bluuebunny/crossref_metadata_2025 huggingface dataset:
Popular Views of Old Age in America, 1900–1950
Authors: Hirshbein Laura Davidow
Published: March 2003

The aging of the American population has significantly changed medical practice over the last century. As is well known, life expectancy first began to increase dramatically in the late 19th century, but at the same time that the numbers of older people have been increasing, the social and cultural meanings of growing old have also changed. It is likely that different cohorts of older people have had different experiences with old age because of the time periods they lived through. This paper offers one way to look at some of the historical changes that have affected the public and the medical profession on the subject of old age by looking at old age through American popular literature in the first half of the 20th century in three overlapping time periods. In the first three decades of the century, the concept of old age was widely defined, and older people (rather than physicians) were the principal authorities in describing the qualities of old age. In the third and fourth decades of the century, the idea of old age was starting to acquire increasing negative connotations, but chronological age itself did not signal the beginning of old age. However, by the late 1930s and 1940s, old age became widely viewed as a specific social and medical problem to be addressed by professionals, and older people had become a recognizable population, with a variety of groups organized around their care. This paper illustrates changes in American understandings of old age within and without the medical profession and suggests ways in which popular conceptions of old age might continue to shift and affect how physicians take care of their older patients in the future.
Medical Mistakes and Older Patients: Admitting Errors and Improving Care
Authors: Kapp Marshall B.
Published: March 2003

The topic of medical errors has received substantial professional and public attention over the past few years. However, very little of this attention has focused specifically on the implications of this problem for older patients or on the healthcare professionals and settings specifically serving them. This article examines some of the most salient of those implications, with particular emphasis on the physician's ethical duty to admit and address errors. Practical obstacles, including physicians' legal anxieties, to admitting and thereby reducing and mitigating medical errors are outlined, along with potential strategies for effectively addressing and overcoming those barriers.
A Decision Aid for Long‐Term Tube Feeding in Cognitively Impaired Older Persons
Authors: Mitchell Susan L. , Tetroe Jacqueline , O'Connor Annette M.
Published: March 2003

OBJECTIVE: To describe the development and evaluation of a decision aid for long‐term tube feeding in cognitively impaired older people.

DESIGN: Before‐and‐after study.

SETTING: Acute care hospitals in Ottawa, Canada.

PARTICIPANTS: Substitute decision makers for 1.5 cognitively impaired inpatients 6.5 years and older being considered for placement of a percutaneous endoscopic gastrostomy tube.

MEASUREMENTS: Questionnaires were used to compare the substitute decision makers' knowledge, decisional conflict, and predisposition regarding feeding tube placement before and after exposure to the decision aid. The acceptability of the decision aid was also assessed.

RESULTS: Substitute decision makers significantly increased their knowledge (P= .004) and decreased their decisional conflict (P= .004) regarding long‐term tube feeding after using the decision aid. The impact of the decision aid on predisposition toward the intervention was greatest for those who were unsure of their preferences at baseline. All substitute decision makers found the decision aid helpful and acceptable despite very difficult and emotional circumstances.

CONCLUSIONS: A decision aid improves the decisionmaking process for long‐term tube feeding in cognitively impaired older patients by decreasing decisional conflict and by promoting decisions that are informed and consistent with personal values. There are particular challenges for developing and evaluating these tools in the context of end‐of‐life decisions.
The Effects of Mammographic Detection and Comorbidity on the Survival of Older Women with Breast Cancer
Authors: McPherson Carol P. , Swenson Karen K. , Lee Martin W.
Published: March 2003

OBJECTIVES: To determine an upper age limit or quantifiable level of comorbidity that would render mammography screening ineffectual in decreasing mortality in women aged 65 and older.

DESIGN: Retrospective cohort study.

SETTING: Upper midwestern United States.

PARTICIPANTS: Five thousand one hundred eighty‐six predominantly Caucasian women aged 65 to 101 diagnosed with invasive breast cancer from 1986 through 1994. Data were obtained from The Upper Midwest Tumor Registry System, a regional consortium database in Minnesota, North Dakota, and South Dakota.

MEASUREMENTS: Relative risks (RRs) of death were computed for patients with mammographically detected tumors, stratified by age and comorbidity. Survival analysis was performed, stratified by level of comorbidity and method of tumor detection.

RESULTS: Patients with mammographically detected tumors and no comorbidity experienced significantly lower RRs of death in every age group (range P < .001 to P = .039). Women with mammographically detected tumors and mild to moderate comorbidity had RRs of death as follows: age 65 to 69 (RR = 0.32, 95% confidence interval (CI) = 0.15–0.69), age 70 to 74, (RR = 0.45, 95% CI = 0.22–0.91); age 75 to 79 (RR = 0.47, 95% CI = 0.25–0.88), age 80 and older (RR = 0.52, 95% CI = 0.33–0.80). Women with severe or multiple comorbidities experienced no improvement in survival with mammographically detected tumors.

CONCLUSIONS: Mammographic detection of breast cancer may be associated with a significantly decreased risk of death for older women of all ages, even for women with mild to moderate levels of comorbidity, but for older women with severe or multiple comorbidities, mammography is not associated with improvement in overall survival.
Tuberculosis in Older People: A Retrospective and Comparative Study from Hong Kong
Authors: Leung Chi C. , Yew Wing W. , Chan Chi K. , Chau Chi H. , Tam Cheuk M. , Lam Chak W. , Tam Wai O. , Lau Kam S. , Liu Wai T.
Published: March 2003

OBJECTIVES: To compare tuberculosis (TB) in older and younger patients.

DESIGN: A retrospective and comparative observational study.

SETTING: Four chest clinics and two chest hospitals in Hong Kong.

PARTICIPANTS: All notifications from the participating hospitals and clinics in 1996 were extracted from the TB notification registry. The characteristics of patients aged 65 and older were compared with a one‐in‐three random sampling of those aged 16 to 64.

MEASUREMENTS: Demographic, clinical, radiological, and laboratory data of the two groups were compared alongside treatment and outcomes.

RESULTS: Older people with TB were more likely to be male, to smoke, to have had TB previously, to have coexisting medical diseases, to be socioeconomically disadvantaged, and to weigh less than younger people with TB. Dyspnea, weight loss, and malaise were more common, whereas extrathoracic lymph node enlargement was less common. Chest radiograph showed more extensive disease and lower zone involvement. Positive tuberculin test was present in only 61.9%. Sputum bacteriology was more likely to be positive. There was a longer delay in presentation and commencement of treatment, and 77.2% required at least one admission. Adverse effects of treatment, notably hepatic dysfunction, occurred more commonly. Fluoroquinolones appeared well tolerated. Only 72.5% of the older people were cured or completed their treatment. Mortality was 16%. Age of 65 and older, comorbidity, socioeconomic disadvantage, moderate‐extensive disease, positive sputum smear, and poor adherence were factors independently associated with unfavorable outcomes (P < .001 to P = .01; odds ratios = 1.61–27.02).

CONCLUSION: Substantial differences were found between older and younger TB patients. Many of these were associated with unfavorable outcome. Increased awareness in disease recognition and better medical and social support are therefore needed in addressing the growing problem of TB in older people.
Corrected Arm Muscle Area: An Independent Predictor of Long‐Term Mortality in Community‐Dwelling Older Adults?
Authors: Miller Michelle D. , Crotty Maria , Giles Lynne C. , Bannerman Elaine , Whitehead Craig , Cobiac Lynne , Daniels Lynne A. , Andrews Gary
Published: March 2003

OBJECTIVES: Older people are at risk of undernutrition because of a number of physiological conditions and lifestyle factors. The purpose of this study was to explore the predictive relationship of corrected arm muscle area (CAMA) with 8‐year mortality in a representative sample of older Australians.

DESIGN: Prospective cohort study: The Australian Longitudinal Study of Ageing.

SETTING: Community.

PARTICIPANTS: One thousand three hundred ninety‐six participants aged 70 and older.

MEASUREMENTS: Trained observers measured baseline weight, height, mid upper arm circumference, and triceps skinfold thickness using standard techniques. Body mass index (BMI) and CAMA were calculated. Baseline BMI and CAMA measurements were categorized according to cutoff values proposed by Garrow et al. and Friedman et al., respectively. Subsequent analyses were undertaken using Cox proportional hazards regression.

RESULTS: After adjustment for potential confounders (baseline age, gender, marital status, smoking, self‐rated health, ability to conduct activities of daily living, comorbidity, cognition performance, and presence of depression), those older Australians with a low CAMA (≤21.4 cm2 for men and ≤21.6 cm2 for women) had an increased risk of mortality at 8‐year follow‐up (hazard ratio = 1.94, 95% confidence interval = 1.25–3.00, P = .003). There was no increased risk in 8‐year mortality identified for those with a high or low BMI.

CONCLUSION: CAMA is a useful assessment of undernutrition in older adults that has better prognostic value than BMI in predicting death in older, community‐living Australians.
Prescription Drug Costs for Dually Eligible People in a Medicaid Home‐ and Community‐Based Services Program
Authors: Phillips Victoria L. , Atherly Adam
Published: March 2003

This study examined the prescription drug costs of Medicare beneficiaries participating in a Medicaid home‐ and community‐based services (HCBS) program and discussed possible implications of providing a prescription drug benefit under Medicare. The study examined Medicaid pharmaceutical claims data using two random samples (n = 766) of dually eligible Medicare beneficiaries in a HCBS program from four regions in Georgia. The average total monthly Medicaid prescription drug expenditure was determined.

Annual prescription expenditures for this group averaged more than $1,500 per person. Prescription drugs intended for the treatment of cancer and circulatory disorders combined to account for 61% of total program drug expenditures. Multivariate analysis found that drug expenditures were higher for those who died during the observation period, the young‐old, Caucasians, and those who self‐selected into the program. Higher drug expenditures for the self‐selected group, even after frailty adjustments, suggest the presence of adverse selection. Medicare prescription drug benefit proposals that rely on voluntary enrollment may also experience adverse selection from frail, low‐income beneficiaries.
The Relationship Between Weight Loss and All‐Cause Mortality in Older Men and Women With and Without Diabetes Mellitus: The Rancho Bernardo Study
Authors: Wedick Nicole M. , Barrett‐Connor Elizabeth , Knoke James D. , Wingard Deborah L.
Published: March 2003

OBJECTIVES: To examine the relationship between measured weight change over an approximate 10‐year time period on all‐cause mortality over the following 12 years in 1,801 community‐dwelling men and women (mean age 71 at the beginning of mortality follow‐up) with and without diabetes mellitus.

DESIGN: A longitudinal cohort study.

SETTING: A geographically defined community in southern California.

PARTICIPANTS: One thousand eight hundred one older men and women with and without diabetes mellitus.

MEASUREMENTS: Weight, body mass index (BMI), blood pressure, and fasting plasma glucose were measured in 1972–74 (Visit 1) when participants were aged 40 to 79 and again in 1984–87 (Visit 2). Lifetime weight history and dieting for weight control were ascertained in 1985 using a mailed questionnaire. Vital status was determined for the next 12 years, from Visit 2 (1984–87) through 1996. The Cox proportional hazards model was used to assess the age‐ and multiply adjusted effect of weight change on mortality.

RESULTS: At Visit 1, diabetic men (n = 140) and women (n = 90) were more overweight than nondiabetic men (n = 633) and women (n = 938). Weight gain between Visits 1 and 2 was not a significant predictor of mortality in this cohort. Men and women losing 10 or more pounds between visits had higher age‐adjusted death rates during the following 12 years than those with stable weight or weight gain. Weight loss was associated with an increased hazard ratio (HR) for all‐cause mortality in nondiabetic men (HR = 1.38, 95% confidence interval (CI) = 1.06–1.80) and women (HR = 1.76, 95% CI = 1.33–2.34) and diabetic men (HR = 3.66, 95% CI = 2.15–6.24) and women (HR = 1.65, 95% CI = 0.70–3.87) after adjustment for age, smoking, and sedentary lifestyle. Significant associations persisted in analyses excluding cigarette smokers and those with depressed mood and low baseline BMI. After excluding those who died within 5 years of the weight loss, the increased HR was statistically significant in men and women with and without diabetes mellitus. Stratified analyses comparing those who reported dieting for weight control with those not dieting showed similar trends, with a higher mortality risk for weight loss in those who lost weight without dieting.

CONCLUSION: In this population of older individuals, weight loss predicted increased all‐cause mortality risk not explained by covariates.
Cost of Anemia in the Elderly
Authors: Robinson Bruce
Published: March 2003

As the aging population and the incidence of age‐related health conditions increase, the cost of healthcare is also expected to rise. Anemia commonly occurs in the elderly, and is associated with a number of health conditions such as falls, weakness, and immobility. It can also lead to more‐serious complications such as cardiovascular and neurological impairments. Consequently, anemia can have a significant effect on healthcare requirements and healthcare expenditure. Research is needed into the opportunity to reduce costs.
Clinical aspects of multifocal or generalized tonic dystonia in reflex sympathetic dystrophy. (Leiden University Medical Center, Leiden, The Netherlands) Neurology. 2001;56:1762–1765.
Authors: Van Hilten J. J. , Van de Beek W. J. T. , Vein A. A. , Van Dijk J. G. , Middelkoop H. A. M.
Published: March 2003

The authors of this article described 10 patients with reflex sympathetic dystrophy that progressed to a multifocal or generalized tonic dystonia. The neuropsychologic profile was similar to that of other patients with chronic pain, irrespective of its cause. The distribution pattern of dystonia, the stretch reflex abnormalities, and the worsening of dystonia after tactile and auditory stimuli suggest impairment of interneuronal circuits at the brainstem or spinal level. Antibody titers for glutamic acid decarboxylase, tetanus, and Sjögren antigens were all normal.
Headache, neck pain, and neck mobility after acute whiplash injury: a prospective study. (Aarhus University Hospital, Denmark) Spine. 1994;26:1246–1251.
Authors: Kasch Helge , Stengaard‐Pedersen Kristian , Arendt‐Nielsen Lars , Jensen Troels Staehelin
Published: March 2003

This article discussed a 6‐month prospective study of neck mobility in patients with acute whiplash injury and a control group with acute ankle distortion. The results of this study indicated that patients with whiplash injury had significantly reduced flexion, extension, lateral flexion, and rotation of the neck as compared with patients with ankle distortion injury. Neck mobility, however, was similar in the 2 groups after 3 months. Conclude that neck mobility is reduced immediately after, but not 3 months after, a whiplash trauma. Headache and neck mobility are related inversely and neck pain and neck mobility are related inversely during the first 6 months after acute whiplash injury.
An Updated Interdisciplinary Clinical Pathway for CRPS: Report of an Expert Panel
Authors: Stanton‐Hicks Michael D. , Burton Allen W. , Bruehl Stephen P. , Carr Daniel B. , Harden R. Norman , Hassenbusch Samuel J. , Lubenow Timothy R. , Oakley John C. , Racz Gabor B. , Raj P. Prithvi , Rauck Richard L. , Rezai Ali R.
Published: March 2003

Abstract: The goal of treatment in patients with complex regional pain syndrome (CRPS) is to improve function, relieve pain, and achieve remission. Current guidelines recommend interdisciplinary management, emphasizing 3 core treatment elements: pain management, rehabilitation, and psychological therapy. Although the best therapeutic regimen or the ideal progression through these modalities has not yet been established, increasing evidence suggests that some cases are refractory to conservative measures and require flexible application of the various treatments as well as earlier consideration of interventions such as spinal cord stimulation (SCS). While existing treatment guidelines have attempted to address the comprehensive management of CRPS, all fail to provide guidance for contingent management in response to a sudden change in the patient's medical status. This paper reviews the current pathophysiology as it is known, reviews the purported treatments, and provides a modified clinical pathway (guideline) that attempts to expand the scope of previous guidelines.
Effect of circulating immune complexes on transfusional therapy in patients with hemophilia or von Willebrand's disease
Authors: CELADA A. , AGUADO M. T. , MAIRE M. , ORTEGA F. , MAGALLON M. , MARTIN‐VILLAR J. , LAMBERT P. H.
Published: March 2003

Circulating immune complexes were examined in patients with hemophilia or von Willebrand's disease in order to determine the immediate or long‐ term side effects after transfusion. The conglutinin binding assay which allows quantitation of C3bi‐bearing immune complexes was used for 82 patients with hemophilia A. Immune complexes were detected in 37 (45%) of these cases prior to transfusion. Immune complexes also were detected in four of 11 patients with hemophilia A and factor VIII inhibitors, in five of 11 patients with hemophilia B, and in three of 10 patients with von Willebrand's disease. The levels of circulating immune complexes in 21 patients with hemophilia A and seven with von Willebrand's disease significantly increased 24 hours after concentrate or cryoprecipitate transfusions. Purified immune complexes from three patients with hemophilia A were shown to contain IgG, IgM, and complement components. No factor VIII coagulant or antigenic protein or fibrinogen was identified in the immune complexes using specific antisera. Side effects immediately after transfusion were not associated with immune complexes. The levels of factor VIII or IX after transfusion were not particularly decreased in relation to the presence of immune complexes. Finally, the presence of circulating immune complexes in the patients studied did not correlate with the number of transfusions, the units of concentrates injected, the presence of HBsAg or HbsAb, the levels of plasma aspartate transferase, or the presence of rheumatoid factor. Proteinuria was absent in all the patients studied.
Proposed standardization of methods for determining the 24‐hour survival of stored red cells
Authors: Moroff G. , Sohmer P.R. , Button L.N.
Published: March 2003

Two methods of determining the survival of stored red cells are described: one using a double label and one using a single label. It is not suggested that one is superior, but rather both methods are presented in the hope that the personnel of laboratories engaged in determining the effectiveness of anticoagulant‐preservation will follow one of the protocols presented. Were this to occur, many of the interlaboratory variations that have decreased the value of data from red cell survival studies would be decreased.
Immunological characteristics and clinical significance of anti‐H in the Ah phenotype
Authors: Whitsett C.F. , Cobb M. , Pierce J.A. , Parvin M.
Published: March 2003

A red cell survival study with 51Chromium‐labeled A1 cells was performed in a patient with the Ah phenotype whose serum contained IgM anti‐H but not anti‐A1. A1 cells were agglutinated weakly at 37 degrees C in the crossmatch, but not in the antiglobulin test. One hour after the survival study was begun, 67 percent of injected cells had been destroyed, and only 20 percent of the labeled cells remained after 24 hours. This study suggests that Ah individuals should be transfused only with Ah or Oh red cells.
Plateletapheresis program. II. Computer selection of HLA compatible donors
Authors: Jorgensen DW , McFarland JG , Hillman RS , Slichter SJ
Published: March 2003

A rapid, cost‐effective data entry and computerized matching system was developed for selection of HLA compatible cytapheresis donors for platelet‐alloimmunized patients. The system was user‐orientated with a computer‐generated prompting system that facilitated program operation. Expansion of the number of compatible donors was achieved by treating splits and crossreactive HLA antigens as identical. By this mechanism, a 500‐member donor pool easily supported the needs of a large patient population for single‐donor cytapheresis platelets. An average of 3.4 compatible donors per patient was identified. For only two of the 48 (4%) thrombocytopenic recipients was transfusion support from the available donors inadequate to provide a posttransfusion platelet increment. At the end of 7 months, donation frequency for the 441 donors then in the pool averaged 2.0 +/− 2.4. This figure increased to 2.8 +/− 2.4 donations for the 176 panel members who actually underwent cytapheresis. Thus, the impact on donors participating in this program was not excessive.
Platelet viability following storage for 5 days
Authors: Moroff G. , Morse E.E. , Kakaiya R.M. , Mann E.W. , Rosales L. , Cable R.G. , McCullough J. , Robkin‐Kline L. , Friedman A. , Kiraly T. , Feeney L.
Published: March 2003

Regional blood centers frequently need to hold units of whole blood at 20 to 24° C for several hours after phlebotomy so that sufficient platelet concentrates can be prepared to meet the increasing need. We have evaluated the in vivo viability and in vitro properties of platelets that were prepared from whole blood drawn into citrate‐ phosphate‐dextrose‐adenine (CPDA‐1) either immediately after phlebotomy or after an 8‐hour hold at 20 to 24° C. Platelet concentrates were stored for 5 days at 20 to 24° C in polyolefin containers (PL 732, Fenwal) with end‐over‐end tumbler agitation. The autologous in vivo recovery (mean ± SD) and one‐half disappearance of 51Cr‐labeled platelets prepared immediately after phlebotomy were 44.4 ± 9.4 percent and 4.0 ± 0.5 days, respectively. Platelets prepared after the delay of 8 hours showed a recovery of 44.5 ± 8.4 percent and a one‐half disappearance of 4.1 ± 0.4 days. After 5 days of storage, platelet concentrates showed a mean pH of 7.21 ± 0.20 when prepared immediately after phlebotomy, and of 7.22 ± 0.15 when prepared after an 8‐hour delay. Mean morphology scores were 280 ± 33 and 302 ± 27 for platelets from units prepared immediately after phlebotomy or after a holding period of 8 hours, respectively. Platelets underwent synergistic aggregation after 5 days of storage, independent of the length of time that the units of whole blood were held prior to centrifugation. These studies indicate that platelet concentrates prepared from units of whole blood held initially for 8 hours can be stored for 5 days at 20 to 24° C and survive satisfactorily in vivo and retain in vitro characteristics.
Use of an electromechanical infusion pump for transfusion of platelet concentrates
Authors: Snyder E. L. , Ferri P. M. , Smith E. O. , Ezekowitz M. D.
Published: March 2003

To determine whether platelet concentrates can be administered safely through electromechanical infusion devices, we studied stored platelet concentrates passed through one pump system (Abbott). We measured in vitro changes in platelet count and lactic dehydrogenase (LDH) and beta‐ thromboglobulin (beta‐TG) release which occurred after passing the concentrates through the pump system. To compare in vivo survival, five normal volunteers were given an injection of autologous Indium‐111‐ labeled platelet concentrates at two different times, once using platelets which had been passed through the pump system (test group) and once using platelet concentrates which had not (control group). In vitro studies showed no significant changes (p greater than 0.05) in platelet count, or in LDH or beta‐TG release after passage through the pump system. In vivo platelet recovery at 2 hours was 39.8 +/− 4.7 percent (mean +/− 1 SD) for the control platelets and 40.7 +/− 9.3 percent for the platelets passed through the pump system (p greater than 0.05; n = 5). There was no significant difference in platelet survival measured in days between the control group and the test group using a linear (8.0 +/− 0.9 vs. 7.2 +/− 0.3), exponential (3.7 +/− 0.7 vs. 3.1 +/− 0.5), or multiple hit (5.4 +/− 2.3 vs. 4.8 +/− 1.0) (p greater than 0.05; n = 5) model. We conclude that this pump system is acceptable for use in clinical practice when control over volume and rate of platelet transfusion is important.
Extended storage of platelets in a new plastic container
Authors: Snyder E. L. , Ezekowitz M. , Aster R. , Murphy S. , Ferri P. , Smith E. , Rzad L. , Davisson W. , Pope C. , Kakaiya R. , Buchholz D. H.
Published: March 2003

A new blood container material (PL 1240 plastic) made of polyvinyl chloride containing a tri(2‐ethylhexyl) trimellitate plasticizer was evaluated in three laboratories. When platelet concentrates (50–60 ml) were stored on a variety of agitators for 7 days at 22 ± 2°C, poststorage pH (mean ± SD) ranged from 7.29 ± 0.05 (6 rpm elliptical rotator) to 6.87 ± 0.8 (70 cycles per minute flatbed agitator). The platelet counts ranged from 1.51 ± 0.12 to 0.95 ± 0.36 × 106 per μ|. Morphology scores and hypotonic shock response values of platelets stored 7 days in PL 1240 plastic containers were better than those noted following 3‐day storage of control platelets in PL 146 plastic containers. The percent discharge of lactic dehydrogenase from platelets stored 7 days in PL 1240 plastic containers for 3 days (p < 0.05). Mean platelet recoveries of 44 ± 15 percent (n = 11; 111Indium) and 39 ± 8 percent (n = 29; 51Chromium) were seen when autologous platelets were infused following 5‐day storage in PL 1240 plastic bags. Platelet half‐lives of 3.6 ± 0.4 (n = 9) 4.1 ± 0.4 (n = 20) days were reported in the two laboratories which used 51Cr labeling, while survival values of 7.0 ± 1.0, 2.8 ± 0.8, and 5.4 ± 1.9 days were seen when data from the 111Indium studies (n = 11) were analyzed using linear, exponential, and multiple hit programs, respectively. Platelets stored for 5 days also were administered to 13 thrombocytopenic oncology patients. In eight instances, a second (control) transfusion of platelets stored 2 to 5 days in PL 732 plastic containers was given to the recipient. There was no difference seen in postinfusion corrected platelet increments (15.6 ± 12.1 × 103/μ| versus 15.2 ± 10.4 × 103/μ| per m2/1011 platelets infused) for cells stored in PL 1240 and PL 732 plastic containers, respectively. Hemostatic efficacy was seen posttransfusion in all four bleeding recipients. We conclude that platelets stored in PL 1240 plastic containers for 5 days are safe and efficacious for use in clinical transfusion practice.
Hydroxyethyl starch accentuates von Willebrand's disease
Authors: Strauss R. G. , Stump D. C. , Henriksen R. A.
Published: March 2003

A healthy man with previously undiagnosed, mild von Willebrand's disease received one 1 of 6 percent hydroxyethyl starch solution intravenously. Following infusion, the bleeding time lengthened, platelet adhesion decreased, and the partial thromboplastin time was prolonged in association with decreased plasma levels of factor VIII coagulant activity, factor VIII‐related antigen, and factor VIII ristocetin cofactor. Abnormalities persisted for days, but overt bleeding did not occur. Care should be taken to screen and possibly reject prospective granulocyte donors with positive personal or family bleeding histories. Caution should be used when administering hydroxyethyl starch as a colloidal plasma volume expanding agent to patients with underlying hemostatic defects.
Comparison of plateletapheresis with two continuous‐flow cell separators using identical donors
Authors: Mintz P. D.
Published: March 2003

Each of 20 donors underwent plateletapheresis on both the CS‐3000 (Fenwal) and the 2997 (IBM) blood cell separators. The same operator performed both procedures and conducted all product studies for each donor. Platelet collection efficiency was significantly greater with the 2997 (81%) than the CS‐3000 (60%) (p less than .0005). Both techniques provided high platelet yields that were not significantly different (2997: 6.1 × 10(11), CS‐3000: 5.7 × 10(11)), permitting comparison of other variables without accounting for different yields. Significantly more leukocytes were present in products collected with the CS‐3000 (0.46 × 10(9)) than the 2997 (0.09 × 10(9), p less than 0.0005). More acid‐citrate‐dextrose was infused during procedures with the 2997 (471 ml) than the CS‐3000 (324 ml, p less than 0.0005); the donors' ionized calcium decreased significantly more during procedures with the 2997 (27.3%) than the CS‐3000 (17.0%, p less than 0.0005). Hypocalcemic symptoms were more common during procedures with the 2997. Product volume was greater with the 2997 (414 ml) than the CS‐3000 (237 ml, p less than 0.0005). All products contained less than 1 ml of red cells. Set‐up time was significantly greater with the 2997 (37 minutes) than the CS‐3000 (18 minutes, p less than 0.0005), but processing time was significantly less with the 2997 (90 minutes) than the CS‐3000 (110 minutes, p less than 0.0005). There was no difference in the decrease in donor platelet count with procedures between the 2997 (27%) and the CS‐3000 (26%).(ABSTRACT TRUNCATED AT 250 WORDS)
Factors affecting white cell content in platelet concentrates
Authors: Champion A. B. , Carmen R. A.
Published: March 2003

In this study, we investigated the factors affecting white cell content in platelet concentrates. White cell yields can be reduced 50 percent by stopping platelet‐rich plasma expression when the interface is 1 cm from the top of the blood bag as compared to stopping expression when the interface reaches the top of the bag. Further reductions can be achieved by careful handling during transfer of units from the centrifuge cups to expressors (after the first spin) and by carefully balancing units against each other to ensure proper rotor balance during the first spin. Following these suggestions, blood banks should be able to produce platelet concentrates with white cell yields between 2 and 6 × 107 and with platelet yields between 7.5 and 8 × 1010. Transfusion of this product may reduce febrile reactions and lower the incidence of alloimmunizations.
Inactivation and partition of human T‐cell lymphotrophic virus, type III, during ethanol fractionation of plasma
Authors: WELLS MARTHA A. , WITTEK ALEC E. , EPSTEIN JAY S. , MARCUS‐SEKURA CAROL , DANIEL SYLVESTER , TANKERSLEY DONALD L. , PRESTON M. SUE , QUINNAN GERALD V.
Published: March 2003

Abstract: Because of concern about the safety of immune globulins prepared for injection, we studied the effects of ethanol fractionation of human plasma on human lymphotropic virus, type III, (HTLV‐III) by spiking the products of various fractionation stops with HTLV‐III. Tests of inactivation and removal indicated that the ratio of residual live virus in plasma fractions/live virus in starting plasma was about 1 × 10‐15 for precipitate II from which immune globulin for injection is manufactured. The results are reassuring regarding the potential safety of immune globulin.
The distribution of ABO and Rh (D) and selected high‐ and low‐frequency antigens in the people in the Kingdom of Tonga
Authors: Roberts S. K. , Vengelen‐Tyler V.
Published: March 2003

The incidence of red cell A, B, and D antigens in 7903 people from the Kingdom of Tonga is reported. ABO and D typings were performed by the slide method while establishing a registry of potential blood donors. The results of selected high‐frequency antigens and one low‐frequency antigen typing of 1009 donors also are reported.
ABH antibodies causing platelet transfusion refractoriness
Authors: Brand A. , Sintnicolaas K. , Claas F. H. J. , Eernisse J. G.
Published: March 2003

Two alloimmunized patients with multispecific anti‐HLA and high‐titered ABH antibodies showed transfusion failures after ABH‐mismatched HLA‐identical platelet transfusions, whereas ABH‐matched HLA‐identical platelets showed sufficient increments. The anti‐A and ‐B could be demonstrated on platelets by immunofluorescence tests using FITC‐labeled goat anti‐human IgG. These platelet antibodies could be absorbed with red cells and platelets of the appropriate ABH type. In contrast to previous reports about the influence of ABH antibodies on platelet survival, not only a proportion of the platelet population were destroyed after infusion, but almost all ABH‐incompatible platelets were destroyed.
Increased risk of a positive test for antibody to hepatitis B core antigen (anti‐HBC) in autologous blood donors
Authors: Grossman Brenda J. , Stewart Nadina C. , Grindon Alfred J.
Published: March 2003

ABSTRACT: Controversy exists about the suitability of blood from autologous donors for homologous use. We compared the infectious disease test results of 426 autologous donors, designated by donor history as suitable for homologous use, to those of 86,138 volunteer donations collected over the same 5 month period. Although donor characteristics differed, the relative risk of a positive test for anti‐HBc in the autologous group was 2.09. When 413 autologous donors were compared to 413 volunteer donors matched for age, sex, and zip code, the relative risk of a positive test for anti‐HBc in the autologous group was 3.2. If anti‐HBc is a marker for non‐A, non‐B hepatitis transmissibility, then our autologous group is not as safe as our volunteer donors. We recommend that autologous blood, even when designated by donor history and laboratory screening results as suitable for homologous transfusion, not be used for other than the intended autologous recipient.
Current autologous transfusion practices
Authors: Anderson B.V. , Tomasulo P.A.
Published: March 2003

ABSTRACT: A questionnaire was distributed to 509 AABB institutional members to evaluate current autologous transfusion practices. Results were returned from 47 blood centers, 108 transfusion services and 64 hospital blood banks (response rate 43%). Results indicate that not all eligible patients are allowed to donate due to unnecessarily strict eligibility criteria. Thirty percent of autologous units are not tested for infectious disease markers. Of those units tested and found positive for anti‐HIV or HBsAg, 53 and 72% respectively, of the institutions provide the units to the intended recipient. Forty‐seven percent of institutions perform an AHG crossmatch for autologous recipients. Sixty five percent of institutions permit “crossing‐over” of autologous units for homologous use. Implications of these findings for the development of standards for autologous transfusion programs are discussed.
Summary of the Biosafety Workshop: Application of biosafety principles in blood establishments
Authors: Grumet F. C. , MacPherson J. L. , Hoppe P. A. , Smallwood L. A.
Published: March 2003

ABSTRACT: In light of increasing public and employee concern over potential infectious hazards associated with blood and other body fluids, several government agencies (the Food and Drug Administration, the Centers for Disease Control, the Occupational Safety and Health Administration, the Environmental Protection Agency, the Health Care Financing Administration and the National Heart, Lung and Blood Institute) cosponsored a Biosafety Workshop in April 1988. The objective of the workshop was to identify appropriate biosafety practices and standard control procedures to protect workers involved in the collection, storage, and transportation of human blood donations with the least possible disruption of the nation's blood supply. Speakers focused on human immunodeficiency virus (HIV) and hepatitis B virus (HBV); however, the safety principles discussed were considered equally applicable to other known (e.g., non‐A, non‐B hepatitis and human T‐ lymphotropic virus type I (HTLV‐1) blood‐transmitted infections. The resulting consensus included the need for blood establishments to develop and apply thoughtful biosafety programs to address staff training, accident prevention, HBV vaccination, handling spills, managing contaminated waste and transporting blood specimens. There was lack of agreement, however, on the usefulness of gloves during the phlebotomy of healthy blood donors.
Preparation of packed red cells suitable for intravascular transfusion in utero
Authors: GALLIGAN BRIAN R. , CAIRNS RONALD , SCHIFANO JOSEPH V. , SELBING ANDERS , BERNVIL STENER S.
Published: March 2003

ABSTRACT: Intra‐cardiac transfusion in utero is a recent development in the treatment of erythroblastosis foetalis. As with intra‐umbilical cord transfusion, the procedure has been described as having a high risk of complication characterized by bradycardia and cardiac‐arrest. Intra‐coronary hyperkalemia was suspected as being a major contributing factor towards the complications experienced, particularly by the intra‐cardiac delivery. The procedure is warranted, however, in cases where intra‐umbilical cord transfusion is not possible. Therefore, studies comparing various methods of preparing packed cells for intravascular transfusion were initiated. The plasma potassium levels of gravity sedimented packed cells and saline washed red cells resuspended in either Ringer's lactate, pooled donor plasma or saline were measured. Products of saline washed/resuspended packed red cells transfused within 2 hours of preparation were found to have low potassium levels while exposing the fetus to minimal risk of transfusion transmitted infection and were therefore selected to be the most suitable product. Using this product, a significant decrease in the incidence of severe bradycardia resulting in cardiac‐arrest, following intravascular transfusion (32 procedures) was observed.
5‐day storage of single‐donor platelets obtained using a blood cell separator
Authors: Rock G. , Tittley P. , McCombie N.
Published: March 2003

Platelets were collected from normal donors via a blood cell separator (Fenwal CS‐3000). Platelets were stored initially in two separate 1000‐ml bags (average count per bag, 2.3 ± 0.5 × 1011) in 100 ml of autologous plasma for 5 days. Little change in platelet count was noted after 5 days of storage; however, the white cell count fell from 5.1 ± 1.7 × 109 at Time 0 to 3.4 ± 2.3 × 109 per I at Day five. The initial lactate values were 32 ± 11 mg per dl and rose to 165 ± 28 mg per /dl by 5 days. Platelet aggregation was impaired both by the collection procedure and during storage: whereas the response to ADP of the donors' platelets before the procedure was 100 percent, samples taken from the product immediately after collection had only a 45 percent response, which fell to 12 percent by Day 5. Aggregation using epinephrine was similarly affected, with a 75 percent response after collection and 0 percent response by Day 5. The plasma β‐thromboglobulin (β‐TG) level was high, both after collection (5.0 μg/ml at Time 0) and after storage (11.0 μg/ml), indicating a considerable effect of collection on platelet alpha granule release. In vivo recovery of these platelets was very good at 67 ± 6 percent, with an average survival of 7.3 ± 1.4 days (multiple hit; n = 4). The addition of 100 ml of autologous plasma to one bag of platelets before storage did not change the results significantly, except for the aggregation response to ADP immediately after collection (76% with plasma; 45% without; p > 0.05); improvement was still apparent after 5 days of storage. The concentration of lactate and β‐TG was reduced by one‐half by 5 days, but this value simply reflects the doubled plasma volume. The in vivo platelet recovery of autologous platelets in four normal individuals after 5 days of storage was extremely good, 78 ± 10 percent; survival was 6.1 ± 0.9 days.
Suitability of liquid‐stored donor platelets in platelet compatibility testing
Authors: Kiss J. E. , Salamon D. J. , Wilson J. , Ramsey G. , Duquesnoy R. J.
Published: March 2003

Current platelet crossmatch procedures to select compatible donors for alloimmunized thrombocytopenic patients are hampered by the lack of a convenient platelet storage method. This study examined the feasibility of using washed apheresis donor platelets stored for up to 1 year in a modified Hank's buffer solution at 4° C as crossmatch reagents in an indirect IgG‐enzyme immunoassay. Pooled and monospecific HLA and PlA1 antisera were used to determine the antigenic reactivity of donor platelets in relation to duration of storage. There were no significant differences between mean HLA and PlA1 antigen expression in fresh and stored platelets. HLA reactivity was detected on 12 of 13 donor platelet samples stored for 3 to 9 months and on 14 of 17 platelets stored for 12 to 14 months. PlA1 reactivity was maintained at 12 to 14 months for all 12 donor platelet samples tested. In addition, incompatibility remained in 23 of 24 paired fresh and stored platelet crossmatches using individual alloimmunized patient plasmas. These data indicate that both HLA and platelet‐specific PlA1 antigen reactivity can be maintained adequately in liquid storage at 4° C for up to 1 year. The availability of a convenient platelet storage method should facilitate the general application of platelet crossmatching procedures for alloimmunized patients.
Reduction of human immunodeficiency virus‐ infected cells from donor blood by leukocyte filtration
Authors: RAWAL B. D. , BUSCH M. P. , ENDOW R. , GARCIA‐DE‐LOMAS J. , PERKINS H. A. , SCHWADRON R. , VYAS G. N.
Published: March 2003

Several filters for leukocyte removal were evaluated in terms of their ability to reduce the cell‐associated human immunodeficiency virus (HIV) load in units of blood either inoculated in vitro with lymphocytes from a chronically infected cell line or collected directly from seropositive donors. Filtration of the experimentally inoculated units of blood resulted in a 5.9 log10 mean reduction (95% confidence interval:7.4–4.5) of tissue culture infectious units (TCIU) as assayed by end‐point titration using the cocculture assay. Filtration of the units of blood from anti‐HIV positive donors lowered the infectivity by over 2 logs, as detected by the coculture and polymerase chain reaction (PCR) techniques. However, residual cell‐associated virus was detected in the majority of experiments. Clinical studies are warranted to determine if leukocyte filtration of blood will reduce the risk of transfusion transmitted viral infections.
Refreezing previously thawed fresh‐frozen plasma, Stability of coagulation factors V and VIII:C
Authors: Dzik W. H. , Riibner M. A. , Linehan S. K.
Published: March 2003

With the growth in autologous blood programs and the increased scrutiny of the indications for transfusion of fresh‐frozen plasma (FFP), an increase has been seen in the number of occasions on which FFP was requested and thawed but then not transfused. The coagulation properties of FFP units that were refrozen and then rethawed were therefore studied. Fifty‐eight units of plasma were studied, with each experimental unit of FFP paired with an identical control unit. Experimental units were frozen, stored at ‐65° C, thawed, stored at 1 to 6° C for various periods of time up to 24 hours, and then refrozen, stored at ‐65° C, rethawed, and stored again in the refrigerator for up to 24 hours. Control units were frozen once at the time the experimental units were first frozen and thawed once at the time of the second thaw of the experimental units. Aliquots of plasma were sampled periodically and were later batch‐tested for prothrombin time (PT), activated partial thromboplastin time (aPTT), and factor V and VIII:C activity. The results of coagulation testing of the twice‐frozen plasmas were always within the normal range. There was a slight but statistically valid prolongation of the PT and aPTT and a decrease in the factor V and VIII:C levels for twice‐frozen plasma compared with control plasma. The greatest decline occurred in the level of factor VIII:C. The measured deterioration in coagulation of twice‐frozen FFP is unlikely to be of clinical importance. Refreezing FFP may eventually prove useful for rare donor, autologous, and massive transfusion programs.
Invalidation of antiglobulin tests by a high thermal amplitude cryoglobulin
Authors: Ylagen E.S. , Curtis B.R. , Wildgen M.E. , Mass M.D. , Chaplin H.
Published: March 2003

A multiply transfused patient was referred for evaluation of a transfusion reaction. The direct and indirect antiglobulin tests (DAT, IAT) for alloantibody were negative. However, IgG‐coated control cells failed to agglutinate in the negative reactions, casting doubt on their validity. At 4°C, the patient's serum exhibited a large cryoprecipitate (2.9 mg/mL), made up predominantly of an IgG kappa paraprotein and having trace amounts of IgM and C3. Clear serum separated at 37°C became cloudy within 10 minutes at room temperature (RT); within 4 hours, approximately 60 percent of the total precipitable cryoprotein had precipitated. Red cells (RBCs) incubated in fresh serum that had cooled to RT or RBCs obtained from RT or refrigerated samples contained cryoprecipitate that sedimented with the RBCs during washing with RT saline. On resuspension, enough IgG cryoglobulin redissolved to neutralize completely the commercial anti‐IgG reagents. If the patient's samples were maintained at 37°C, cryoprecipitate did not form, and RBCs washed four times at 37°C gave valid DAT and IAT reactions. The removal of all cryoprecipitate from the patient's serum by centrifugation after overnight incubation at 4°C also made possible valid antibody screening and compatibility tests.