bluuebunny/crossref_metadata_2025 huggingface dataset:
Establishing a Case‐Finding and Referral System for At‐Risk Older Individuals in the Emergency Department Setting: The SIGNET Model
Authors: Mion Lorraine C. , Palmer Robert M. , Anetzberger Georgia J. , Meldon Stephen W.
Published: March 2003

Older emergency department (ED) patients have complex medical, social, and physical problems. We established a program at four ED sites to improve case finding of at‐risk older adults and provide comprehensive assessment in the ED setting with formal linkage to community agencies. The objectives of the program are to (1) improve case finding of at‐risk older ED patients, (2) improve care planning and referral for those returning home, and (3) create a coordinated network of existing medical and community services. The four sites are a 1,000‐bed teaching center, a 700‐bed county teaching hospital, a 400‐bed community hospital, and a health maintenance organization (HMO) ED site. Ten community agencies also participated in the study: four agencies associated with the hospital/HMO sites, two nonprofit private agencies, and four public agencies. Case finding is done using a simple screening assessment completed by the primary or triage nurse. A geriatric clinical nurse specialist (GCNS) further assesses those considered at risk. Patients with unmet medical, social, or health needs are referred to their primary physicians or to outpatient geriatric evaluation and management centers and to community agencies. After 18 months, the program has been successfully implemented at all four sites. Primary nurses screened over 70% (n = 28,437) of all older ED patients, GCNSs conducted 3,757 comprehensive assessments, participating agency referrals increased sixfold, and few patients refused the GCNS assessment or subsequent referral services. Thus, case finding and community linkage programs for at‐risk older adults are feasible in the ED setting.
Pain Assessment and Management in Cognitively Impaired Nursing Home Residents: Association of Certified Nursing Assistant Pain Report, Minimum Data Set Pain Report, and Analgesic Medication Use
Authors: Fisher Susan E. , Burgio Louis D. , Thorn Beverly E. , Allen‐Burge Rebecca , Gerstle John , Roth David L. , Allen Scott J.
Published: March 2003

OBJECTIVES: The primary purpose of this preliminary study was to investigate the associations between certified nursing assistant (CNA) report of pain, Minimum Data Set (MDS) report of pain, and analgesic medication use in cognitively impaired nursing home residents.

DESIGN: Correlational study.

SETTING: Three nursing homes in the greater Birmingham, Alabama area.

PARTICIPANTS: Fifty‐seven cognitively impaired nursing home residents with a mean Mini‐Mental State Examination (MMSE) score of 11.1.

MEASUREMENTS: Pain was assessed using a three‐item proxy pain questionnaire (PPQ), developed by the researchers and administered to the residents' primary CNA. MDS and analgesic medication data corresponding with the time of PPQ data collection were gathered from medical records. Cognitive status was measured with the MMSE.

RESULTS: The PPQ elicited substantially higher estimates of pain prevalence than the MDS (48% versus 20%), and the PPQ and the MDS were not well correlated (pain frequency: r = .19, P = .18; pain intensity: r = .22, P = .11). The PPQ was also more strongly associated with analgesic medication use than the MDS. Cognitive status was significantly associated with pain report on the PPQ but not on the MDS. Test‐retest reliability coefficients for the three items of the PPQ were excellent, ranging from .84 to .87 (P≤ .01).

CONCLUSIONS: The CNA‐generated PPQ was a more sensitive measure of pain than the MDS for this sample. Although the MDS represents an important step toward systematic and standardized assessment of pain, more emphasis should be placed on multimodal assessment, including CNAs' perceptions and observations about pain experienced by cognitively impaired nursing home residents.
When Home Care Ends—Changes in the Physical Health of Informal Caregivers Caring for Dementia Patients: A Longitudinal Study
Authors: Gräsel Elmar
Published: March 2003

OBJECTIVES: To verify the change in health variables and parameters of health service utilization in a group of active caregivers for older persons with dementia in comparison with former caregivers who had ceased to provide home care for at least 6 months (death of the patient or institutionalized care).

DESIGN: A prospective longitudinal study with 1‐year follow‐up. Active and former caregiver groups originated from a sample of active caregivers at baseline.

SETTING: Participants were recruited mainly via advertisements placed in two magazines with large, nationwide circulation. The questionnaires were sent on request.

PARTICIPANTS: Seven hundred twenty primary caregivers of dementia patients living in the community. All patients had a medical diagnosis of dementia and had a score of 20 or greater on the mental‐mnestic disturbances factor of the Sandoz Clinical Assessment—Geriatric scale. Their care needs covered at least one of four activities of daily living (personal hygiene, eating, toilet use/excretion, mobility). After 12 months, 681 caregivers were reinterviewed.

MEASUREMENTS: The physical complaints were assessed with the 24‐item Giessen Symptom List (subscales: aching limbs, stomach complaints, heart complaints, physical exhaustion). Other key variables were the number of illnesses, number of somatic and psychotropic medications, and number of physician visits.

RESULTS: Although the somatic symptoms of the active caregivers (n = 427) remained stable at a high level, they decreased significantly (24%) in the group of former caregivers (n = 121). Simultaneously, the number of visits former caregivers made to physicians almost doubled. The reason why home care was terminated (death or institutionalization) did not influence health variables or health service utilization.

CONCLUSION: The physical health of former caregivers improves in the long term once they cease to provide home care. The fact that former caregivers go to the doctor much more frequently is to be interpreted as an indication that they take the time to attend to their own physical and medical needs.
Underestimation of Disability in Community‐Living Older Persons
Authors: Gill Thomas M. , Hardy Susan E. , Williams Christianna S.
Published: March 2003

OBJECTIVES: When ascertaining the occurrence of disability, long assessment intervals may be problematic because they do not account for the possibility of recovery or for deaths or losses to follow‐up. Our objective was to compare the rates of disability obtained from single follow‐up assessments with those obtained from monthly assessments for intervals up to 24 months.

DESIGN: Prospective cohort study.

SETTING: General community.

PARTICIPANTS: Seven hundred fifty‐four nondisabled persons, aged 70 and older, categorized into three groups according to their risk for disability (low, intermediate, and high).

MEASUREMENTS: Participants were followed with monthly telephone interviews to determine the occurrence of disability in one or more of four key activities of daily living (ADLs).

RESULTS: For each risk group, the rates of disability obtained from monthly assessments of ADL function (cumulative disability) were considerably greater than those obtained from single follow‐up assessments (prevalent disability). These differences in rates increased progressively as the length of the assessment interval increased. For example, the cumulative and prevalence rates of disability in participants in the intermediate risk group were 0.24 and 0.11 at 6 months, 0.36 and 0.20 at 12 months, 0.46 and 0.16 at 18 months, and 0.53 and 0.20 at 24 months, respectively. Although the overall rates were lower, the results for persistent disability, defined as a new disability that was present for at least 2 consecutive months, were similar. Although these differences in rates were attributable almost exclusively to recovery from disability in the first 6 months, they were due increasingly to deaths and losses to follow‐up over the next 18 months, particularly in participants in the high‐risk group.

CONCLUSIONS: The occurrence of disability is substantially underestimated by longitudinal studies with long assessment intervals. More frequent assessments of functional status could lead to an improved understanding of the course and overall burden of disability in community‐living older persons.
The Development of Outpatient Clinical Glidepaths™
Authors: Flaherty Joseph H. , Morley John E. , Murphy Donald J. , Wasserman Michael R.
Published: March 2003

For clinicians who are struggling with the complexities of medical decision‐making, practice guidelines and evidence‐based medicine (EBM) have become increasingly popular and have potential to positively influence the practice of medicine. Nevertheless, they have their limitations. Guidelines are often rigid, based solely on age, and usually do not take into account a patient's comorbidities, life expectancy, and nonmedical preferences. EBM studies may not always include particular patient populations commonly seen by the geriatric clinician (e.g., studies on lipid‐lowering agents or antihypertensive drug usually exclude the very old or patients who are frail, demented, or at the end of life). These limitations have made it difficult for geriatric clinicians to use these guidelines because of the need to individualize evaluation and treatment approaches and take into account the varied preferences of their older patients. The purpose of this paper is to present an alternative model of care for geriatric clinicians called The Clinical Glidepaths. The Clinical Glidepaths are outpatient tools intended to assist geriatric clinicians in their decision‐making process. They are based on the following principles. (1) Clinicians need guidance concerning many different types of patients, not rigid guidelines based solely on age. (2) EBM should be used but has some limitations of which to be aware. (3) Clinical experience, which emphasizes individual outcomes instead of populations, is an important component of medical decisions. (4) There needs to be room for patient preferences in medical decision‐making. (5) An approach to patients based on probable life expectancy and function, instead of age, will be more applicable and useful. (6) Making a useful tool will focus on common problems seen in every day geriatric practices.
Pneumococcal Polysaccharide Revaccination: Immunoglobulin G Seroconversion, Persistence, and Safety in Frail, Chronically Ill Older Subjects
Authors: Lackner Thomas E. , G Hamilton Robert , J Hill John , Davey Cynthia , Guay David R. P.
Published: March 2003

OBJECTIVES: To determine the 1‐month postpneumococcal polysaccharide‐revaccination immunoglobulin G (IgG) antibody response, its persistence at 1 year, and tolerability of revaccination in frail, chronically ill older nursing facility residents.

DESIGN: Prospective study conducted between December 1998 and July 2000.

SETTING: Six skilled nursing facilities in the Minneapolis‐St. Paul, Minnesota, metropolitan area.

PARTICIPANTS: Sixty‐seven subjects aged 65 and older having received primary vaccination with pneumococcal polysaccharide vaccine (PPV) at least 5 years before enrollment.

INTERVENTION: Revaccination with one dose of 23‐valent PPV.

MEASUREMENTS: Adverse events and concentrations of seven individual pneumococcal polysaccharide type‐specific IgG antibodies (against serotypes 4, 6B, 9V, 14, 18C, 19F, 23F) and their aggregate before and 1 and 12 months after revaccination.

RESULTS: A significant increase in all individual and aggregate median antibody concentrations over baseline was observed 1 month after revaccination. However, after 1 year, the increase remained significant only for serotypes 6B and 18C and the aggregate parameter. One month after revaccination, the mean increase in antibody concentration over baseline was significantly greater than 1.4‐fold for six of the seven serotypes and the aggregate. However, the increase was not significantly greater than 1.4 at 1 year for any of the serotypes or the aggregate. Minor, self‐limited localized adverse reactions and systemic reactions occurred in 11.3% of the subjects.

CONCLUSIONS: In frail, chronically ill older nursing facility residents, revaccination with 23‐valent PPV at least 5 years after primary vaccination (whether primary vaccination occurred before or after age 65) is associated with a significant, albeit brief, immunological response for most of the serotypes tested. Revaccination was well tolerated.
Preventing Disability Through Community‐Based Health Coaching
Authors: Holland Stephen K. , Greenberg Jay , Tidwell Lynette , Newcomer Robert
Published: March 2003

The California Public Employees Retirement System (CalPERS) Health Matters program is a randomized controlled trial of a community‐based health coaching program operating in Sacramento, California, since January 2001. It is modeled after the Health Enhancement Program and Senior Wellness Program of Seattle, Washington. Like the Health Enhancement Program, this program incorporates a menu of disability‐prevention strategies, with health coaching, patient education on the self‐management of chronic illness, and fitness forming the program's core. Unlike the Health Enhancement Program, the Health Matters program focuses as much attention on linking participants to existing community, health plan, and self‐directed programming as it does encouraging them to participate in programming developed especially for the project. All participants and controls continue to receive their usual medical care from their managed care providers. Eligibility criteria for the program include having one or more qualifying chronic health conditions, being aged 65 and older, being a member of a participating health plan, and being accepted into CalPERS' Long Term Care Insurance Program. Baseline exclusions include being cognitively impaired or qualifying for long‐term care insurance benefits due to deficiencies in two or more activities of daily living. The project has been successful in its enrollment strategy. It has also been successful in recruiting participants into project‐sponsored, community‐based, and self‐directed disability‐prevention programming. This is particularly true for programming related to diet, exercise, and various aspects of disease management.
Antimicrobial Resistance and Aging: Beginning of the End of the Antibiotic Era?
Authors: Yoshikawa Thomas T.
Published: March 2003

Throughout the history of mankind, infectious diseases have remained a major cause of death and disability. Although industrialized nations, such as the United States, have experienced significant reductions in infection‐related mortality and morbidity since the beginning of the “antibiotic era,” death and complications from infectious diseases remain a serious problem for older persons. Pneumonia is the major infection‐related cause of death in older persons, and urinary tract infection is the most common bacterial infection seen in geriatric patients. Other serious and common infections in older people include intra‐abdominal sepsis, bacterial meningitis, infective endocarditis, infected pressure ulcers, septic arthritis, tuberculosis, and herpes zoster. As a consequence, frequent prescribing of antibiotics for older patients is common practice. The large volume of antibiotics prescribed has contributed to the emergence of highly resistant pathogens among geriatric patients, including methicillin‐resistant Staphylococcus aureus, penicillin‐resistant Streptococcus pneumoniae, vancomycin‐resistant enterococci, and multiple‐drug‐resistant gram‐negative bacilli. Unless preventive strategies coupled with newer drug development are established soon, eventually clinicians will be encountering infections caused by highly resistant pathogens for which no effective antibiotics will be available. Clinicians could then be experiencing the same frustrations of not being able to treat infections effectively as were seen in the “pre‐antibiotic era.”
Disordered Hematopoiesis and Myelodysplasia in the Elderly
Authors: Rothstein Gerald
Published: March 2003

Normal hematopoiesis constitutes the process of producing diverse, differentiated blood cell types in a manner related to physiological requirement. During aging, modulation of hematopoiesis becomes disordered, impairing the ability of older people to respond appropriately to the physiological demand for blood cell replacement triggered by stimuli such as blood loss or cytoreductive chemotherapy. This may contribute to the increase in the prevalence of anemia that is observed during aging. In addition, various age‐related events, such as genomic mutations secondary to oxidative stress and impaired regulation of cytokine production, may contribute to or cause the emergence of abnormal clones of hematopoietic cells. Therefore, normal hematopoiesis is disrupted, and the hematopoietic system is populated with cells that are quantitatively and functionally deficient and are also subject to leukemic transformation. These defects in the production and maturation of the various differentiated blood cells are referred to as myelodysplastic syndromes. These syndromes are so tightly associated with aging that they are considered to be geriatric disorders; they can lead to anemia, neutropenia, and thrombocytopenia and to the development of acute nonlymphoblastic leukemia. Dysregulation of mechanisms controlling hematopoiesis is therefore an important characteristic of the hematopoietic system in the elderly, but the response of progenitor cells to humoral stimulators is preserved and accounts for the effectiveness of recombinant hematopoietic growth factors used as emerging treatment modalities for hematopoietic disorders in the elderly.
Pain and Quality of Life
Authors: Niv David , Kreitler Shulamith
Published: March 2003

Abstract: This paper deals with the impact of pain on quality of life (QOL). Two major factors have contributed to the enhanced importance of QOL in recent years: the increasing frequency of pain and the resources devoted to its treatment, and the growing theoretical insight that pain affects the person as a whole. QOL is defined as the person's evaluation of his or her well‐being and functioning in different life domains. It is a subjective, phenomenological, multidimensional, dynamic, evaluative, and yet quantifiable, construct. Commonly used scales for its assessment (eg, WHOQOL, SF‐36) are described. Studies show that pain affects most domains of QOL, primarily physical and emotional functioning. The effect depends on the extent, duration, acuteness, intensity, affectivity, and meaning of the pain as well as on the underlying disease and the individual's characteristics. QOL is sensitive also to the treatment of pain and treatment modalities, as shown particularly by studies on cancer pain. Pain reduction is not always attended by the expected improvement in QOL. Pain is not synonymous with poor QOL and constitutes only one important factor determining QOL. The main conclusions are that treatment of pain should be multidisciplinary, considering the impact of pain and the treatment on QOL and targetting also improvement of the affected domains of QOL.
Role of Facet Joints in Chronic Low Back Pain in the Elderly: A Controlled Comparative Prevalence Study
Authors: Manchikanti Laxmaiah , Pampati Vidyasagar , Rivera Jose , Fellows Bert , Beyer Carla , Damron Kim
Published: March 2003

Abstract: Evaluation of the age related prevalence of persistent low back pain has been estimated to be consistently higher in the elderly compared to the younger population. Facet joints have been shown to be the cause of chronic low back pain in 15% to 45% of the patients in controlled studies. Prevalence of facet joint mediated pain has not been studied in the elderly. The study population consisted of 100 patients. Group I consisted of 50 patients that were 64 years of age or younger. Group II consisted of 50 patients 65 years of age or older. The patients were randomly allocated into 1 of the 2 groups. Facet joints were investigated with diagnostic blocks initially using lidocaine 1% followed by bupivacaine 0.25%, usually 2 weeks apart.

The prevalence of facet joint mediated pain was determined to be 30% in the adults and 52% in the elderly, which was significantly higher with a false positive rate of 26% in adults and 33% in the elderly.

In conclusion, the results of this study show that facet joint mediated pain is a significant problem in all patients suffering with chronic low back pain with the prevalence of 52% in the elderly and 30% in adults.
Chronic Pain and Self‐efficacy: The Effects of Age, Sex, and Chronicity
Authors: Chong Gary S. , Cogan Dennis , Randolph Patrick , Racz Gabor
Published: March 2003

Abstract: Higher self‐efficacy (SE) is associated with lower pain ratings in chronic pain patients, although longer experience with chronic pain leads to lower SE scores. Self‐efficacy in pain patients does not appear to be clearly related to sex or age, however. This study investigated the effects of gender, age, length of pain experience (chronicity) on SE and pain ratings.

Archival data from the records of 187 patient's charts were evaluated for demographic information, chronicity, pain ratings and SE. Analyses found a significant inverse relationship between SE and pain ratings (r = −.22) and lower SE for young adult patients. Results support the conclusion that enhanced SE is an important psychosocial intervention in the treatment of chronic pain patients.
Evaluation of age and American Society of Anesthesiologists (ASA) physical status as risk factors for perianesthetic morbidity and mortality in the cat
Authors: Hosgood Giselle , Scholl Daniel T
Published: March 2003

Objective: To evaluate age and American Society of Anesthesiologists (ASA) physical status as risk factors for perianesthetic morbidity/mortality in cats.

Design: Prospective cohort study.

Setting: Institution teaching hospital.

Animals: 138 cats ≥ 6 months of age that received inhalation anesthesia for ≥ 30 min

Interventions: Observations were made during the 24 h post‐anesthetic period.

Measurements and main results: Sixty‐one females and 77 males were included. Serious perianesthetic complications occurred in 15 cats (15/138; 11%), including cardiopulmonary arrest in 3 cats (3/138; 2%), and death or euthanasia in 7 cats (7/138; 5%). Age was not a factor in establishing risk for developing serious or minor perianesthetic complications in the cats in this study. However, ASA status was a risk factor. Cats having an ASA status of 3 or more were nearly 4 times as likely to develop serious perianesthetic complications, even when accounting for the significant confounding effects of anesthesia duration.

Conclusions: ASA status, but not age, was a risk factor for the development of serious or minor perianesthetic complications in the 138 cats included in this study.
Acquisition of K: 1 ‐like antigen during terminal sepsis
Authors: MCGINNISS M.H. , MACLOWRY J.D. , HOLLAND P.V.
Published: March 2003

This report describes a patient whose own and transfused K:‐1 red cell populations became strongly K:1 during a terminal episode of sepsis due to a group D streptococcus organism, Streptococcus faecium. Subsequent in vitro studies using normal K:‐1 red cells inoculated with that organism showed that it could render the red cells agglutinable by reagents containing IgG anti‐K1. In addition, disrupted S. faecium organisms rendered Jkb‐negative red cells agglutinable by those reagents.
A new method for evaluating the hepatitis risk of the multiply‐implicated donor
Authors: LADD DANIEL J. , HILLIS ARGYE
Published: March 2003

The usual method of estimating probability of infectivity for donors implicated in more than one case of post‐transfusion hepatitis fails to take adequate account of the donor's past history and underestimates the risk of infectivity. A corrected method of calculation is presented and shown to give substantially different results.
Incidence of antibody formation and positive direct antiglobulin tests in a multitransfused hemodialysis population
Authors: Lasky L.C. , Rose R.R. , Polesky H.F.
Published: March 2003

In order to determine the degree and significance of red cell antibody production by dialysis patients, two groups of patients were studied retrospectively. One hundred and five randomly selected dialysis patients (Group I) receiving a total of 1074 units of blood were reviewed, as were 38 patients who were given frozen‐thawed red cells because of intractable nonhemolytic febrile reactions following transfusions of red cells stored conventionally (Group II). Eleven patients in Group I produced alloantibodies: nine after the start of dialysis. Of these, two patients had antibodies that were judged clinically insignificant. Eleven of 38 patients in Group II had red cell alloantibodies at the time of study, four of which were judged clinically significant. The direct antiglobulin test (DAT) was positive in 14 patients in Group I and eight patients in Group II for an overall percentage of 15. The cause of the positive DAT was determined in eluates for 26 percent of the cases studied. Clinically significant antibodies were produced by 6.7 percent of randomly selected dialysis patients (Group I). This incidence is lower than other chronically transfused patient populations reported, but higher than that reported in transfused patients at large. The incidence of positive DATs was higher than in some populations reported but not others.
Acute hemolytic anemia associated with a chlorpropamide‐induced apparent auto‐anti‐Jka
Authors: Sosler S.D. , Behzad O. , Garratty G. , Lee C.L. , Postaway N. , Khomo O.
Published: March 2003

A patient with acute hemolytic anemia and a positive direct antiglobulin test was found to be Jk(a + b +) with anti‐Jka in her serum. For 2 weeks prior to admission, the patient had taken chlorpropamide, a hypoglycemic agent. The drug was discontinued upon the diagnosis of hemolytic anemia, and the hemoglobin concentration gradually increased. When chlorpropamide was added to the patient's serum in vitro, it enhanced the reactivity of the anti‐Jka, and 40 days posttransfusion, the serum would only react with Jk(a+) red cells when chlorpropamide was present. These findings suggest that a chlorpropamide‐dependent antibody with Jka specificity had formed. We do not know why the antibody induced by chlorpropamide reacted preferentially with Jk(a+) red cells.
Harvest of young red cells on an automated cell separator
Authors: Bracey AW , McFarland F
Published: March 2003

Red cells can be fractionated by age on a blood processor (Model 2991, IBM). However, little data exist on processing a product for transfusion. This report details a method for collecting young erythrocyte (YE) units containing a mean hemoglobin content of 56.43 +/− 1.39 (SEM) grams. Enrichment with YEs was indicated by greater activity of the enzyme pyruvate kinase (PK) in aliquots of YE units. The mean ratio of PK activity in the young red cell product compared to unfractionated blood was 1.14 +/− 0.03 (SEM). An increased PK ratio was noted in 23 of 26 units studied. Based on the PK ratio, the mean age of the erythrocytes was 46 days, compared to 60 days for standard units of blood. In the 6 units assayed, the reticulocyte count was increased. Collection of YE units was relatively easy, no untoward donor reactions were observed, and no deleterious effects developed in the recipient. Although these data suggest enrichment with a young population of red cells, YE units produced by this method are experimental. Routine use of this procedure awaits demonstration of a significant decrease in transfusion frequency in patients receiving YE units for chronic red cell therapy.
Mitogen response of lymphocytes in platelet concentrates
Authors: Margo B. , Dzik W.
Published: March 2003

The mitogen responsiveness of lymphocytes obtained from platelet concentrates under standard platelet storage conditions was measured. Blastogenic response to phytohemaglutinin, concanavalin A, and pokeweed mitogen declined significantly during storage to 19, 51, and 26 percent respectively of original activity. The presence of adenine supplementation in the anticoagulant preservative solution did not significantly effect the mitogen responses.
Red cell and platelet‐bound IgG penicillin antibodies in a patient with thrombocytopenia
Authors: Salamon D.J. , Nusbacher J. , Stroupe T. , Wilson J.H. , Hanrahan J.B.
Published: March 2003

A patient was found to have a positive direct antiglobulin test and thrombocytopenia while on a moderate dose of intravenous penicillin. Serological evaluation of the patient's red cells demonstrated that the positive antiglobulin test was due to antipenicillin antibody. This antibody also was demonstrated in the patient's serum. The patient's platelets had increased quantities of IgG; an eluate from her platelets gave positive test results with platelets treated with penicillin but not normal platelets. Her serum also reacted only with penicillin‐treated platelets. Multiple absorptions of her serum with red cells treated with penicillin reduced reactivity against both fresh red cells and platelets treated with penicillin. This patient demonstrated the coexistence of drug‐induced immune phenomena directed against both red cells and platelets.
Alloimmunization in patients with warm autoantibodies
Authors: Wallhermfechtel M. A. , Pohl B. A. , Chaplin H.
Published: March 2003

We examined the value of performing alloabsorptions to detect clinically significant alloantibodies in patients with warm autoantibodies who must receive crossmatch‐incompatible blood. One hundred and twenty‐five (125) patients were evaluated using alloabsorption with red cells (RBCs) from three donors: R1R1, R2R2, and rr, whose phenotypes other than Rh were selected to exclude 98 percent of clinically significant alloantibodies. This technic was selected rather than autoabsorption due to insufficient quantities of patient cells available and to the possible presence of transfused cells in some instances. Patients were divided into three risk categories: I‐no prior pregnancy or transfusion; II‐history of pregnancy and/or one to five transfusions; and III‐greater than five transfusions. No significant alloantibodies were found in 32 category I patients. Of 74 category II patients, 13 (17.5%) had significant alloantibodies detectable after absorption. Six of 19 (31.5%) category III patients had alloantibodies. The majority showed Rh specificity: anti‐E (13), ‐C (6), ‐c (2), ‐D (1). Anti‐K was found in five samples. Forty‐two (42%) percent of the alloantibodies were undetectable prior to the alloabsorptions. We conclude that category II and particularly category III patients are at significant risk of allosensitization and should be evaluated by an absorption procedure prior to the transfusion of crossmatch‐incompatible red cells.
The rare red cell phenotype Lan negative in Japanese
Authors: Okubo Y. , Yamaguchi H. , Seno T. , Araki Y. , Noguchi M. , Shioda K. , Takai M. , Daniels G. L.
Published: March 2003

Two patients and a healthy blood donor were found to be Lan negative and to have anti‐Lan in their sera. These are the first three examples of the Lan‐negative phenotype to be described in Japanese. The families of two of the propositi were studied: the parents of both were first cousins and one of the propositi had a Lan‐negative sibling. No Lan‐ negative examples were found in 15,000 Japanese donors screened with anti‐Lan.
Measures to decrease the risk of acquired immunodeficiency syndrome transmission by blood transfusion
Authors: Pindyck J. , Waldman A. , Zang E. , Oleszko W. , Lowy M. , Bianco C.
Published: March 2003

We studied whether volunteers giving blood to the Greater New York Blood Program (GNYBP) cooperated with procedures implementing public health recommendations intended to decrease the risk of acquired immunodeficiency syndrome (AIDS) transmission by blood transfusion. Predonation medical screening was expanded to exclude donors who might be ill with AIDS. To exclude possible asymptomatic carriers of the disease, members of groups at increased risk of AIDS were asked either not to give blood or to give it for laboratory studies. A confidential questionnaire, administered to all donors after medical screening, provided the vehicle for donors to advise the GNYBP whether their donation was for laboratory studies or for patient transfusion. We found that the number of male donors decreased; AIDS‐related questions in medical history led to a 2 percent increase in donor rejections; 97 percent of donors said their blood could be used for transfusions; 1.4 percent said their blood could be used for laboratory studies only; and 1.6 percent did not respond. Only units designated for transfusion were released to hospitals.

People who indicated that their donation was for laboratory studies had a higher prevalence of markers for hepatitis B virus and of antibodies to cytomegalovirus. White cell counts and helper/suppressor T lymphocyte ratios were not significantly different in the two groups.

We conclude that volunteer donors have cooperated with the established procedures. None of the laboratory assays identified blood units donated by individuals who, based on information about AIDS high‐risk groups, designated their donation for laboratory studies.
The effects of pH and agitation on platelet preservation
Authors: Bannai M. , Mazda T. , Sasakawa S.
Published: March 2003

Platelet concentrates made with an initial pH of 7.85 or 6.85 by addition of alkali or acid were stored at 22°C on tumbler or horizontal agitators. The combination of a high pH and use of a tumbler rotator was associated with a 40 percent reduction in platelet count, fragmentation of platelets, release of lactate dehydrogenase, and a marked loss in response to adenosine diphosphate. Similar, but less striking changes occurred in acidified platelet concentrates stored on the tumbler rotator. Preservation was good for both alkaline and acidified concentrates stored on the horizontal agitator.

These in vitro studies showed that, even at a pH of up to 7.7, gently agitated platelets were relatively undamaged for up to 60 hours, while vigorous agitation destroyed platelets at the same pH.
Effects of hydroxyethyl starch on blood coagulation, particularly factor VIII
Authors: Stump D. C. , Strauss R. G. , Henriksen R. A. , Petersen R. E. , Saunders R.
Published: March 2003

The effects of hydroxyethyl starch (HES) on hemostasis were investigated extensively. In order to simulate acute blood loss due to surgery or trauma, one unit (450 ml) of blood was drawn from normal healthy men. This was followed by a 1‐liter infusion over 60 minutes of either 6 percent HES, 5 percent albumin, or 0.9 percent sodium chloride (NaCl) as replacement. Coagulation studies were performed before phlebotomy, before infusion and at 0, 4, 20, 27, and 92 hours following infusion. Following infusion of HES and albumin, plasma fibrinogen and antithrombin‐III levels fell slightly due to plasma volume expansion and hemodilution. In subjects receiving HES, partial thromboplastin times (PTTs) were significantly (p less than .05) prolonged and factor VIII activities were significantly (p less than .05) decreased when compared to the albumin and NaCl groups. These findings could not be attributed solely to hemodilution. The effects of HES on PTT and factor VIII could not be correlated with plasma HES levels; neither could they be reproduced in vitro by mixing HES with normal plasma. Mean values of the following studies remained normal after infusion of all replacement fluids: prothrombin time, bleeding time, fibrin monomer, fibrin‐ fibrinogen degradation products, platelet adhesion, circulating platelet aggregates, and platelet count.(ABSTRACT TRUNCATED AT 250 WORDS)
The predictive value of crossmatching platelet transfusion for alloimmunized patients
Authors: Kickler T. S. , Braine H. , Ness P. M.
Published: March 2003

To determine the predictive value of a radiolabeled antiglobulin test for platelet crossmatching to select platelets for transfusion, we evaluated 230 transfusions in 42 alloimmunized oncology patients. Transfusions were classified according to the degree of HLA match. The value of the crossmatch in predicting platelet transfusion outcome was analyzed for each HLA category. For predicting the 1‐hour corrected platelet count increment of all transfusions, the sensitivity of the test was 86 percent, specificity 84 percent, and total predictive value 84 percent. The crossmatch technique had similar predictive ability in all categories of HLA match, whether analyzing the results on the basis of the 1‐ or 24‐hour platelet count rise.
Granulocytes do not have surface ABO antigens
Authors: Kelton J.G. , Bebenek G.
Published: March 2003

There is disagreement whether granulocytes have ABO antigens on their surfaces. We investigated this issue using pure populations of washed granulocytes from healthy individuals of known ABO, Lewis, and secretor phenotypes. The presence of ABO antigens on granulocytes was sought using four different techniques: a granulocyte‐red cell mixed agglutination assay; a microleukoagglutination assay; a microgranulocyte cytotoxicity assay; and an immunoradiometric assay for granulocyte‐associated IgG. Both fixed and unfixed granulocytes were tested. All tests were negative. Granulocytes do not have ABO antigens on their surfaces.
Diagnostic and pathogenetic considerations in transfusion‐related acute lung injury
Authors: Popovsky M. A. , Moore S. B.
Published: March 2003

Transfusion‐related acute lung injury (TRALI) is an infrequent but life‐ threatening complication of hemotherapy. The findings in 36 cases are described. The typical clinical presentation includes acute respiratory distress characterized by hypoxemia and fulminant pulmonary edema. The onset is usually within 4 hours of transfusion and is accompanied by hypotension. In most patients (81%), recovery is rapid and complete. In 89 percent of cases, granulocyte or lymphocytotoxic antibodies are found in the serum of the implicated blood product which contained plasma. HLA‐specific antibodies were identified in donor serums in 65 percent of cases evaluated. The passive transfer of these antibodies may promote complement activation and subsequent pulmonary injury. TRALI is an important cause of transfusion‐associated morbidity and is probably often misdiagnosed. Blood banks need to identify donors whose plasma causes these reactions in order to prevent their recurrence.
Cost‐benefit analysis of a plateletapheresis program
Authors: McFarland J. G. , Larson E. B. , Hillman R. S. , Slichter S. J.
Published: March 2003

We determined costs and benefits of a community donor plateletapheresis program (CDPP) designed to provide HLA‐matched platelet transfusions for patients who were refractory to random‐donor platelets (RDPs). Costs of establishing and maintaining the CDPP were $127,520 for the first year (1982). Benefits were expressed as cost savings attributed to the CDPP. After the program began, the use of RDP in the community was 17,458 units less than projected. Estimates of net cost savings during the first year ranged from $177,570 to $272,253 (1982 dollers; cost‐to‐benefit ratios were 1:1.39 to 1:2.14.) in a matched cohort study of marrow transplant patients, CDPP platelet transfusions were as effective as those from family donors while total platelet and red cell use was unchanged. In patients with acute leukemia treated with chemotherapy, significant reduction in both platelet and red cell use was seen after institution of CDPP support. We conclude that the CDPP is a cost‐effective approach to platelet support.
Elimination of infectious retroviruses during preparation of immunoglobulins
Authors: MITRA G. , WONG M. F. , MOZEN M. M. , McDOUGAL J. S. , LEVY J. A.
Published: March 2003

ABSTRACT: Safety concerns for immunoglobulin preparations have led us to study partition/inactivation of two prototype retroviruses, mouse xenotropic type C and lymphadenopathy‐associated virus (LAV) of the acquired immunodeficiency syndrome (AIDS), during manufacture and storage of immunoglobulins. Reduction of infectious retrovirus titers were 105 to 108‐fold through Cohn‐Oncley cold ethanol fractionation from plasma to fraction II, 103 to 105‐fold through incubation at pH 4.0 and another 104‐fold through incubation of the purified liquid immunoglobulin preparations at 27°C or 45°C. The results support the clinical and epidemiological evidence that therapeutic immunoglobulin preparations do not transmit AIDS virus.
A simple method for high‐quality frozen red cells in blood group serology
Authors: Högman C. F. , Hornblower M. L‐S. , Flodin M. , Gillberg G. , Meryman H. T. , Säfwenberg J.
Published: March 2003

A high‐glycerol method for long‐term storage of red cells for use in blood group serology testing is described. Total freezing‐thawing‐washing hemolysis was 8.05 ± 0.3 percent. Enzyme treatment could be performed before freezing or after reconstitution. The cells performed well with manual and automated techniques. No changes in agglutinability were noted during 10 days of liquid storage at 4°C following thawing.
A comparison of frozen and fresh platelet concentrates in the support of thrombocytopenic patients
Authors: Towell B. L. , Levine S. P. , Knight W. A. , Anderson J. L.
Published: March 2003

Ten patients scheduled to receive intensive chemotherapy were plateletapheresed and the platelet‐rich plasma was frozen with 5 percent dimethyl sulfoxide at –80 to –95° C until needed. Paired comparisons of frozen autologous platelets with fresh single‐donor platelets were made in seven patients using corrected platelet increments at 1 and 24 hours, and pre‐ and posttransfusion bleeding times. In vitro tests of 12 units of plateletrich plasma before and after freezing included platelet factor 4 (PF4) secretion, malondialdehyde production, and electron microscopic evaluation of morphology. Fresh platelets provided significantly better 1‐ and 24‐hour corrected increments compared with frozen autologous platelets. In only one case of alloimmunization did frozen autologous platelets provide a better increment than fresh platelets. Bleeding times after transfusion showed no consistent improvement regardless of type of transfusion or platelet count. Secretable PF4 remained constant after freezing, but malondialdehyde production fell significantly. Platelets showed considerable structural damage with 33 percent balloon forms counted after thawing, compared to less than 1 percent before freezing. Except in the case of alloimmunization, frozen autologous platelets are inferior to single‐donor fresh platelets, and are significantly damaged in the freezing process.
Red cell alloantibodies produced after bone marrow transplantation
Authors: Pun A. , Dodds A. J. , Atkinson K. , Biggs J. C. , Ting A.
Published: March 2003

This article describes the production of red cell alloantibodies in 13 of 150 patients after bone marrow transplantation. New alloantibodies appeared 12 days to 11 months after the transplantation. The specificities of these antibodies were anti‐N, ‐Jka, ‐E‐like, ‐Kell‐ like, ‐M, ‐Leb, ‐Hl, ‐H and ‐A1. The posttransplantation production of antibody could be due to either the transfusion of mature lymphocytes along with the marrow, the ability of the grafted immune system to produce alloantibodies, or the viable immunocompetent cells remaining despite high‐dose chemotherapy and irradation.
ABO and Lewis blood group antigens of donor origin in the bile of patients after liver transplantation
Authors: Dzik W.H. , Mondor L.A. , Maillet S.M. , Jenkins R.L.
Published: March 2003

The authors prospectively studied the expression of blood group antigens and their corresponding glycosyltransferases in the bile of 11 patients who received orthotopic liver transplants. In six patients, the donor was of the same ABO/Lewis/secretor as the recipient, and the expected blood group antigens were found in the postoperative bile. Five patients who received transplants from donors discordant for either ABO, Lewis, or secretor status continued to produce blood group antigens of donor origin. This study provides evidence that the expression of soluble blood group antigens is under autonomous end‐ organ control.
Determination of an appropriate size of unrelated donor pool to be registered for HLA‐matched platelet transfusion
Authors: Takahashi K. , Juji T. , Miyazaki H.
Published: March 2003

HLA‐matched platelet transfusions from related or unrelated donors are effective in correcting bleeding tendencies of alloimmunized thrombocytopenic patients. To supply HLA‐matched platelets, registration of unrelated HLA‐typed donors and selection of compatible donors are necessary and practical considering HLA polymorphism. In this study, the frequencies of each possible HLA phenotype and of corresponding possible compatible donors were calculated with a computer from the table of frequencies of HLA‐A and ‐B haplotypes. Appropriate sizes of such donor pools were theoretically evaluated in Japanese as well as in European Caucasoid and in North American Caucasoid populations. To enable more than 80 percent of patients to get more than five completely compatible donors, only 5000 donor candidates would be necessary for the Japanese population, whereas 18,000 and 25,000, respectively, would be required for European Caucasoid and North American Caucasoid populations.
Leukocyte depletion of red cell units at the bedside by transfusion through a new filter
Authors: Sirchia G. , Rebulla P. , Parravicini A. , Carnelli V. , Gianotti G.A. , Bertolini F.
Published: March 2003

Standard packed red cell (PRC) units can be depleted of leukocytes and platelets if they are transfused through a blood administration set in which the usual 170‐mu filter has been replaced by a leukocyte removal filter (Sepacell R‐500). During a 6‐month period, 1550 PRC units were transfused through this filter in 611 transfusions to 80 multitransfused patients with thalassemia who had had a patient reaction rate (PRR) of 63 percent and a transfusion reaction rate (TRR) of 13 percent when given standard PRC or buffy‐coat‐depleted PRC. When given filtered PRC, PRR and TRR became 3.7 percent and 0.5 percent, respectively. The effectiveness of the filter was also evaluated in vitro. By filtering 2 standard PRC units through the same filter, median values (and ranges) for red cell recovery and for residual leukocytes and platelets were 87 percent (83–92), 6.1 × 10(6) (0–100), and 2.7 × 10(9) (0.6–9.7), respectively. Although refinements are needed to improve standardization of the filter and to increase red cell recovery (which is low when 1 unit is filtered through one filter) and blood administration rate, the ability to provide leukocyte‐free red cells prepared at the bedside for virtually all recipients appears to be a realistic goal.
Radiolabeled red cell viability
Authors: Marcus C.S. , Myhre B.A. , Angulo M.C. , Salk R.D. , Essex C.E. , Demianew S.H.
Published: March 2003

The simultaneous determination of autologous 99mTc red cell (RBC) and 51Cr RBC viability at 24 hours was measured in 19 normal volunteers whose RBCs had been stored in additive media (Nutracel) for 42 or 49 days. The ratio of the 51>Cr:99mTc value was 1.23. In this experiment we also calculated 51Cr RBC viability by both the single‐isotope method (extrapolation) and the double‐isotope method (using 125I human serum albumin for an independent plasma volume) in the same volunteers. The corresponding viability values were not significantly different. The simultaneous determination of autologous 111In‐oxine RBC and 51Cr RBC viability at 24 hours was measured in 19 other normal volunteers whose RBCs had been stored in citrate‐phosphate‐dextrose‐adenine (CPDA‐1) for 1 or 15 days. The ratio of the 51Cr:111In value was 1.1. Use of these 24‐hour viability ratios as conversion factors permits direct comparison of 99mTc or 111In RBC viability with a 51Cr standard, and therefore expands the application of these newer RBC radiolabels.