bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring TFE3-Rearranged Renal Cell Carcinoma: A Case Study showing minimal expression of PAX-8
Authors: Rivera Sustache J M , Bhalla R 
Published: October 2024

Abstract

Introduction/Objective
TFE3-rearranged renal cell carcinoma accounts for 1.6-4% of adult renal cell carcinomas (RCC). The histological characteristics of this entity can mimic many other renal cell neoplasms and definite diagnosis is based on immunohistochemical (IHC) and fluorescent in situ hybridization (FISH) analysis. Nonspecific IHC findings can lead to diagnostic challenges delaying confirmatory studies and underdiagnosis.

Methods/Case Report
A 28-year-old male with sickle cell disease and a right kidney multilocular cystic mass incidentally found during evaluation of splenomegaly underwent partial nephrectomy. The tumor showed papillary, alveolar and sheet-like growth patterns composed of eosinophilic to clear cells with pleomorphic nuclei, including multinucleate forms. Initial ancillary studies showed minimal neoplastic expression (less than 5%) of PAX-8. Repeat PAX-8 yielded similar results and laboratory controls were evaluated successfully. A full work-up showed positivity of AMACR (diffuse), CD10 (diffuse), Cathepsin K (patchy), CK7 (focal), CAIX (focal), and no significant expression of pancytokeratin, HMB-45, Melan-A and SMA. Fumarate hydratase was retained, and the tumor showed a non-specific staining pattern of S (2-succinyl)-cysteine. Controls were appropriate. A high suspicion for a TFE-rearranged RCC was maintained, and a final diagnosis was confirmed with FISH analysis demonstrating a TFE3 (Xp11.23) rearrangement.

Results (if a Case Study enter NA)
NA

Conclusion
Reports in the literature detail diffuse PAX-8 expression in TFE3-rearranged RCC. A high index of suspicion based on morphology in our case prompted FISH analysis leading to correct diagnosis. This case highlights the inconsistencies in the reported IHC profile of this entity. More studies are required to elaborate the presentations of this RCC subtype with numerous histologic mimics including the spectrum of immunostaining patterns to better assist patient care for this uncommon variant.
Case-Based Training on Best Practices in Effective Test Utilization for Clinical Laboratories: A Comparison of Two Educational Formats
Authors: Kelly M , Basu D , Engel M , Landgraf K 
Published: October 2024

Abstract

Introduction/Objective
While a survey of ASCP membership showed improvements being made in effective test utilization (ETU), there is an ongoing need for formal education on best practices. Case-based education drawn from real-world scenarios provides an opportunity to address this need, aimed at increasing the understanding of evidence- based guidelines to inform clinical test ordering and reduce overconsumption of supplies without compromising patient care. The poster presents two examples of case-based education presented in an innovative microlearning format and an eLearning format designed for clinical laboratory professionals.

Methods/Case Report
The activities presented 9 - 10 practical, real-world scenarios as educational cases along with assessment questions addressing a range of topics that included ETU for pancreatitis and cardiac injury, blood collection tube consumption and conservation, strategies for reducing repeat daily lab test ordering, and others. Each case was designed for learners to be able to review the content and answer the assessment questions in 5 minutes. In the microlearning activity, learners received the cases and questions via email on a scheduled frequency and completed them via mobile device. The questions were repeated up to 2 times to reinforce learning. Participants in the eLearning activity accessed the same cases and assessment questions via a different learning platform (with no staggered delivery).

Results (if a Case Study enter NA)
More than 2,500 learners have participated in one or both ETU activities, and feedback has been highly positive. The assessment results show proficiency gains for a range of laboratory personnel, including laboratory managers/supervisors, histotechnologists, medical laboratory scientists, laboratory technicians, pathologists, and other laboratory roles.

Conclusion
The results also show how case-based scenarios can help promote best practices in ETU, which may be particularly beneficial for laboratory decision-makers. In addition to showing increased understanding of ETU strategies, the results also pose lessons learned for designing similar types of case-based education.
Assessing the Effect of Changing the Average Hematocrit in Red Blood Cell (RBC) Units on the Post- Procedure Hematocrits of Patients Undergoing Erythrocytapheresis
Authors: Musante K L , Roome L , Yurtsever N , Rinder H , Tormey C , Lee E S 
Published: October 2024

Abstract

Introduction/Objective
Red cell exchange (RCE) is utilized as a therapeutic or prophylactic procedure for patients with sickle cell disease (SCD). When performing RCE, three hematocrits (Hct) are taken into account: pre-procedure and goal Hct for the patient and average Hct (avg-Hct) of the transfused RBC units. Although there is no definitive community consensus, many transfusion services employ RBC unit avg-Hct of 55% per available guidance. Our center anecdotally observed that utilizing RBC unit avg-Hct of 55% often resulted in post-procedure patient Hcts higher than intended goal Hct, potentially causing hyperviscosity. This study aims to examine the effect of changing the avg-Hct from 55% to 60% on the accuracy of post-procedure HCTs, with the 60% avg-Hct employed based on prior quality studies of RBC units at our facility.

Methods/Case Report
We performed a retrospective chart review for SCD patients receiving chronic, prophylactic RCE at a large academic hospital, collecting the following for each procedure: goal procedure Hct, number of RBC units exchanged, avg-Hct used, and pre-/post-procedure patient Hcts. Differences between goal Hcts and post- procedure Hcts for each procedure in the avg-Hct=55% and avg-Hct=60% groups were calculated. Next, mean calculated differences for both groups were compared using a two-sample t-test (P&lt;0.05 was considered significant).

Results (if a Case Study enter NA)
From 1/2023–2/2024, 293 prophylactic RCEs were performed for SCD patients. Median number of RBC units per procedure was 7, with 51% of procedures (n=149) employing unit avg-Hct=55%, while 49% of procedures (n=144) used a unit avg-Hct=60%. Post-procedure patient Hct and goal Hct differences were statistically different according to unit avg-Hct values utilized (mean difference=1.31% for avg-Hct=55% vs mean difference=0.52% for avg-Hct=60%; P&lt;0.0001).

Conclusion
Changing our protocol to use RBC unit avg-Hct=60% resulted in post-procedure patient Hcts significantly closer to intended goals. Utilization of a more accurate average-Hct value has a substantial impact on post-procedure Hct in RCEs and may limit adverse events.
Transfusion reaction patterns by blood component
Authors: Yune S , O’Brien K 
Published: October 2024

Abstract

Introduction/Objective
Blood transfusion is becoming safer by continuous improvement of donor screening, patient identification, blood management, and infectious disease screening. This study was conducted to examine the rate and characteristics of transfusion reactions in the setting of universal leukoreduction of cellular products as well as pathogen reduction and/or irradiation of apheresis platelets.

Methods/Case Report
Data from the blood bank database for a 5-year period from 1/1/2019 to 12/31/2023 was collected. Transfusion reaction data as reported to National Healthcare Safety Network (NHSN) was analyzed.

Results (if a Case Study enter NA)
A total of 134,552 transfusions and 491 transfusion reactions were reported over the study period, resulting in the overall transfusion reaction rate of 0.36%. Allergic reaction was the most common reaction (38%), followed by febrile non-hemolytic transfusion reaction (FNHTR, 30%), delayed serologic transfusion reaction (DSTR, 14%), transfusion-associated circulatory overload (TACO, 10%), and transfusion-associated dyspnea (TAD, 4%).
Platelets had the highest rate of transfusion reaction at 0.61% (n=167 of 27,180), red blood cells (RBC) at 0.35% (n=289 of 82,963), plasma at 0.13% (n=24 of 19,114), and cryoprecipitate at 0.06% (n=3 of 5295). The most common reaction associated with platelet transfusion was allergic reaction (64%, n=107), while FNHTR was the most common reaction associated with RBC transfusion (37%, n=106).
By severity, 9 (2%) reactions were life-threatening, 21 (4%) were severe, 374 (75%) were non-severe, and 87 (18%) were not determined. Of life-threatening reactions, allergic reactions were the most common (5 of 9), while TACO was the most common severe reaction (9 of 21). Platelets were the most commonly implicated component in life- threatening reactions (4 allergic and 2 TACO), and RBCs were more commonly implicated in severe reactions.

Conclusion
Platelet transfusions were associated with a higher rate of transfusion reactions and life-threatening allergic reactions compared to other blood components.
Neonatal Alloimmune Thrombocytopenia with HLA and HPA-3a Antibodies in a Down Syndrome Neonate
Authors: Yakut E , Talabong D , Gabutan E , Ahmadi M , Kang S 
Published: October 2024

Abstract

Introduction/Objective
Neonatal Alloimmune Thrombocytopenia (NAIT) is a rare cause of thrombocytopenia seen in 1 in 11,000 neonates with lethal risks such as intracranial hemorrhage. This is caused by maternal antibodies against fetal platelets and the most common culprits are antibodies to Human Platelet Antigen-1b (HPA-1b) but rarely to Human Leukocyte Antigen (HLA) antibodies. We describe a rare case of a newborn with Down syndrome with maternal antibodies against HLA and presumed antibodies against HPA-3a. Down syndrome causes hematologic abnormalities with mild thrombocytopenia.

Methods/Case Report
A preterm male with Down syndrome was born via Cesarean delivery due to non-reassuring fetal heart tracing at a gestational age of 35 weeks. He was admitted for low birth weight and his hospital course was complicated by severe thrombocytopenia of 37 x 10^9/L without bleeding symptoms. Initially attributed to his trisomy 21 but due to his suboptimal response to platelet transfusion, NAIT was suspected. The mother had antibodies against HLA on initial screen and was presumed to have HPA-3a antibodies since she was homozygous for HPA-3b antigen. The neonate was managed with multiple transfusions of platelets and Intravenous Immunoglobulin (IVIG).
The platelet count stabilized to 325 x 10^9/L on his 25th day of life.

Results (if a Case Study enter NA)
n/a

Conclusion
To our knowledge, this is the only published case of NAIT with both HPA-3a and HLA antibodies in a Down syndrome neonate. It is unclear whether the primary reason for thrombocytopenia is due to NAIT caused by HPA-3a antibodies or HLA antibodies or his existing Down syndrome. This case contributes to understanding the complexity between immune-related diseases such as NAIT and genetic conditions such as Down syndrome.
Although NAIT occurs rarely, timely diagnosis and treatment is of utmost importance to prevent lethal complications.
Where did my O units go? Assessing a Month of O RBC Utilization in a Level 1 Trauma Center
Authors: Haque A , Agaronov M , Talabong D , NGICHABE J , Yakut E , Rana-Gupta T , Gabutan E , Kang S 
Published: October 2024

Abstract

Introduction/Objective
The availability of red blood cells (RBCs) can be unpredictable and influenced by various factors affecting inventory levels. Anticipating future requirements can prove difficult, particularly in medical facilities catering to both trauma and chronically ill patients. By analyzing the fluctuation in blood indications, we can improve our planning and promote the responsible use of O RBCs.

Methods/Case Report
O units transfused in December 2023 in a level 1 trauma center were reviewed for transfusion indication, which was categorized into symptomatic anemia (SA), bleeding, sickle cell-related transfusion (SCRT), and surgery-related transfusion (SRT).

Results (if a Case Study enter NA)
During this month, our institution transfused 320 O units, of which 79% (254/320) were D positive. Most RBCs were given to patients with bleeding (43%,136/320) and SA (36%, 115/320). About half of the units used for acutely bleeding patients had massive transfusion protocol (MTP) activated (48%, 51/105), with 2/3 of those units used for trauma patients. Because most of our patients are African Americans, SCRT was also evaluated. Only 17/320(5%) of the units were given to our sickle cell disease patients. Lastly, we evaluated SRT because of our busy surgical service. We noted that 46 (14%) are SRT units, with 20% used prophylactically on the same admission and 50% used post-operatively.

Conclusion
It’s important to note that while patients with acute bleeding can cause a sudden depletion in the blood supply, patients with chronic anemia and bleeding can still make up a significant portion of those who require RBCs in a level 1 trauma hospital. In such a setting, where cases requiring MTP can be unpredictable, managing inventory levels can be challenging, and it requires careful monitoring to ensure that the appropriate blood units are used.
Validating a Pneumatic Tube System for Blood Product Delivery
Authors: CHAUDHARY R , Maheshwari T , Kyle P , Johnston S E 
Published: October 2024

Abstract

Introduction/Objective
Timely delivery of blood products can be of utmost importance to providing quality care. We aimed to validate the use of a high-speed pneumatic tube system (PTS) that was already installed at our hospital. By reducing delivery times, patient resuscitation and survivability can be increased.

Methods/Case Report
We followed the Association for the Advancement of Blood & Biotherapies (AABB) guidelines to validate a PTS in a large tertiary academic medical center. The requirements include: verifying product suitability, ensuring product integrity, temperature monitoring, transportation time measurements, and proper packaging and tracking of product receipt. We validated the transfer of packed red blood cells (PRBC), plasma, platelets, and cryoprecipitate from the central blood transfusion services lab (BTS) to nursing stations in a separate building up to 1500 feet (&gt;1/4 mile) away using a Swisslog Translogic® PTS Inclusion with foam inside the PTS carriers helped reduce bumps during transit and insulated products from heat.

Results (if a Case Study enter NA)
The mean temperature of the PRBC was 6.6 degrees Celsius and none exceeded the AABB maximum of 10 degrees Celsius. The mean time for blood products transit to the nursing stations was 3 minutes (m) and 33 seconds (s). The median time was 3m 31s, and it ranged from 2m 18s to 5m 38s. The PTS reduced delivery times of blood products by up to 10-12 minutes compared to manual porters.

Conclusion
Transporting blood products via PTS is an efficient method that reduces the required manpower and leads to better utilization of resources. However, it is essential to validate the PTS system before implementing it operationally.
Molecular testing in a patient with multiple alloantibodies and warm autoimmune hemolytic anemia: A case study
Authors: Bauer L J , O’Brien T E , Mumtaz M 
Published: October 2024

Abstract

Introduction/Objective
We present a case of RBC alloimmunization and warm autoimmune hemolytic anemia (WAIHA) in a patient with a recent RBC transfusion. Serological testing followed by molecular testing revealed a rare D+ C- E- partial c+ partial e+ VS+ V+ hrS+ hrB+vw/- predicted phenotype.

Methods/Case Report
A 75-year-old black male with secondary myelofibrosis presented with a sudden onset of chest pain, dyspnea and weakness during an RBC transfusion. The patient was subsequently admitted for further workup. Labs showed low hemoglobin, low haptoglobin, elevated LDH and a positive direct antiglobulin (DAT) test. The patient was started on intravenous immunoglobulin and steroids for suspected WAIHA. On immunohematology serologic testing, blood typed as B-positive and polyspecific DAT positive with anti-IgG positive and anti-C3 negative. Serum plasma studies showed probable warm autoimmune hemolytic anemia and allo anti-S, -E, and -C by previous history. Eluate studies showed panagglutinin and antibody with D-like specificity. Immucor PreciseTypeTM Human Erythrocyte Antigen (HEA) Molecular BeadChip test predicted a partial e antigen and potential hrB-. Genotyping for RHD variants was performed and revealed RHD*01 (homozygous or hemizygous). Targeted genomic testing did not detect variants associated with common partial or weak RhD antigens. Based on this testing, the patient was not predicted to be at risk of allo-anti-D. An RHCE genotype for C, c, E and e variants including hrB and hrS showed RHCE*ce48C,733G/RHCE*ce733G with predicated phenotype of D+ C- E- partial c+ partial e+ VS+ V+ hrS+ hrB+vw/-. Based on the RHCE testing, the patient was predicted to be at risk for allo-anti-c, -e, -f (ce) and possibly anti-hrB.

Results (if a Case Study enter NA)
NA

Conclusion
In this case, serologic testing alone did not reveal a precise diagnosis. Molecular testing aided in the diagnosis of WAIHA and will help guide future transfusions. Pathologists must consider molecular testing when faced with a challenging serologic diagnosis.
Sub-Acute Toxicity Assay of the smoke of Seeds of Azadirachta indica and Peels of Citrus sinensis used as natural insecticides on the Liver, Kidney, Lungs and Heart of Albino Rats
Authors: Bello Aliyu Maje , Babagana Kamaluddeen , Yakasai Hafeez Muhammad , Mohammed Ibrahim Ahmed , Abubakar Salisu Adam , Muhammad Murtala , Wudil Alhassan Muhammad , Madungurum Muhammad Abubakar 
Published: October 2024

Abstract
Natural plant parts such as seeds of Azadirachta indica (neem seeds) and peels of Citrus sinensis (sweet orange) have been used as house-hold remedies against various ailments and bio-pesticides for agricultural purpose due to their repellent, growth regulatory and anti-feedant properties against insects. Despite their beneficial role, these natural insecticides could also have toxic effects on some vital organs of human. Therefore, this study aimed to investigate the sub-acute toxicity of smoke of the Seeds of Azadirachta indica and Peels of Citrus sinensis on the liver, kidney, lungs and heart of swiss albino rats. In this study, three groups of white swiss albino rats were exposed to the smoke of A indica seeds, peels of C sinensis and their combination at different duration of one hour and two hours respectively. The Control group were not exposed to any of the natural insecticides and were fed normal diet and water. After four weeks of the treatment, the animals were all sacrificed and their liver, kidneys, lung and heart were evaluated using standard biochemical and histopathological techniques. The levels of serum biochemical indices for liver (aspartate amino transferase (AST), alanine amino transferase (ALT), alkaline phosphatase (ALP), total bilirubin and protein), kidneys (urea, creatinine and electrolytes), and heart (creatine kinase and lactate dehydrogenase) were found to be significantly higher at (p&lt;0.05) for all the groups treated with the two natural insecticides when compared to control group. Histopathological changes including fibrosis, hemorrhages, vascular congestion and necrosis were observed in the liver, kidneys and lungs tissues of the rats exposed to the smoke of the seeds of A indica. However, no histopathological changes were observed in all organs of rats exposed to the smoke of the peels of C sinensis compared to control group. Moreover, the severity of the effects of smoke of these natural insecticides on both biochemical and histopathological indices increases with increase in duration of exposure. The results of this study revealed that seeds of A indica have significant toxic effects on both the tissue and biochemical markers of all the major organs of the Swiss albino rats, while peels of C sinensis shows effect on only the biochemical indices at the specific duration of time studied.
Resolving Ambiguities in Deceased Donor HLA Typing: Next Generation Sequencing’s Role in DPB1 Allele Discrimination and Immunological Implications
Authors: Achram Robert , Morris Anna , Bray Robert , Sullivan H Cliff 
Published: October 2024

Abstract
HLA typing is crucial for assessing immunological compatibility between donors and recipients before transplantation. Deceased donor (DD) typing, typically via real-time PCR (rtPCR), provides rapid results vital for organ allocation. rtPCR primarily targets exons encoding the highly polymorphic peptide binding region (PBR) of HLA molecules. rtPCR cannot target all polymorphic sequences. Consequently, several possibilities of allele combinations are provided, leading to ambiguous typing results. As recent evidence suggests antibody responses can target regions in exons outside the PBR, notably in Exon 3 of the DPB1 locus, typing ambiguities can lead to the inability to assess histocompatibility between a donor and recipient. Herein, the aim was to investigate the utility of Next Generation Sequencing (NGS) in resolving DPB1 ambiguities in DD typing. A retrospective analysis of DD typing from February 2022 to January 2024 examined instances where NGS was used to resolve ambiguities reported via rtPCR. Each case was reviewed to understand the reason for resorting to NGS typing. The study focused on DPB1 ambiguities and assessed whether NGS effectively reduced ambiguity and differentiated alleles with polymorphisms outside the PBR. In total, 29 DD cases were found to have NGS testing results. In 14 cases, NGS was specifically performed to resolve DPB1 ambiguities. The ambiguities were significantly reduced from hundreds detected in rtPCR to 4 or fewer possible allele combinations with NGS. Eleven cases demonstrated polymorphism in exons outside the PBRs. Of these, only 2 cases showed no typing ambiguity with NGS. In the remaining 9 cases, though polymorphisms could be resolved in the PBR, ambiguities remained in exon 3, specifically at codon 96. In these cases, NGS could not distinguish lysine (K) from arginine (R). For example, DPB1*835:01 with the 96R motif could not be distinguished from DPB1*34:01with the 96K motif. The current investigation found that NGS cannot resolve all ambiguities at position 96, likely due, at least in part, to persistent cis-trans ambiguities. Our results suggest that although NGS drastically limited the number of ambiguities in 9 of 11 cases, it still could not adequately distinguish all immunologically relevant alleles. Inability to resolve the 96R/K epitope, which has been shown to be immunogenic, could impact solid organ transplantation, potentially leading to rejection in mismatched recipient-donor pairs at this position. Sequencing methods that generate longer reads, such as nanopore, may help resolve some of these cases if they are indeed due to cis-trans ambiguities.