimizu M. , Imai M. , Miyakawa Y. , Mayumi M.
Published: March 2003

A hemagglutination inhibition assay was developed for the determination of immunoglobulin A1 and A2 (IgA1 and IgA2) with subclass‐specific rabbit antiserums. Among 93,020 apparently healthy blood donors, selective absence of IgA1 was found in six and that of IgA2 in 15, at a prevalence much higher than the absence of total IgA that was revealed by only one donor. Among 6800 hospital patients with various disorders, the absence of IgA1 was found in one with breast cancer and that of IgA2 in two with rheumatoid arthritis.
A potent cold autoagglutinin that recognizes Type 2H determinant on red cells
Authors: Uchikawa M. , Tohyama H.
Published: March 2003

An example of an IgM (lambda) cold autoagglutinin against a Type 2H determinant of the ABO blood group system is described. The direct antiglobulin test was positive due to C3d on the patient's red cells. The antibody in the patient's serum was active at 37°C, and the degree of agglutination was almost the same at 37 and 4° C. It agglutinated group O red cells preferentially, but not Bombay (Oh) red cells. The specificity was determined by adsorption with synthetic oligosaccharide immunoadsorbent.
Bacterial sepsis secondary to platelet transfusion: an adverse effect of extended storage at room temperature
Authors: BRAINE H.G. , KICKLER T.S. , CHARACHE P. , NESS P. M. , DAVIS J. , REICHART C. , FULLER A.K.
Published: March 2003

ABSTRACT: In a 3‐month period four episodes of bacterial sepsis related to contaminated random donor platelet concentrates were observed. Evaluation incriminated extended (5 or more days) platelet storage. To determine if platelets stored for longer periods were likely to have greater bacterial contamination, platelet concentrates were innoculated with bacteria and daily quantitative bacteriology was performed. In vitro studies using polyolefin bags indicated contamination could occur with a single organism of Staphylococcus epidermidis. By 72 hours, platelet concentrates contained from 103 to 108 organisms per 0.1 ml depending on the inoculum size. By 6 days all inoculated units contained 107 to 109 organisms per 0.1 ml.
Platelet adherence and phagocytosis
Authors: MacPherson B. R. , Cornish N.
Published: March 2003

An assay was developed to identify platelet antibodies based on the adherence and phagocytosis of sensitized platelets by blood monocytes. Platelets obtained from normal HLA‐typed donors were labeled with carboxyfluorescein diacetate (COFDA), fixed in paraformaldehyde, and sensitized with antibody. T cell‐depleted mononuclear cells (MNCs) were mixed with antibody‐sensitized platelets. Following an incubation phase, monocytes were isolated by adherence to glass tissue culture slides. Phagocytosis and adherence were evaluated by fluorescence microscopy. Thirteen of 18 donor‐specific HLA antibodies and four of six sera from patients with chronic immune thrombocytopenic purpura enhanced platelet uptake. This assay was useful in detecting allo‐ and autoantibodies directed against platelets and may be valuable in investigating the pathophysiology of macrophage‐mediated platelet destruction.
Emm
Authors: Daniels G. L. , Taliano V. , Klein M. T. , McCreary J.
Published: March 2003

Anti‐Emm, an antibody to a public red cell antigen, was found in the serums of four Emm‐propositi and in the serum of the Emm‐brother of one of them. Three of the propositi were men, and their antibodies, as well as that of the compatible brother, were believed to be “naturally occurring.” Since there are two Emm‐siblings in one family, Emm is probably an inherited characteristic.
Protein changes occurring during storage of platelet concentrates
Authors: Snyder E. L. , Dunn B. E. , Giometti C. S. , Napychank P. A. , Tandon N. N. , Ferri P. M. , Hofmann J. P.
Published: March 2003

The changes in thrombocyte proteins during 22 degrees C storage of platelet concentrates (PC) were studied. To prepare a reference protein “map” of stored PC, platelet samples were taken on days 1, 7, and 21. The platelet proteins were separated by isoelectric focusing (first‐ dimension) followed by second‐dimension polyacrylamide gradient gel electrophoresis with sodium dodecylsulfate (2D). The silver‐stained gels were analyzed by computer to obtain a composite map of stored PC proteins. The pattern seen on day 1 changed during 7 days of storage, with 30 proteins increasing or decreasing in spot density. In general, the spot density for lower‐molecular‐weight proteins increased, whereas that for higher‐molecular‐weight proteins decreased. Membrane proteins of intact fresh and stored platelets were labeled with 3H using sodium metaperiodate‐[3H]NaBH4 and with 125I using lactoperoxidase‐H2O2. A comparison on the fluorographs of 2D gels of [3H]NaBH4‐labeled platelet proteins showed several protein spots in the stored Day 7 sample that had not been seen in the Day 1 sample. Similarly, for the autoradiographs, several 125I‐labeled proteins detected in Day 7 PC were not seen in the Day 1 samples. The results provide evidence that platelet proteins are altered during PC storage and that these changes involve platelet membrane proteins.
‘Immune complex’ mediated intravascular hemolysis due to IgM cephalosporin‐dependent antibody
Authors: Salama A. , Gottsche B. , Schleiffer T. , Mueller‐Eckhardt C.
Published: March 2003

Immune hemolytic anemia (IHA) related to cephalosporins is rare and generally considered to be the result of a drug‐adsorption mechanism. In previously reported cases, the hemolysis was usually extravascular and the causative antibodies were IgG, incapable of activating complement, and demonstrable by the direct or indirect antiglobulin test using red cells (RBCs) pretreated in vitro with cephalosporin. The authors report a patient in whom acute intravascular hemolysis developed while she was receiving cefotaxime (a cephalosporin as yet not reported to cause IHA). The patient's RBCs were coated only with complement fragments (C3d), even at the peak of the hemolytic episode. Her serum and eluates repeatedly yielded negative results when tested against normal or cephalosporin‐coated RBCs. However, strong hemagglutination and C5b‐9‐mediated hemolysis were observed if the patient's serum was tested against RBCs in the presence of the drug, its ex vivo antigen and, to a lesser degree, cephalothin and ceftriaxon, but not in the presence of penicillin and other related cephalosporins. The positive reactions were not changed by preincubating the serum with different amounts of the drugs. All of these findings reflect the typical picture of drug‐induced IHA by the so‐called “immune complex” mechanism and not by the drug‐adsorption mechanism. The authors conclude that cephalosporin can cause immune hemolysis in two ways: the drug‐adsorption mechanism and, as described here, the “immune complex” mechanism.
Superoxide generation and cytotactic response of irradiated neutrophils
Authors: Eastlund D.T. , Charbonneau T.T.
Published: March 2003

Irradiation of blood components has been used to prevent transfusion‐related graft‐versus‐host disease (GVHD) in immunocompromised patients. This study was designed to determine the effect of irradiation on neutrophil aggregation, chemotaxis, and superoxide generation. Purified neutrophils were irradiated with a Cesium source at four doses ranging from 0 to 17,500 rads. Formyl‐methionyl‐leucyl‐phenylalanine (FMLP) and zymosan‐treated serum (ZTS) cytotaxin‐induced chemotaxis and migration were determined in the agarose assay. Neutrophil aggregation to FMLP was determined by aggregometry. Superoxide generation and random migration were not affected by irradiation at doses up to 17,500 rads. When compared to nonirradiated controls, the chemotactic response to ZTS remained normal, with an insignificant decline from 174 ± 31.0 to 150 ± 42.3 (mean ± SD) units. The chemotactic response to FMLP declined insignificantly, from 228 ± 31.3 at 0 rad to 207 ± 26.4 at 17,500 rads. The aggregation response to FMLP remained within the normal range but declined from 0.78 ± 0.11 to 0.61 ± 0.18. At the radiation doses currently used to reduce the risk of transfusion‐related GVHD, neutrophil superoxide generation and chemotactic response remain essentially normal.
Methods for the detection of Jk heterozygotes: interpretations and applications
Authors: Edwards‐Moulds J. , Kasschau M. R.
Published: March 2003

The lytic properties of red cells from Jk(a+,b+), Jk(a−, b+) and Jk(a+b−) (normal), Jk(a−b−), and obligate Jk heterozygotes were studied. The Jk(a−b−) cells did not hemolyze for at least 15 minutes in either 2 M urea or methylurea, whereas normal cells were completely hemolyzed in 2 minutes. Red cells from Jk heterozygotes demonstrated intermediate levels of hemolysis when compared to normal and Jk(a−b−) red cells. In addition, these cells had less than 10 percent hemolysis when suspended in 2 M methylurea prepared in 0.4 percent phosphate‐buffered saline (pH 7.2). This method may be an alternative to hemagglutination titration scoring for the detection of Jk, especially in paternity cases.
Frequency of platelet‐specific antigens PlA1, Baka, Yuka, Yukb, and Bra in South American (Mapuches) Indians
Authors: Inostroza J. , Kiefel V. , Mueller‐Eckhardt C.
Published: March 2003

One hundred twelve unrelated Mapuches Indians from the area of Temuco, Chile were studied for the prevalence of five platelet‐specific antigens. The prevalences found were: PlA1 (Zwa), > 99 percent; Baka, 89.3 percent; Yuka (Penb), 0.9 percent; Yukb (Pena), > 99 percent; and Bra, 4.9 percent.
An application of immunoblotting in the classification of the Miltenberger series of blood group antigens
Authors: King M. J. , Poole J. , Anstee D. J.
Published: March 2003

A simple scheme is described for the classification of Miltenberger cell classes I to VI, which is consistent with the serologic definition of the determinants. The scheme is based on the reaction patterns obtained by immunoblotting the normal and abnormal sialoglycoproteins (SGPs) found in these cells with several murine monoclonal antibodies that recognize different epitopes on α‐SGP (Glycophorin A). The abnormal α found in Mil and Mill cells is easily identified with these antibodies, as is the abnormal α‐Δ SGP found in MiV cells. Certain α‐SGP antibodies recognize epitopes on the abnormal SGPs found in MiIII, MiIV, and MiVI cells, although the mode of inheritance of these abnormal SGPs suggests that they are related to Δ‐SGP (Glycophorin B). Antibody R18 reacts with the abnormal SGP of Milll cells but not that of MiIV or MiVI cells, whereas antibody BRIC 119 reacts with MiIII, MiIV, and MiVI cells. None of the abnormal components in these three cell classes react with antibody R10 or with an antibody (BRIC 163) that recognizes an epitope on the cytoplasmic portion of α‐SGP. The immunostaining of membranes from persons heterozygous for the MiVII and MiVIII classes revealed patterns identical to those of normal red cell membranes. However, antibody R18 did not react with any of the SGP components of homozygous MiVII cells.
Use of Indium‐ 111 as a red cell label
Authors: AuBuchon J. P. , Brightman A.
Published: March 2003

To select the most promising 111In chelate for use as a second red cell (RBC) label for comparison of the survival of autologous and allogeneic cells, 49 normal RBC samples were studied in vitro after being labeled with 111In‐8‐hydroxyquinolinol (111In‐oxine) prepared by three different methods, 111In‐tropolone, and 111In‐acetylacetone. Labeling efficiencies reached 99 percent and did not decline when the amount of 111In used was increased from 1.75 to 50 μCi per ml of RBCs. Storage of labeled RBCs in normal AB plasma at 4, 22, and 37°C for up to 48 hours resulted in a similar rate of loss of the label from the RBCs with all labeling methods. These rates were time‐ and temperature‐dependent and were accurate predictions of the rates found in later in vivo experimentation. Fresh RBCs from 11 subjects were labeled with 111In chelated with oxine in the presence of the RBCs or chelated with tropolone just prior to the labeling. RBC mass determinations using these autologous RBCs labeled with 111In accurately reflected the subjects' RBC masses as predicted through standard morphometric formulae. The rate of disappearance of the radionuclide after reinfusion of the autologous RBCs decreased with time. At 24 hours after reinfusion, 89.5 ± 1.29 percent (mean ± SEM) of the 111In‐tropolone and 87.3 ± 1.25 percent of the 111In‐oxine continued in circulation. 111In is a simple and efficient agent for the labeling of RBCs for blood volume determinations and short‐term survivals.
A model to determine required pool size for HLA‐typed community donor apheresis programs
Authors: Bolgiano D. C. , Larson E. B. , Slichter S. J.
Published: March 2003

Community donor plateletpheresis programs must have adequate numbers of HLA‐typed donors to support the transfusion needs of alloimmunized patients, and donor pool size calculations should reflect the fact that each patient needs more than one donor to provide his or her support. The average number of donors needed to provide a patient's support was estimated as a function of donor usage and commitment. A model was developed for determining an appropriate size of the donor pool for a community donor plateletpheresis program that would incorporate the average number of donors needed per patient, the level of HLA compatibility to be maintained between patient and donor, and the frequencies of patient and donor HLA phenotypes. A database of 4338 plateletpheresis transfusions given to 591 patients from a pool of up to 870 community donors over a 3‐year period was analyzed retrospectively to validate the estimates of the average number of donors needed to support a patient, which ranged from 4 to 33 donors. This database was also used to illustrate the application of the pool size determination model. Model results suggest that plateletpheresis donor pools of 1000 to 3000 donors are capable of meeting the transfusion needs of most patients at an HLA‐match grade of B2 or better.
Impact of explicit questions about high‐risk activities on donor attitudes and donor deferral patterns. Results in two community blood centers
Authors: SILVERGLEID A.J. , LEPARC G.F. , SCHMIDT P.J.
Published: March 2003

Abstract: Concern about the ineffectiveness of indirect questioning of donors about participation in activities with a high‐risk of exposure to human immunodeficiency virus (HIV) led our two community blood centers independently to begin direct and explicit questioning of donors about such activities. The impact of direct questioning was assessed via a donor attitude survey and by comparing the number of donors deferred for a positive response to a direct verbal question with the number previously deferred for a positive response to indirect questions. Our donor attitude survey indicated 90% donor approval of direct questioning, and analysis of donor deferral patterns indicated almost a five‐fold increase in the number of donors deferred for participation in high‐risk activities. Our experience documents the acceptability of direct questioning of donors and indicates that such questioning may well have a positive impact on blood safety.
Heterogeneity of anti‐U demonstrable by the use of papain‐treated red cells
Authors: IssittPhD P. D. , Marsh W. L. , Wren M. R. , Theuriere M. , Mueller K.
Published: March 2003

When red cells (RBCs) are treated with papain, one form of the U antigen, which we have named UPS (U papain‐sensitive), is almost completely removed or denatured. A second form, UPR (U papain‐resistant), remains unaltered on the treated RBCs. Tests on 42 examples of anti‐U showed that two contained only anti‐UPS, 19 contained only ‐UPR, and 21 contained separable ‐UPS and ‐UPR. In those sera containing both antibodies, anti‐UPR was always the stronger of the two. These findings suggest 1) that UPS is located on the Ss sialoglycoprotein (glycophorin B) at a position distal to a papain‐sensitive site or that the cleavage point is within the portion of the SGP that comprises UPS, and 2) that UPR is located between the papain‐sensitive site and the RBC membrane. The UPS determinant was not denatured by neuraminidase, L‐cysteine, trypsin, ficin, or α‐chymotrypsin, and it was only partially denatured by pronase. The finding that RBCs treated with para‐chloromercuribenzoic acid or para‐chloromercuriphenyl sulfonic acid did not react with anti‐UPR but did continue to react with anti‐UPS suggests that the in situ configuration of UPR, but not UPS, is dependent on the presence of one or more disulfide bonds. RBCs of the S−s−U+(weak) phenotype were shown to carry markedly reduced amounts of both UPS and UPR.
Establishment of a schedule of optimal preoperative collection of autologous blood
Authors: Axelrod F. B. , Pepkowitz S. H. , Goldfinger D.
Published: March 2003

Autologous blood donation prior to elective surgery can protect patients from unnecessary exposure to allogeneic blood. However, the inappropriate use of autologous blood programs, which results in the collection of excessive quantities of blood or of the collection of any blood prior to low‐risk surgical procedures, can be wasteful and potentially hazardous. All patients donating autologous blood at a large institution during a period of three months were studied in an effort to develop a schedule of optimal preoperative collection of autologous blood (SOPCAB), which is similar to a maximum surgical blood order schedule. Some 461 consecutive autologous donations from 264 patients were investigated. For certain surgical procedures, primarily the cardiac and orthopedic procedures, undercollection appeared to be the most common problem. For other procedures (laminectomies, nasal surgery), overcollection was more common. A model is presented for the careful scrutiny of autologous blood collection and use to allow for the creation of a SOPCAB for patients undergoing elective surgery.
Survival of Borrelia burgdorferi in human blood stored under blood banking conditions
Authors: Nadelman R. B. , Sherer C. , Mack L. , Pavia C. S. , Wormser G. P.
Published: March 2003

Hematogenous dissemination of organisms occurs in many spirochetal diseases, including Lyme disease and syphilis. Although syphilis has been transmitted by transfusion, in the vast majority of cases, only fresh blood products were involved, in part because Treponema pallidum survives poorly when refrigerated in citrated blood. Because of the rising incidence of Lyme disease in certain areas, whether its causative agent, Borrelia burgdorferi, could survive under blood banking conditions was studied. Dilutions of stock cultures of two strains of B. burgdorferi were inoculated into samples of citrated red cells (RBCs). Viable spirochetes were recovered from RBCs inoculated with 106 organisms per mL, after refrigeration for as long as 6 weeks. It is concluded that B. burgdorferi may survive storage under blood banking conditions and that transfusion‐related Lyme disease is theoretically possible.
Donor selection for alloimmunized patients by platelet crossmatching of random‐donor platelet concentrates
Authors: O'Connell B. A. , Schiffer C. A.
Published: March 2003

Samples obtained from bag segments of stored platelet concentrates (PCs) were crossmatched with sera from alloimmunized patients to identify potentially compatible donors. Sera from 41 patients who were refractory to random‐donor platelet transfusions were tested. All sera had lymphocytotoxic antibody (LCTAb), and 37 patients had LCTAb that reacted strongly against >75 percent of the cells in the panel. At least 18 units of PCs were tested per patient. Sera from 33 patients were tested by microenzyme‐linked immunosorbent assay (microELISA). Crossmatches with 703 (74 percent) of 944 PCs were positive, 23 percent were negative, 3 percent were indeterminate. Eight additional patients were also tested with a solid‐phase system; 352 (85 percent) of 417 crossmatches were positive and 15 percent were negative. Patients with more reactive LCTAb had very few (often 0–2) in vitro compatible units. Thirty‐four transfusions of pooled compatible PCs, all stored <3 days, were administered to clinically evaluable patients. Six of 20 transfusions selected by microELISA produced satisfactory increases (corrected count increments [CCIs] >7500) 10 minutes after transfusion in 4 of 14 patients. Eight of 14 transfusions selected by solid‐phase produced CCIs >7500 in 5 of 8 patients. Although it is difficult to select large numbers of compatible units for heavily alloimmunized patients by these techniques, some transfusions were successful in patients who had very few HLA‐compatible donors. This approach may be of particular value in emergency situations.
BLOOD SCREENING FOR NON‐A, NON‐B HEPATITIS BY HEPATITIS C VIRUS ANTIBODY ASSAY
Authors: KATAYAMA T. , KIKUCHI S. , TANAKA Y. , SAITO I. , MIYAMURA T. , CHOO Q.‐L. , HOUGHTON M. , KUO G.
Published: March 2003

ABSTRACT: Hepatitis C virus (HCV) antibody was detected in 1499 donor sera by radioimmunoassay using an antigen expressed in yeast from a cDNA clone of the HCV genome. Eighteen samples over 4200 counts per minute (cpm) were considered to contain infectious HCV because these recipients developed typical posttransfusion non‐A,non‐B hepatitis after transfusion. The antibody‐positive sera were all within the normal range of ALT levels. This assay system is thus useful for the screening for blood transfusion.
Prenatal identification of potential donors for umbilical cord blood transplantation for Fanconi anemia
Authors: Auerbach A. D. , Liu Q. , Ghosh R. , Pollack M. S. , Douglas G. W. , Broxmeyer H. E.
Published: March 2003

Reported here are studies of Fanconi anemia fetal cells that led to the first use of umbilical cord blood for hematopoietic reconstitution in a clinical trial. Prenatal diagnosis and HLA typing were performed in fetuses at risk for Fanconi anemia (FA) to identify, prior to birth, those that were unaffected with the syndrome and were HLA‐identical to affected siblings. Umbilical cord blood was harvested at the delivery of these infants; assays of progenitor cells indicated the presence of colony‐forming units‐granulocyte‐macrophage (CFU‐GM) in numbers similar to those of bone marrow CFU‐GM that are associated with successful engraftment in HLA‐matched allogeneic bone marrow transplantation. The possibility that umbilical cord blood from a single individual can be used as an alternative to bone marrow for hematopoietic reconstitution has now been demonstrated by the successful engraftment of two patients with FA. Progenitor cell assays of umbilical cord blood collected at the birth of a child affected with FA, who had been misdiagnosed on the basis of chorionic villus sampling (CVS) studies, indicated a profound deficiency in colony formation, consistent with previously reported abnormalities in the growth of FA cells in vitro. These results suggest that the hematopoietic disorder in FA is related to an underlying problem with cell proliferation.
Evaluation of the manual hexadimethrine bromide (Polybrene) technique in the investigation of autoimmune hemolytic anemia
Authors: Owen Irene , Hows J.
Published: March 2003

The use of the direct manual hexadimethrine bromide (Polybrene) test (DPT) in the investigation of patients for autoimmune hemolytic anemia (AIHA) was evaluated. Seventy‐nine blood samples from 68 patients were tested. A direct antiglobulin test (DAT) using monospecific reagents and the DPT were performed, and a concentrated ether eluate was tested. The DAT was positive in 62 (78%) of 79 patients and negative in 17 (22%). There is a good correlation among DAT, eluate, and DPT in demonstrating the presence of immunoglobulin on the red cell surface. In contrast, the DPT does not detect C3d and is often negative in cases of AIHA in which C3d alone is demonstrated by the DAT. In DAT‐negative cases, DPT results correlated with reactive eluates. However, in four cases of steroid‐responsive, DAT‐negative hemolytic anemia, the DPT supported the diagnosis of AIHA when the eluate did not react. The DPT is a useful additional screening test for the investigation of AIHA, but it is not recommended as a replacement for either eluate testing or the DAT.
Evaluation of the red cell storage lesion after irradiation in filtered packed red cell units
Authors: Hillyer CD , Tiegerman KO , Berkman EM
Published: March 2003

Packed red cell units (n = 10) were filtered and divided equally. One‐ half unit from each donor was irradiated (x) (3500 cGy). On Days 0, 14, 28, and 42, ATP, K+, Na+, lactate dehydrogenase (LDH), plasma‐free hemoglobin (PFH), and pH were determined. The reduction in ATP was greater in the irradiated than the nonirradiated (y) units by Day 42 (mean x−y: −70, p = 0.0005). The increase in K+ was greater in the irradiated than nonirradiated units on Days 14, 28, and 42 (mean x−y: 17−20, p = 0.0001). Decrease in pH and increases in LDH and PFH were significant (p less than 0.05) on Day 42 only. K+ increases added only 1.7 to 2.0 mmol per unit, a difference felt to be clinically insignificant. The changes noted in ATP, pH, LDH, and PFH are significant but minimal on Day 42 and imply that viability changes would also be minimal. These biochemical data support the storage of irradiated units for at least 28 days.
A rapid screening test for detection of IgA deficiency
Authors: Schulenburg B.J. , Plapp F.V. , RachelMT(ASCP)MA J.M.
Published: March 2003

A solid‐phase red cell adherence (SPRCA) assay has been developed to screen blood donors for IgA deficiency, and 6117 donor sera have been screened by this method. Eighteen sera were found to be IgA deficient, which represents a frequency of 1 in 340. Seventeen of these sera were retested by passive hemagglutination inhibition, which has a sensitivity of approximately 0.1 mg per dL. Eight sera were confirmed as IgA deficient, and nine were found to contain low levels of IgA (< 1 mg/dL). The approximate sensitivity of the SPRCA assay is 1 mg per dL. The speed, simplicity, and sensitivity of this assay make it a good alternative to conventional methods of screening.
Suitable survival and half‐life of red cells after frozen storage in excess of 10 years
Authors: Umlas J. , Jacobson M. , Kkevy S.V.
Published: March 2003

To examine the appropriateness of the Food and Drug Administration's 10‐year storage time for previously frozen red cells, 24‐hour posttransfusion survival studies were performed, and the half‐life of 3 units of autologous red cells that had been stored for 13.5, 14, and 17 years, respectively, was measured. The units had acceptable freeze‐thaw‐ wash recovery (83.3–91.4%). When a 51Cr label was used for the previously frozen red cells and a simultaneous 52Cr label for freshly drawn autologous red cells was used as a comparison, it was seen that the previously frozen cells had normal 24‐hour posttransfusion survival (75.1–88.4%) as well as normal half‐life (23–33.7 days). These findings support further extension of the maximum allowable storage time for previously frozen red cells.
Moderate and severe reactions in blood donors
Authors: Kasprisin D. O. , Glynn S. H. , Taylor F. , Miller K. A.
Published: March 2003

During the period April 1985 to March 1986, 217 blood donors were found to have moderate (syncopal) to severe (convulsive) reactions. This population was compared to 5630 randomly selected donors who did not have reactions. An examination of demographic, physical, and societal/emotional factors was conducted to determine if any were predictive of reactions in donors. The results of the research supported the hypothesis that first‐time donors have a higher frequency of reactions (1.7%) than do repeat donors (0.19%). A review of the above predictive factors documented that, with regard to demographic factors, 1) the number of prior donations was inversely proportional to the risk of reaction; 2) the gender of the donor was not predictive; and 3) youth was a predictor of reactions. An analysis of the physical factors revealed that donors who reacted were of lower weight (mean, 153.7 lb) than those who did not (mean, 166.4 lb) and that systolic blood pressure was slightly lower in the group with reactions. Although the difference was significant (3 torr), it was not thought to be significant clinically. In a comparison of a group with systolic blood pressure ranging from 80 to 100 torr and a group with systolic blood pressure ranging from 120 to 140 torr, the first group had a 70‐percent higher risk of reaction. Finally, with regard to the last category of societal or emotional factors, the research demonstrates 1) that the ingestion of caffeinated beverages was associated with a reduced risk of reactions; 2) that the food intake of donors who reacred was significantly different from that of those who had no reaction, but this difference was not thought to be clinically significant; and 3) that the duration between registration and the onset of phlebotomy was directly predictive of reaction status. The research indicates that first‐time donor status and several specific demographic, physical, and societal or emotional factors are predictors of donor reactions.