bluuebunny/crossref_metadata_2025 huggingface dataset:
Importance of Hyperexcitability of DRG Neurons in Neuropathic Pain
Authors: Chung Jin Mo , Chung Kyungsoon
Published: March 2003

Abstract: A number of good animal models have been developed in recent years that provide insights into the mechanisms of neuropathic pain. It now becomes evident that there are two separate peripheral components influencing neuropathic pain: one dependent on the hyperexcitability of axotomized dorsal root ganglion (DRG) neurons and the other independent of this hyperexcitability. The purpose of this review is to consider one of these components, the hyperexcitability of axotomized DRG neurons, as one of the important mechanisms underlying neuropathic pain. Several hours after nerve lesions, some axotomized DRG neurons become hyperexcitable and begin to show ongoing discharges that last many days or weeks. These ectopic discharges then enter the spinal cord and induce central sensitization, the underlying central mechanism for the generation of pain and allodynia. Although the exact causes of the development of hyperexcitability and ectopic discharges are not clear, various ion channels seem to play important roles, particularly sodium channels. In addition, important modulatory factors for ectopic discharges are purinergic and adrenergic components of the sympathetic nervous system. These findings suggest that manipulating sodium channels and/or adrenergic and purinergic receptors on axotomized DRG cells may give neuropathic pain sufferers some relief that is not available from present treatment regimens.
Application of Radiofrequency Treatment in Practical Pain Management: State of the Art
Authors: Van Zundert J. , Raj P. , Erdine S. , Van Kleef M.
Published: March 2003

Abstract: Many therapeutic interventions for chronic pain are available, and decisions about optimal management are not easy to make. Radiofrequency (RF) treatment is classified as a percutaneous minimal invasive procedure for patients who do not respond to appropriate medical and physical therapy. Although RF treatment is widely used differences in current practice exist due to ongoing controversies.
Epidural Calcitonin: Does it Provide Better Postoperative Analgesia? An Analysis of the Haemodynamic, Endocrine, and Nociceptive Responses of Salmon Calcitonin and Opioids in Epidural Anesthesia for Hip Arthroplasty Surgery
Authors: Gabopoulou Zoi , Vadalouca Athina , Velmachou Kyriaki , Karanastasi Chryssoula , Van Zundert André
Published: March 2003

Abstract: Calcitonin is an endogenous regulator of calcium homeostasis, which acts principally on bone. At present, the principal indications for the therapeutic use of calcitonin are disorders involving hypercalcemia Paget's disease, acute pancreatitis, high‐bone‐turnover osteoporosis, pain associated with osteoporosis or bone metastases, and Sudeck's atrophy. The aim of this study was to compare the analgesic effects on postoperative pain of salmon calcitonin versus opioids administered epidurally. Our prospective study included 53 ASA I‐II patients who were scheduled for total hip arthoplasty under epidural anaesthesia and who did not fulfill 1 or more of the exclusion criteria: a history of pituitary gland dysfunction; diabetes mellitus; obesity; contraindications to performing an epidural block and/or an allergy to calcitonin. These patients were randomly allocated into 3 groups (A, B, and C), each of which received postoperatively a different analgesic epidural mixture of 10 mL to control postoperative pain. Group A was given bupivacaine 0.5% (5 mL) + fentanyl 100 (2 mL) + NaCl 0.9% (3 mL). Group B was given bupivacaine 0.5% (5 mL) + salmon calcitonin 100IU (1 mL) + NaCl 0.9% (4 mL). Group C was given salmon calcitonin 100IU (1 mL) + NaCl 0.9% (9 mL). Perioperatively, 4 blood samples were taken from each patient at the following specific times:

1. Before the induction of anesthesia;

2. At the end of the operation and before the epidural administration of the analgesic mixture;

3. At the end of the first postoperative hour (1 hour after the administration of the analgesic mixture); and

4. At the end of the second postoperative hour (2 hours after the administration of the mixture).

In each blood sample, glucose, cortisol, growth hormone, and prolactin plasma levels were determined in order to investigate the changes of these parameters as a result of the endocrine reaction to stress, and to pain relief. The analgesic solution was administered immediately after the second blood sample was taken. At the same time as the 4 blood samples were taken, haemodynamic parameters and pain scores were recorded. Epidural salmon calcitonin in combination with local anaesthetic produces an analgesic effect similar to fentanyl and with stable hemodynamic results. It also eliminates postoperative hyperglycaemia. The cortisol plasma level does not increase during the first postoperative hour, but increases significantly during the second postoperative hour. Growth hormone and prolactin plasma levels were stable in all patients in all 3 groups. This study shows that calcitonin is a suitable alternative for the treatment of acute postoperative pain.
Rapid controlled thawing of fresh‐frozen plasma in a modified microwave oven
Authors: ROCK G. , TACKABERRY E. S. , DUNN J. G. , KASHYAP S.
Published: March 2003

A microwave oven has been specifically modified to permit rapid thawing of fresh‐frozen plasma (FFP) by using a rotating disc with a temperature sensor to hold the plasma bag. This modification makes it possible to mix the FFP continuously during thawing, and automatically shuts the oven off when the plasma reaches 21 degrees C. Comparisons were made between FFP thawed in the modified microwave oven and FFP thawed conventionally in a 37 degrees C waterbath. The following tests were done: total protein, albumin, and immunoglobulin concentrations; plasma fibrinogen, factor VIII, and factor IX activities; protein electrophoresis, albumin aggregation, hemolytic complement activity, and plasma particle count and size. In no case was there a significant difference between plasma thawed in the microwave oven compared with that thawed in the waterbath. Further, microwave thawing was reliable and rapid; all units of FFP thawed in less than 6 minutes, and the thawed plasma did not vary by more than 6 degrees C from the preselected final temperature of 21 degrees C. Thus, it appears that controlled thawing of FFP in a microwave oven specifically designed for this purpose is an effective and reliable method and has many advantages over conventional thawing of FFP.
A comparison of two behavioral influence techniques for improving blood donor recruitment
Authors: Hayes T.J. , Dwyer F.R. , Greenwalt T.J. , Coe N.A.
Published: March 2003

This study was designed to test the viability of two multiple request techniques of behavioral influence for recruiting blood donors by telephone. The first technique utilizes a small antecedent request to encourage behavioral involvement and favorable disposition toward the target activity of the critical request to donate. The second approach frames the critical request as a concession following refusal of a very large request. The two techniques, dubbed the foot‐in‐the‐door (FID) and door‐in‐the‐face (DIF), respectively, were tested against a control condition on three donor groups: active donors, inactive donors, and nondonors. Thus, a three‐by‐three factorial design was used on 910 adults in a Midwest city. Although the DIF was outperformed by the control across all three donor groups, the authors recommend its continued study in face‐to‐face donor solicitation. Importantly, the FID approach produced more donations than the control condition among active donors (Z = 4.30; p < .001), inactives (Z = 7.45; p < .001), and nondonors (Z = 1.98; p < .05). For managing the blood supply, the FID is particularly potent for rekindling donations from inactive donors. Additional research on means of penetrating the nondonor segment is recommended.
Changes in neutrophil aggregation and chemotaxis response during 18‐ hour cold storage
Authors: Eastlund T. , Charbonneau T. , Britten A.
Published: March 2003

Providing neutrophil transfusions to septic neonatal patients with depleted neutrophil reserves can be troublesome and require unscheduled blood donations. Buffy coats from stored whole blood are a potential source of neutrophils provided they remain viable during the interval between the whole blood collection and the buffy coat production. This study determined neutrophil function during storage of whole blood at 4 degrees C for 18 hours. Whole blood pH, hematocrit, platelet, and white cell counts remained unchanged. Chemotactic response to formyl methionyl leucyl penylalanine (FMLP) declined from 172.5 +/− 29 units (mean +/− SD) to 125 +/− 48 at 9 hours and 63.6 +/− 48 (p less than 0.05) at 18 hours. Aggregation response to FMLP remained normal for 9 hours but dropped to 15.5 percent of normal after 18 hours. Neutrophil response to cytaxins was maintained for at least 9 hours during storage of whole blood at 4 degrees C but seriously declined within 18 hours. Limiting 4 degrees C storage of whole blood to 9 hours prior to preparing buffy coats may provide flexibility needed for urgent provision of neutrophil transfusions.
Expression of red cell antigens by K562 human leukemia cells before and after induction of hemoglobin synthesis by hemin
Authors: McGinniss Mary H. , Dean Ann
Published: March 2003

We studied the red cell antigens present on K562 human leukemia cells before and after induction of hemoglobin synthesis by hemin. The fetal antigens i, IF, and IT were detected on uninduced cells. While expression of both i and IT antigens increased after hemin induction, expression of IT was closely related to fetal hemoglobin synthesis as determined in experiments in which the induction was reversed. The EnaFR, NVg, and T antigens of glycophorin A were also present on uninduced cells. In contrast, the M and Pra antigens of glycophorin A, the Kell system antigens, and the P1 antigen became detectable only after hemin induction. Antigens of other major red cell systems were not detected.
Uneventful administration of plasma products in a recipient with T‐activated red cells
Authors: Eversole M. , Nonemaker B. , Zurek K. , South S. , Simon T.
Published: March 2003

A patient with T‐polyagglutinable red cells and a severe coagulopathy provided an opportunity to observe the results of plasma transfusion in the face of T‐activation. The patient was a 52‐year‐old Navajo Indian with a perforated gall bladder and related sepsis due to Clostridium perfringens. The gall bladder was removed surgically. Postoperatively, he had severe thrombocytopenia, and prolonged partial thromboplastin and prothrombin times. The patient's red cells were agglutinated by Arachis hypogaea and Glycine soja lectins but were unagglutinated by extracts of Salvia horminum, Salvia sclarea, and Bandeiraea simplicifolia. No untoward reactions or any evidence of hemolysis were observed when the patient was given platelet concentrates and 4 units of single‐donor plasma. Serial plasma hemoglobin and haptoglobin levels documented that there was no hemolysis. His coagulopathy responded, and he had a successful surgical re‐exploration and recovery. This case documents that serious adverse consequences do not necessarily follow transfusion of plasma in a recipient with T‐activated red cells. T‐activation is a relative but not absolute contraindication to plasma transfusion.
Utilization and effectiveness of a hospital autologous preoperative blood donor program
Authors: Kruskall M. S. , Glazer E. E. , Leonard S. S. , Willson S. C. , Pacini D. G. , Donovan L. M. , Ransil B. J.
Published: March 2003

The utilization and effectiveness of a hospital preoperative autologous blood donation program were analyzed. Over 16 months, 180 donors, or 11.6 percent of eligible patients (those undergoing elective surgical procedures where blood was routinely crossmatched), were enrolled in the program. They donated an average of 2.2 units of red cells, or 59 percent of the mean order of 3.7 units. Donations were completed in 17.9 days, leaving 10.7 days between the last donation and hospitalization. Of all scheduled donations, 25.5 percent were cancelled due to deferrals; 47.8 percent of patients were deferred at least once. Most patients were able to donate a unit of blood weekly, with minimal drops in hematocrit (mean 3.2%). The reaction rate, 4.8 percent, was comparable to figures reported for homologous donors. Nearly two‐thirds of participants used no homologous blood during their hospitalization: 28.6 percent used no blood whatsoever, and 36.9 percent used only autologous components. Including released autologous components subsequently administered to other recipients, transfused autologous red cells were 2.1 percent and fresh‐frozen plasma (FFP) 7.2 percent of the hospital's blood supply. Although the high deferral rate complicated the administration of the program, this complication was offset by the demonstration of donor safety, reduction in the proportion of patients who used homologous blood, and the contribution of autologous blood components to the hospital's blood inventory.
A critical survey of fresh‐frozen plasma use
Authors: Blumberg N. , Laczin J. , McMican A. , Heal J. , Arvan D.
Published: March 2003

The use of 534 units of fresh‐frozen plasma (FFP) during 160 transfusion episodes in 135 consecutive patients was reviewed. Only 27 percent of transfusions were indicated by a need for replacement of labile coagulation factors. Other uses included volume repletion (31%), intraoperative bleeding or massive transfusion without coagulopathy (19%), and miscellaneous indications unrelated to labile coagulation factors (23%). Data from other institutions and national sources support the hypothesis that much of the increase in FFP use over the last decade is related to decreases in whole blood availability rather than to use for labile coagulation factor replacement. The use of FFP and red cells as a substitute for, or in preference to, whole blood may have significant adverse implications in terms of the cost and safety of blood transfusion.
Evaluation of a confidential method of excluding blood donors exposed to human Immunodeficiency virus
Authors: NUSBACHER JACOB , CHIAVETTA JOANNE , NAIMAN RENEE , BUCHNER BARBARA , SCALIA VITO , HERST ROSLYN
Published: March 2003

Abstract: A confidential self‐administered questionnaire was given to all donors prior to blood donation (n=95,917). The questionnaire describes acquired immunodeficiency syndrome (AIDS) high‐risk groups and requires the donor to designate his blood for either laboratory purposes or for transfusion. Six‐hundred and twenty‐seven people (0.65%; 78% men) designated their blood for laboratory purposes. In addition to routine enzyme‐linked immunoassay (EIA) screening for human immunodeficiency virus (HIV) antibody, all units from the latter group of donors were tested by Western blot (WB) irrespective of the EIA result. An equal number of donor units was selected from those designating their blood for transfusion (age, sex and clinic matched) and these too were tested by WB irrespective of the EIA result. We found that donors designating their blood for laboratory purposes had a 10 times (vs transfusion‐designated controls) to 100 times (vs general donor population) greater exposure to HIV. In the laboratory‐designated group, an EIA negative donor was WB positive, yielding an estimated EIA false‐negative rate of 16 per million. A confidential questionnaire, as described, is a valuable adjunct in ascertaining high‐risk blood donors.
A new variant of blood group A
Authors: Stamps R. , Sokol R. J. , Leach M. , Herron R. , Smith G. A.
Published: March 2003

A new variant of blood group A, termed Apae, was found as an inherited characteristic in three unrelated white families. Apae was distinguished from other A variants by its agglutination and absorption‐ elution reactions with only certain human anti‐A and ‐A,B serums, by the red cells that reacted with anti‐A from Helix pomatia without the need for enzyme treatment, by enhancement of the latter reaction with bromelinization, and by the presence in the serum of an anti‐A of normal avidity and titer. Apae also reacted strongly with a recently discovered anti‐A agglutinin derived from the seaweed Codium fragile, subspecies atlanticum, but not with a series of other anti‐A lectins. It was concluded that Apae cells express only part of the normal A antigen and that the anti‐A present in the serum does not have an anti‐ Apae component.
Serologic evidence that Scianna null (Sc:−1,−2) red cells lack multiple high‐frequency antigens
Authors: Devine P. , Dawson F.E. , Motschman T.L. , Skradski K.J. , Orsini L. , Moulds J.J. , Taswell H.F.
Published: March 2003

Sera from three unrelated persons whose red cells (RBC) had the common Scianna phenotype (Sc:1,−2) contained IgG alloantibodies directed against high‐frequency RBC antigens. In each case, sera or eluates or both failed to react only with Scianna null (Sc:−1,−2) cells, although an eluate from one person was compatible with a sibling's Sc:1,−2 cells. Cross‐testing cells with sera or eluates, or both, from the three persons revealed no mutual compatibility. These studies show the existence of three additional RBC antigens phenotypically related to the Scianna blood group system. Sc:−1,−2 cells lack these antigens, which indicates that Scianna null cells lack multiple high‐frequency antigens.
Changing patterns of blood transfusions in four sets of United States hospitals, 1980 to 1985
Authors: Surgenor D. M. , Wallace E. L. , Hale S. G. , Gilpatrick M. W.
Published: March 2003

Annual transfusion activity between 1980 and 1985 was surveyed in four sets of United States (US) hospitals, which together accounted for 4.8 percent of the red cell (RBC) transfusions in the US in 1980. Total RBC transfusion rates (total RBCs transfused/1000 hospital admissions) increased between 1980 and 1982 but remained nearly constant between 1982 and 1985. Plasma transfusion dynamics followed a similar pattern, whereas the preoperative deposit of autologous blood by patients accelerated rapidly after 1982. These changes appear to reflect responses to the acquired immune deficiency syndrome epidemic. In contrast, total platelet transfusion rates grew by 76 percent during the 6‐year period, approaching total RBC rates by 1985. This is the first reported evidence in such a large sample of transfusions that total RBC transfusion rates have moderated.
How well has self‐exclusion worked?
Authors: PERKINS HERBERT A. , SAMSON SUSAN , BUSCH MICHAEL P.
Published: March 2003

ABSTRACT: Review of the dates of prior blood donation by persons later reported to have AIDS demonstrated that most of them had ceased donating blood in 1983. The results indicate that self‐exclusion policies were effective.
Algorithms for evaluating the appropriateness of blood transfusion
Authors: Coffin C. , Matz K. , Rich E.
Published: March 2003

Medicare regulations and the guidelines of the Joint Commission on Accreditation of Healthcare Organizations require assessment of the appropriateness of transfusions by a hospital committee. A set of criteria maps for component transfusion review by nurses or technical personnel was designed, tested, and modified. The algorithms were based on written guidelines developed by a group of physicians. In the first part of the study, 196 medical records of patients from medical and surgical diagnosis‐related groups with the highest utilization of blood (Group I) were screened. Forty patients were excluded because of a preexisting transfusion protocol. Of the remaining 156 patients, 146 (94%) received red cell transfusions, of which 96 percent were indicated, 1 percent not indicated, and 3 percent controversial. Thirty‐five patients (22%) received fresh‐frozen plasma transfusions, of which 69 percent were indicated, 11 percent not indicated, 17 percent controversial, and 6 percent indeterminate. In the second part of the study, medical records were screened from 99 randomly selected patients who had received red cell transfusions (Group II), and the results were similar to those in Group I. Physician review was necessary in 20 percent of the transfused patients screened with the criteria maps. It is concluded that algorithms for transfusion review can be developed and used easily to fulfill regulatory and accreditation requirements and to plan focused educational programs.
Depletion of white cells from platelet concentrates with a new adsorption filter
Authors: Kickler T. S. , Bell W. , Ness P. M. , Drew H. , Pall D.
Published: March 2003

Removal of white cells (WBCs) from platelets may reduce alloimmunization to WBC antigens, prevent febrile reactions, and improve platelet increments in multiply transfused patients receiving HLA‐matched platelets. A new surface‐modified fibrous polyester filter was evaluated; it requires no special processing of pooled platelet concentrates and can be used at the patient's bedside. The studies were designed to measure WBC removal, platelet function, in vitro platelet recovery, and in vivo platelet survival. WBC mean removal was 99.8 percent ±0.56 (n = 37) when a pool similar in volume to 6 platelet concentrates was tested. The mean number of residual WBCs after filtration was 5.6 × 105. In vitro mean platelet recovery was 86.9 percent for a pool size of 6 units (n = 37). Clot retraction and platelet aggregation were unaffected by filtration. Survival studies of 111Indium‐labeled platelets done with filtered autologous platelets showed no reduction in the normally expected survival. These studies indicated that the filter efficiently removes WBCs without substantially decreasing platelet number, survival, or function. This device offers the potential of considerably improving platelet transfusion therapy.
Epidemiologic background of blood donors with antibody to human T‐cell lymphotropic virus
Authors: OPERSKALSKI E.A. , SCHIFF E.R. , KLEINMAN S.H. , BUSCH M. , TAYLOR P.E. , PARKS W.P. , LEE H. , TOMASULO P.A. , DONEGAN E. , STUART M. , HOLLINGSWORTH C.G. , NEMO G.J. , MOSLEY J.W. ,   T̊ANSFUSION SAFETY STUDY GROUP
Published: March 2003

ABSTRACT: We interviewed 51 blood donors in four major US metropolitan areas subsequently found to have had antibodies to human T‐cell lymphotropic virus (anti‐HTLV) in late 1984‐early 1985. Sixteen donors (31%) reported that they or a sexual contact had a history of blood transfusion. Twelve donors (24%) reported that they or a sexual contact used intravenous drugs. Ten donors (20%) were blacks born in the southeastern US. Four of the male donors (15%) reported homosexual contact. The most common characteristic was an association with Japan or the Caribbean basin (61%). These results show a broader variation of epidemiologic backgrounds than anticipated.
Physiologic effects of acute anemia: implications for a reduced transfusion trigger
Authors: Levine Edward A. , Rosen Arthur L. , Sehgal Lakshman R. , Gould Steven A. , Sehgal Hansa L. , Moss Gerald S.
Published: March 2003

The risks of transfusion‐associated infectious disease have led to a reassessment of transfusion practice, which in turn has resulted in a trend toward the reduction of homologous transfusion. This reduction is primarily due to the initiation of hemotherapy at more severe levels of anemia. The optimum threshold for the initiation of transfusion therapy, or the transfusion trigger (TT), is unknown. The purpose of this study is to evaluate the effects of withholding transfusion or lowering the TT to a hematocrit (Hct) of 15 percent in unanesthetized animals. Nineteen adult baboons underwent a laparotomy to simulate surgical stress. Upon their recovery from anesthesia, hemodynamic measurements were obtained, and the animals underwent an exchange transfusion (ET) with 6‐percent hetastarch to a final Hct of 15 percent. After ET, hemodynamic measurements were repeated, and the animals were followed for 2 months. There was no morbidity after ET or during the 2‐month observation period. After ET, there was a significant increase in both the cardiac output (3.3 vs. 2.5 L/min, p less than 0.001) and the oxygen extraction ratio (59.9 vs. 38.2%, p less than 0.0001). Oxygen delivery fell after ET (18.9 vs. 11.1 cc/kg/min, p less than 0.001), but there was no significant change in oxygen consumption after ET. The unanesthetized animals adapted well to severe anemia and experienced no adverse effects on their long‐term survival in this setting, which suggests that the reduction of the TT to a Hct of 15 percent in normal animals is safe. Adoption of this TT could result in a significant reduction in the requirements for homologous transfusion with its attendant risks.
Detection of platelet activation with monoclonal antibodies and flow cytometry. Changes during platelet storage
Authors: Fijnheer Rob , Modderman Piet W. , Veldman H. , Ouwehand Willem H. , Nieuwenhuis H. Karel , Roos Dirk , de Korte Dirk
Published: March 2003

To investigate whether changes in platelet condition during platelet storage correlate with an altered expression of platelet membrane proteins, the binding of monoclonal antibodies (MoAbs) to fresh platelets was compared with MoAbs' binding to thrombin‐activated platelets and to platelets stored as platelet concentrates. The MoAbs included antibodies against the platelet glycoprotein (GP) IIb/IIIa complex and against two activation‐dependent antigens, one of which was a component of the internal platelet alpha‐granule membrane (GMP 140) and the other of which was a 53‐kD protein derived from platelet lysosomes. The binding of MoAbs to platelets fixed with 1 percent paraformaldehyde was measured by flow cytometry. In thrombin‐activated platelets, a threefold increase was found in the expression of GP IIb/IIIa over that in fresh platelets. The binding of the activation‐ dependent MoAbs increased from 2 to 3 percent to 70 to 80 percent of the platelets. Storage of platelet concentrates for 5 days resulted in a 60 percent increase in GP IIb/IIIa expression compared to Day 0 and increased binding of the MoAbs directed against GMP‐140 from 3 to 16 percent and against the 53‐kD protein from 2 to 8 percent of the platelets, respectively. These changes correlated with modifications in platelet morphology (decrease in swirling), leakage of lactate dehydrogenase, and release of beta‐thromboglobulin. These data indicate that platelets become activated and are damaged during the storage of platelet concentrates.(ABSTRACT TRUNCATED AT 250 WORDS)
Evaluation of pediatric transfusion practice using criteria maps
Authors: Hume H.A. , Ali A. M. , Décary F. , Blajchman M. A.
Published: March 2003

Pediatric blood transfusion practice in a tertiary‐care pediatric hospital was evaluated retrospectively by using the technique of criteria mapping. A total of 630 transfusion episodes involving red cell concentrates, frozen plasma (plasma frozen within 24 hours of collection), platelet concentrates, and albumin were reviewed: 243 (86.2%) were reviewed only by a technical assistant, and 87 (13.8%) required additional physician review. Of these, 138 were red cell concentrate transfusions: 79.7 percent of that group were considered appropriate, 11.6 percent of unknown benefit/risk ratio, 5.8 percent inappropriate, and 2.9 percent impossible to evaluate. Some 246 frozen plasma transfusions were reviewed: 42.3 percent were considered appropriate, 32.5 percent of unknown benefit/risk ratio, 17.5 percent inappropriate, and 7.7 percent impossible to evaluate. A total of 139 platelet concentrate transfusions were reviewed: 64.7 percent were considered appropriate, 16.5 percent of unknown benefit/risk ratio, 10.1 percent inappropriate, and 8.6 percent impossible to evaluate. Some 107 albumin transfusions were reviewed: 90.6 percent were considered appropriate, 1.9 percent inappropriate, and 7.5 percent impossible to evaluate. The criteria maps developed for this study were easy for the technical assistant to use, and areas of appropriate and inappropriate pediatric transfusion practice were clearly identified.
An empirical evaluation of the performance of antibody identification tasks
Authors: Smith P. J. , Miller T. E. , Fraser J. , Smith J. W. , Svirbely J. R. , Rudmann S. , Strohm P. L. , Kennedy M.
Published: March 2003

Four empirical studies were conducted for better understanding of the nature of problem‐solving activities by medical technologists and medical technology students when performing antibody identification tasks. The results indicated the importance of strategies that ensure the collection of converging evidence, as these strategies protect against the fallibility of commonly used heuristics and against errors due to simple slips. The results also indicate that not only do students make significant numbers of errors, but so do practicing technologists. In one of the studies covering a 1‐year period, for instance, a group of 16 technologists made a total of 41 errors in 1057 cases. On the basis of these findings, several alternatives are proposed to reduce errors.
Blood warming: current applications and techniques
Authors: Iserson KV , Huestis DW
Published: March 2003

Active blood warming is a recent practice and arises out of conflicting needs. On the one hand, the safety and preservation of blood require refrigerated storage and delivery up to the moment of transfusion. On the other hand, modern methods of very rapid transfusion in resuscitation would cause clinically dangerous hypothermia if unmodified, ice‐cold blood were to be so transfused. These needs must be reconciled in the interest of adequate patient care–hence the need for blood warming. Nevertheless, blood warming creates risks of its own and should not be used without justifying clinical indications. Within limits that extend somewhat above normal body temperature, the application of heat does no harm to stored RBC, a fact that is not reflected in current standards for blood warmers. Bearing in mind the human tendency to “stretch” standards and the fallibility of mechanical devices, caution is always wise. But perhaps the time has come for reconsideration of the present upper limit of 38 degrees C. Many varieties of blood warmers are available in the US, but none at this time is based on electromagnetic activity. The most common systems now in use are in‐line warmers, most of which are not adequate for the type of rapid‐transfusion systems currently available. Countercurrent in‐ line blood warmers and the method of rapid warm saline admixture can both be used successfully for rapid, massive transfusions. Blood warming is seldom necessary or desirable for elective transfusions at conventional rates, even for patients with cold autoagglutinins.
Human immunodeficiency virus type 1‐infected blood donors: behavioral characteristics and reasons for donation.
Authors: Petersen L.R. , Doll L.S. ,   The HIV Blood Donor Study Group
Published: March 2003

Transmission of human immunodeficiency virus type 1 (HIV‐1) by homologous blood transfusion in the United States (US) is minimized by the deferral of potential donors who are at risk for HIV‐1 infection and by the screening of all donations for HIV‐1 antibody. HIV‐1‐ seropositive donors at 20 blood centers were studied for information to be used in evaluating the safety of the US blood supply and making recommendations to increase that safety. From June 1988 to August 1989, 829 (0.04%) of 2,192,000 donors were found to be seropositive; 512 were interviewed. Of 388 seropositive men, 56 percent had had sex with men, 10 percent had used drugs intravenously, 8 percent had had sex with intravenous drug users, and 27 percent had no identified risk. Of 124 seropositive women, 58 percent had had sex with men at risk for HIV (81% of whom used drugs intravenously), 5 percent had used drugs intravenously, and 41 percent had no identified risk. Racial and ethnic minorities made up 68 percent of seropositive donors (black, 38%; Hispanic, 30%) and approximately 14 percent of all donors. The 157 persons with no identified risk had demographic characteristics and serologic test results for syphilis and hepatitis B that were more similar to those of HIV‐1‐seropositive donors with recognized risk than to those of seronegative donors. Three health care worker‐blood donors (from an estimated 93,100 health care worker‐donors) had infection that was probably acquired occupationally. The very low HIV‐1 seroprevalence indicated that the current donor deferral process was highly effective and that, even in high acquired immune deficiency syndrome (AIDS) incidence areas, the risk of HIV‐1 transmission via trans‐fusion was minimal. However, further efforts to defer from donation men with ho‐ mosexual contact and persons with heterosexual contact with intravenous drug users, especially among black and Hispanic potential donors, are necessary to improve transfusion safety.
Effects on donors of second bone marrow collections
Authors: Stroncek D.F. , McGlave P. , Ramsay N. , McCulloug J.
Published: March 2003

Second bone marrow transplants have been used successfully to treat marrow graft failure or relapse following the original marrow transplantation. Hospital records of 16 related two‐time bone marrow donors were reviewed to determine what risks a person faces in making a second marrow donation. One donor suffered a minor complication following the first collection, but no donors suffered complications during the second donation. The volume of marrow collected for the first and second donations (1253 +/− 504 vs. 1261 +/− 471 mL) was similar. However, more marrow donors received transfusions of homologous red cells during the second collection than during the first collection (5/16 compared to 1/16; p = 0.06). To determine what factors might contribute to the high incidence of homologous red cell transfusion during second donations, the experiences of donors who received homologous blood during the second donation were compared to the experiences of donors who received only autologous blood. Persons receiving homologous blood during the second collection received more red cell units than persons receiving autologous blood (2.0 +/− 0.7 units compared to 0.9 +/− 0.5 units; p < 0.01). Their precollection hemoglobin levels were lower (12.3 +/− 1.2 vs. 14.4 +/− 1.4 g/dL [123 +/− 12 vs. 144 +/− 14 g/L]; p < 0.01), and the time between the first and second collections was significantly less (45 +/− 8 days vs. 342 +/− 432 days; p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)). Further analysis showehat five of eight persons who donated marrow a second time within 60 days of the first donation were transfused with homologous blood, while none of eight persons who donated bone marrow more than 60 days after their first donation were transfused with homologous blood (p<0.05). These results suggest that people can safely do‐ nate marrow a second time; however, if the second marrow collection occurs within 60 days of the first collection, precautions should be taken to reduce the chances of exposing the marrow donor to homologous blood.
Transmission of human T‐lymphotropic virus type I by blood components from a donor lacking anti‐p24: a case report
Authors: Donegan E. , Pell P. , Lee H. , Shaw G. M. , Mosley J. W. ,   The Transfusion Safety Study Group
Published: March 2003

The present criteria for confirmation of human T‐lymphotrophic virus types I and II (HTLV‐I/II) infection in blood donors are based on seroreactivity to p24 (gag) and gp46 and/or gp61 (env) on Western blot (WB) and radioimmunoprecipitation assays (WB/RIPA). Any single band and other combinations are classified as indeterminate. This case report documents infection in a donor with a repeatedly indeterminate pattern. The blood donor was anti‐HTLV‐I/II positive on enzyme‐linked immunoassay, and two sera taken 5 years apart were WB/RIPA‐ indeterminate (p19 and gp68 only). His donations in the interval were associated with transmission of HTLV‐I to four of the six recipients available for study. Other recipients of blood from donors whose WB/RIPA results were indeterminate by present criteria should be examined to determine if additional patterns are at least occasionally associated with transmission. The likelihood that such donors are infected is important to those who are counseling them and making decisions concerning recipients of their bloody.
Effect of irradiation on red cell cation content and transport
Authors: Brugnara C. , Churchill W.H.
Published: March 2003

The effect of irradiation on red cell (RBC) cation content and membrane transport was studied. When units of RBCs collected in AS‐1 (n = 8) were exposed to radiation (2000 cGy) and then stored at 4 degrees C, there was a significant increase in external K and internal Na and a decrease in internal K relative to control units (n = 3). Similar changes in internal cation contents were noted for RBCs collected in CPD; because of the higher hematocrit, the external K concentration was higher than that in AS‐1‐collected RBCs. Cellular K loss and Na gain were balanced, and the total cation content remained constant; however, both control and irradiated cells swelled over time as a consequence of the decreased pH and 2.3 DPG content. These changes in volume and cation content were reversed when the cells were incubated at 37 degrees C. A specific effect of radiation on the Na‐K pump and Na‐K‐Cl and K‐Cl cotransport systems was ruled out, because no significant differences between irradiated cells and controls were found. These data indicate that radiation induces an increased permeability to Na and K on the part of the RBC membrane lipid bilayer and that this increase is balanced and reversible.
Mechanisms of white cell reduction in red cell concentrates by filtration: the effect of the cellular composition of the red cell concentrates
Authors: Steneker I. , Prins H.K. , Florie M. , Loos J.A. , Biewenga J.
Published: March 2003

The effect of platelets on the removal of white cells (WBCs) from 16 to 24‐hour‐old red cell (RBC) concentrates by filtration was studied. RBC concentrates with various concentrations of platelets and WBCs were filtered on a cellulose acetate column filter and on three polyester flatbed filters. The microscopic study revealed that lymphocytes and most monocytes were captured in the smaller pores of the fiber network, irrespective of the brand of filter, the type of filter material, or the prefiltration platelet amount in the RBC concentrates. In contrast, efficient granulocyte depletion depended on granulocyte‐platelet interaction and on the filter material. In the presence of platelets, granulocytes were captured in the top part of the column filter or in the coarse layers of two of the flatbed filters, where platelets covered the fibers. Platelet depletion of the RBC concentrates prior to filtration diminished the contribution of these parts of the filters to granulocyte capture. A larger part of the column filter or the fine layers of the flatbed filters were now required for granulocyte capture. In one of the flatbed filters, granulocyte‐platelet interaction occurred mainly in the fine layers, which ended in blockage of this filter after the filtration of variable volumes (250‐600 mL) of standard RBC concentrates. A quantitative estimation of the effect of platelets on the WBC‐reduction capacity found that all three flatbed filters had a highly significant decrease (p = 0.001) in WBC‐reduction capacity for platelet‐depleted or buffy coat‐depleted RBC concentrates, as compared with standard RBC concentrates.(ABSTRACT TRUNCATED AT 250 WORDS)
Prevention of transfusion‐associated graft‐versus‐host disease: selection of an adequate dose of gamma radiation
Authors: Rosen N. R. , Weidner J. G. , Boldt H. D. , Rosen D. S.
Published: March 2003

To determine the optimal dose of gamma radiation necessary to inhibit T‐ lymphocyte function and prevent transfusion‐acquired graft‐versus‐host disease (TA‐GVHD), a donor plateletpheresis component was initially divided into ten 20‐mL samples. One sample was not irradiated, while the other nine samples were treated with gamma radiation at doses ranging from 500 to 4500 cGy. T‐lymphocyte function was subsequently measured by mixed lymphocyte cultures and mitogen stimulation assays. The results were assessed in each test by calculating the percentage of inhibition of each irradiated sample as compared to that of the unirradiated sample. The accuracy of the delivered dose of gamma radiation was measured with thermoluminescent dosimeters. It was concluded that a nominal dose of 3000 cGy (actual dose delivered, 2898 cGy) is the appropriate amount of gamma radiation needed to eliminate T‐ lymphocyte‐mediated graft‐versus‐host disease.
The effects of gamma irradiation versus white cell reduction on the mixed lymphocyte reaction
Authors: Dzik W.H. , Jones K.S.
Published: March 2003

The risk of transfusion‐associated graft‐versus‐host disease (TA‐GVHD) is related to the number of viable T cells transfused. Whether white cell (WBC)‐reduced blood components would carry a decreased risk of TA‐GVHD was considered, and the allogeneic mixed lymphocyte reaction was used as an in vitro model for TA‐GVHD. An exponential decline in the mixed lymphocyte reaction was found to occur, as a result of either an arithmetic increase in the dose of gamma irradiation given to responding cells or a logarithmic decrease in the number of unirradiated responding cells. Irradiation of responding cells with 600 cGy or a 0.6 log10 reduction in the number of responding cells produced a 95‐percent decline in the mixed lymphocyte reaction. Although these studies do not validate the use of WBC reduction as a substitute for gamma irradiation for the prevention of TA‐GVHD, they suggest that the relative risk of TA‐GVHD resulting from the use of standard cellular components versus WBC‐reduced components merits further investigation.
The cost‐effectiveness of preoperative autologous blood donation for total hip and knee replacement
Authors: Birkmeyer J.D. , Goodnough L.T. , AuBuchon J.P. , Noordsij P.G. , Littenberg B.
Published: March 2003

Although the frequency of preoperative autologous blood donation is increasing dramatically, the economic implications of its use remain largely unexplored. Decision analysis was used to calculate the cost‐ effectiveness of autologous blood donation for hip and knee replacement. Cost‐effectiveness, expressed as cost per quality‐adjusted year of life saved, was based on observed red cell use in 629 patients undergoing surgery at two tertiary‐care centers. Autologous blood donation for bilateral and revision joint replacement cost $40,000 per quality‐adjusted year of life saved at Center 1 and $241,000 at Center 2. Autologous blood donation for primary unilateral hip replacement cost $373,000 per quality‐adjusted year of life saved at Center 1 and $740,000 at Center 2. Autologous blood donation was least cost‐ effective for primary unilateral knee replacement ($1,147,000/quality‐ adjusted year of life saved at Center 1 and $1,467,000/year at Center 2). Differences between autologous blood collections and transfusion requirements explained variations among procedures in the cost‐ effectiveness of autologous blood donation. Higher transfusion rates in autologous blood donors than in nondonors accounted for the poorer cost‐ effectiveness of autologous blood donation at Center 2 than at Center 1. Autologous blood donation is not as cost‐effective as most accepted medical practices. Its cost‐effectiveness can be improved substantially by the avoidance of overcollection and overtransfusion of autologous blood.
Neonatal mortality following transfusion of red cells with high plasma potassium levels
Authors: Hall T.L. , Barnes A. , Miller J.R. , Bethencourt D.M. , Nestor L.
Published: March 2003

The death of a neonatal infant following cardiac surgery and the transfusion of packed red cells (RBCs) with high plasma potassium levels is reported. The patient had been diagnosed at 2 weeks of age as having multiple cardiac malformations. During cardiopulmonary bypass surgery, multiple units of packed RBCs less than 5 days old were transfused. In response to a “stat” order and after depletion of stock units prepared for neonatal usage, a 32‐day‐old unit of packed RBCs was issued for transfusion. After approximately 60 mL was rapidly transfused from this unit, the patient experienced cardiac arrest. Serum potassium concentration after transfusion and before death was 8.9 mmol per L. Plasma potassium concentration in the remainder of the transfused packed RBC unit was approximately 60 mmol per L. A model was created to calculate the posttransfusion plasma potassium concentration, and close correlation was found between the model and the observed potassium concentration, which assumes that the potassium load had not yet been distributed to the extravascular and intracellular fluid compartments. It is concluded that the transfusion of relatively large volumes of RBCs be limited to fresh packed RBCs or to packed RBCs that have been saline washed, to minimize the complications of electrolyte disturbances.
The preparation of fibrinogen concentrate for use as fibrin glue by four different methods
Authors: DePalma L. , Criss V.R. , Luban N.L.
Published: March 2003

Fibrinogen concentrates for use as fibrin glue were prepared by modification of a cryoprecipitate method. The goals were the optimization of a method for different centrifuges and anticoagulants and the assay of factors not previously analyzed. Following a ‐70 degrees C freeze and a 4 degrees C thaw, CPDA‐1 and ACD plasma were centrifuged at 6500 × g for 5 minutes or, alternatively, at 5000 × g for 7 minutes. The supernatant plasma was expressed to a final volume of 15.5 ± 3 mL, and concentrates were stored at ‐30 degrees C. Preconcentration and postconcentration samples were analyzed for fibrinogen, fibronectin, factor XIII, and plasminogen content. Fibrinogen in CPDA‐1 plasma was significantly higher than that in ACD plasma both before and after concentration at both centrifugation speeds. Fibronectin, factor XIII, and plasminogen concentrations were not significantly affected by centrifugation speed or the type of anticoagulant used. Fibronectin and plasminogen concentrations were significantly increased in components that were held for 5 to 6 days, as compared to those held for 0 to 1 day before freezing. Storage for up to 20 days in CPDA‐1 and up to 5 months in ACD did not affect analyte concentration. It is concluded that ACD plasma centrifuged at 5000 × g yields a significantly low concentration of fibrinogen, while CPDA‐1 plasma centrifuged at 6500 × g yields the highest amount. Acceptable yields were obtained from centrifugation of ACD plasma at 6500 × g and of CPDA‐1 plasma at 5000 × g for use as fibrin glue.