bluuebunny/crossref_metadata_2025_split huggingface dataset:
An evaluation of renal inpatient meals against Renal Nutrition Group standards
Authors: Rai E. M. , Hartley G. H. 
Published: September 2006

AbstractBackground The Renal Nutrition Group (RNG) of the British Dietetic Association has developed standards for the nutritional composition of meals provided to renal patients in hospital. However, no data are available as to whether these are achievable. The purpose of this study was to determine whether renal inpatient meals can meet the standards set by the RNG.Method A prospective 10‐day weighed food analysis of hospital meals provided to renal patients was undertaken. Two sample meals were analysed at each mealtime to include (1) the most energy dense choice and (2) the most frequent patient choice (FPC).Results Energy dense choice meals achieved the standard for protein provision on 90% of days, but provided too little energy on 100% of days (for men) and on 30% of days (for women). Although daily standards for potassium were met on 70% of days, those for sodium and phosphate were exceeded. FPC meals met the daily standards for potassium, sodium and phosphate on at least 80% of days, but provided too little protein on 40% of days and too little energy on 100% of days (for men and women).Conclusion The majority of hospital meals fail to meet the RNG standards. Problems exist in providing sufficient energy and protein whilst restricting sodium, potassium and phosphate.
Home delivery of dietary products in inherited metabolic disorders reduces prescription and dispensing errors
Authors: MacDonald A. , Manji N. , Evans S. , Davies P. , Daly A. , Hendriksz C. , Chakrapani A. 
Published: September 2006

AbstractIn the UK, for patients with inherited metabolic disorders (IMD) the traditional system for acquiring essential dietary products [patient prompted prescriptions generated by a medical general practitioner (GP) and dispensed by a chemist] is problematic.Objective  To investigate the efficacy of a home delivery service (HDS) for essential dietary products (EDP) (i.e. protein substitutes, milk replacements, energy and vitamin and mineral supplements) for subjects with IMD, particularly examining any prescription and dispensing errors, metabolic control and consumer satisfaction.Methods  A prospective, controlled, home delivery trial for EDP was conducted in patients with IMD for 12 months. Sixty‐two patients with IMD [50 with phenylketonuria (PKU); 12 with other IMD: aged 6 months–30 years] were recruited. Thirty subjects used a monthly HDS (Homeward: Nutricia) to receive EDP, 32 remained on the traditional system. Each month, the HDS checked home stock levels of EDP, obtained their prescriptions directly from GP's, and then delivered them to the subjects’ homes. An independent researcher completed monthly telephone interviews with patients/parents about any EDP prescription errors or delay in receipt.Results  Incorrect protein substitute was dispensed once by the HDS compared with nine subjects who had 12 errors in the control group (P = 0.01); incorrect flavours of protein substitute were dispensed to the home delivery group once compared with eight subjects getting 11 errors via the chemist (P = 0.03). The HDS delayed delivery of protein substitute for one subject on three occasions compared with 39 occasions in 16 subjects via the chemist (P = 0.001). In patients with PKU, plasma phenylalanine control deteriorated in the control group (P < 0.05) but not in the HDS group.Conclusions  The long‐term use of a HDS for EDP in IMD is safer, effective and more reliable than conventional systems.
Who should receive a statin these days? Lessons from recent clinical trials
Authors: SHEPHERD J. 
Published: September 2006

Abstract.The 3‐hydroxy‐3‐methylglutaryl coenzyme A reductase inhibitors or statins are the most successful cardiovascular drugs of all time. By interrupting cholesterol synthesis in the liver, they activate hepatocyte low‐density lipoprotein (LDL) receptors and produce consistent and predictable reductions in circulating LDL cholesterol with resulting reproducible improvements in cardiovascular risk by retarding or even regressing the march of atherosclerosis in all major arterial trees (coronary, cerebral and peripheral). Clinical trials have demonstrated their capacity not only to extend life, but also to improve its quality by retarding the progression of diabetes mellitus and chronic renal disease and by enhancing central and peripheral blood flow.They are amongst the most extensively investigated pharmaceutical agents in current clinical use. In cardiovascular end‐point trials they have proven ability to help prevent that first and all important myocardial infarction and to reduce the likelihood of a recurrence in those who do succumb. They are equally effective in men and women of all ages and at all levels of cardiovascular risk, whether caused by hypercholesterolaemia, hypertension, cigarette smoking, diabetes mellitus or the metabolic syndrome. In addition, they improve the outlook of patients with familial hypercholesterolaemia whose LDL receptor function is deficient or defective; and all of this comes at minimal risk to the recipient. Their most important potential side effect is myopathy, which on very rare occasions may lead to rhabdomyolysis. Clinical experience shows that myopathic symptoms with creatine kinase levels raised to more than 10 times the upper limit of normal is seen in <0.01% of recipients and progression to fatal rhabdomyolysis because of renal failure has been recorded in only 0.15 cases per million prescriptions. Liver function abnormalities are also, rarely, seen. Again, the frequency of raised aspartate or alanine aminotransferase to more than three times the normal limit is encountered in no more than 1–2% of all treated patients and is completely reversible upon withdrawal of treatment. Progression to hepatitis or liver failure does not occur.This constellation of benefits with little side effect penalty has resulted in the comparison of statins with antibiotics in the global battle against cardiovascular disease.
YS06 The Use of the MAIEA Assay for Solving Serological Problems and Identifying Novel Blood Group Antigens
Authors: Warke N. 
Published: September 2006

Background The monoclonal antibody‐specific immobilisation of erythrocyte antigens (MAIEA) assay was devised mainly for locating blood group antigens on specific red cell membrane proteins. The assay can also be used to map epitopes on protein molecules when used as a competitive binding assay, using monoclonal antibodies to different areas of a protein. The MAIEA assay has proved to be a very useful additional technique in the red cell reference laboratory when serological results are inconclusive and for assigning novel antigens to particular blood group systems.Methods The MAIEA assay detects trimolecular complexes formed by the reaction of an unknown human antibody and a known monoclonal antibody with a particular red cell protein. The trimolecular complex is captured on a microtitre plate coated with goat anti‐mouse immunoglobulin (Ig) and detected by the addition of peroxidase conjugated goat anti‐human Ig. A positive reaction indicates that the epitopes recognised by the human and monoclonal antibodies are present on the same membrane protein and are binding at different regions. A negative reaction indicates that the epitopes are either not on the same protein or the two antibodies are competing for the same or similar epitopes resulting in inhibition.Results During a 39 month period we carried out the MAIEA assay on 65 samples using the following monoclonal antibodies: CR1 (Knops) [54]; CD44 (Indian) [3]; AChE (Yt) [2]; DAF (Cromer) [3]; Kell [2]; Lutheran [1]. A suspected specificity was confirmed on 28 occasions: CR1 [21]; CD44 [3]; AChE [1]; DAF [1]; Kell [1]; Lutheran [1]. The Kell, Lutheran and two of the CD44 antibodies were to novel specificities which have since been defined by molecular analysis.Conclusions The MAIEA assay is a useful technique in the identification of unknown and novel specificities. Assigning a specificity to a particular blood group protein, followed by competitive binding assays, can indicate the region of the gene for molecular analysis. In addition to solving many difficult and complex serological problems, four novel antigens have been identified using the MAIEA assay over a 39 month period.
SI40 Conflicting Direct Antiglobulin Test Results when Investigating a Delayed Haemolytic Transfusion Reaction
Authors: Stamps R. , Tomlinson T. , Scott M. , Lumley A. , Ward D. 
Published: September 2006

Background  A post‐transfusion sample from a patient suffering a delayed haemolytic transfusion reaction due to anti‐Jka was found to have a negative direct antiglobulin test (DAT) when the test was performed manually in our laboratory. The DAT on the same sample performed by the hospital transfusion laboratory using a Diamed gel station was strongly positive.Methods  The 6 mL EDTA sample was centrifuged (RCF 2665) for 4 minutes prior to sampling of the red cells. Two manual DAT tests were carried out using 10 μL aliquots of concentrated red cells removed from just below the buffy layer and from the bottom portion of red cells and resuspended in 1 mL of Diamed diluent II. The sample was also tested on the Diamed gel station with the probe aspirating cells from the bottom portion of the red cells. Both manual and automated tests were performed using the Diamed monospecific DAT card containing anti‐IgG, IgA, IgM, C3c, C3d and an inert control reagent. Jka phenotyping was performed using monoclonal anti‐Jka (M15‐Imumed). An eluate was prepared from the mixed sample using an acid elution method (Gamma Elu‐kit II).Results  The manual DAT on the cells from the upper layer was negative. The automated and manual DAT's performed on the cells taken from the bottom of the sample were strongly positive for C3d and weakly positive for IgM. No IgG was detected on the red cells. Jka phenotyping did not reveal any evidence of surviving Jka+ cells in either layer. The eluate did not contain any detectable antibody using IAT. There was no evidence of cold autoagglutination.Discussion  The separation of immunoglobulin coated and uncoated red cells at the centrifugal force used has not, to our knowledge, been reported previously. The population of cells that were strongly C3d positive were not Jka+ and it is postulated that activated complement was binding to autologous red cells. These findings indicate that when investigating a possible haemolytic transfusion reaction it may be necessary to use cells taken from the bottom of a centrifuged sample or only aspirate cells after thorough mixing of the concentrated cells.
P18 Which Patients Receive Platelets Transfusions in the South West Region and Why?
Authors: Birchall J. , Webb M. , Copplestone A. ,   on behalf of the South West Regional Blood Transfusion Committee
Published: September 2006

Introduction  Although the use of red cells in England has declined since 2000 platelet transfusions have continued to increase and this rise has been more pronounced in the South West (issue figures between April 02 and March 05 identify a 22.5% increase compared with 7.5% nationally). To investigate this the South West Regional Blood Transfusion Committee organised a study to determine which patients are being transfused platelets and why.Methods  Information was collected for one month, 14th November to 11th December 2005, by transfusion laboratory staff and a simple data set was defined to identify ‐ age of the recipient, directorate/specialty, use for prophylaxis/bleeding, operation (if relevant), platelet count prior to issue and number of doses requested and number used.Results  A total of 21 out of 28 hospitals returned satisfactory information. Overall 1323 units were requested and 1226 (93%) units used for the initial request. Using NBS issue data this represents 86% (1323/1535) of all platelets issued to participating hospitals. Variation in usage between hospitals was large with 4 hospitals requesting more than 100 and 2 hospitals requesting more than 200 units. Platelet use increased with age and over 500 units were requested for patients 65 years or over. 779 units (59% total), were requested for haematology patients. Oncology and cardiac surgery were the next highest users requesting 149 (11% total) and 139 (11% total) respectively. When prophylactic or therapeutic use was known, 904 units (74%) were requested for prophylaxis. 75% of these were for haematology patients and 73% when the preceding platelet count was greater than 10 × 109 L−1. 310 (24%) units were requested for bleeding. 30% of these were for cardiac surgery and 53% when the previous count was more than 50 × 109 L−1.Conclusion  This study indicates that around 40% of all platelet requests are to prevent bleeding in haematology patients when the preceding platelet count is greater than 10 × 109 L−1. The increasing age profile of the population is likely to put greater demands on the National Blood Service to collect platelets with increasing cost to the hospitals unless platelet use alters. The current British Society of Haematology guidelines should be followed whenever possible and further work to assess the need for prophylactic platelet transfusions should be performed.Acknowledgements  The Executive working group of the RTC would like to thank all the regional Blood Transfusion Laboratory managers for their assistance with this audit.
P19 Appropriateness of Red Cell Transfusion in Medical patients
Authors: Mold D. , Allard S. 
Published: September 2006

There is now increasing attention focused on promoting appropriate use of blood transfusion on the background of significant concerns regarding safety. Wide variations have been described in surgical usage of blood but there is relatively little data available on red cell transfusion in medical patients with anemia.Methods We retrospectively audited transfusion practice in general medical patients over a 1 month period. Appropriateness of transfusion was assessed against national guidance (British Journal of Haematology 2001; 113, 24). Documentation of transfusion episodes was measured against the criteria given in Better Blood Transfusion (HSC 2002/009). Over‐transfusion was classified as a post transfusion haemoglobin (Hb) increment of >2 g dL−1 above transfusion threshold.Results Out of 72 consecutive cases audited, 18 were excluded (three patients transferred to surgical care, five on long term transfusion regimes, 10 case notes unavailable). Data was available on 54 patients (31F;23M) aged 23 to 91 years (mean 67 years) with a wide variety of medical diagnoses. 66 cross‐matches were undertaken resulting in 56 transfusions. 201 units of red cells were cross‐matched with 15 units transfused giving a transfusion ratio of 1.3 and a transfusion index of 2.8. 55 cross‐matches (83.5%) were assessed as appropriate and of these four were not transfused. The indication for transfusion was not recorded in 21% (n = 14) of cases and the outcome was not recorded in 20% (n = 11) of cases. Pre‐transfusion Hb levels ranged between 5.4 g dL−1 and 12.7 g dL−1 (mean 8.2 g dL−1). Post transfusion Hbs ranged between 7.0 g dL−1 and 15.2 g dL−1 (mean 10.7 g dL−1); there were no post transfusion Hb samples taken in five cases (7.6%). The post transfusion increment was found to be >2 g dL−1 in 51.5% (n = 34) of transfusions.Conclusions The documentation of transfusions remains poor with indications and outcome not being recorded in a significant proportion of medical cases audited. Over 15% of cross‐matches were found to be inappropriate against objective audit criteria and there was evidence of overtransfusion. Transfusion practice for medical indications warrants further scrutiny with a view to promoting appropriate use of red cells and better documentation to improve safety.
P28 Storage Study Of Red Blood Cells Treated With The Macopharma P‐CAPT™ Prion Removal Filter.
Authors: Bégué S. , Sumian C. , Walicka I. 
Published: September 2006

Background  Three occurrences of probable blood transfusion transmitted cases of vCJD have recently been reported in the UK. The P‐CAPTTM Prion Removal Filter (MacoPharma) has been developed to remove infectious prions potentially present in leucodepleted red blood cell concentrates (RBCC's). In order to be accepted for use in routine blood processing practice, the filter must retain the quality of RBCC's following treatment, in addition to conforming to blood service operational evaluation and manufacturing specifications.Aims  The aim of this study was to investigate if filtration through the P‐CAPT™ filter has any deleterious effect on the quality of RBCC's stored in SAG‐M or plasma‐CPD.Methods  RBCC's issued from leucodepleted Whole Blood (WB), either prepared in SAG‐M or plasma, were treated with the P‐CAPT™ filter at 20°C on day 0 or day 1 following a 4° storage after blood collection. To ensure comparative trials, a series of 3 WB units were pooled, mixed and then split into 3 equal units before being treated at either day 0 or at day 1. For each pool, one unit was not filtered through the P‐CAPT filter to serve as a reference. RBC Plasma‐CPD units (12) were stored upto 28 days and RBC SAG‐M units (18) were stored upto 42 days at +2°C/+6°C. Stability of the red cell concentrates was evaluated every 7 days by measuring hemolysis, pH, K+, pO2, pCO2, ATP, 2,3 DPG, glucose, lactate, and other parameters according to standard protocols.Results  All the final product specifications (Hb g/unit, hematocrit, residual leucocytes, total volume) as well as end of shelf life product parameters (Hemolysis, ATP, 2,3 DPG, K+, pH) were within the routine specifications acceptable to the UK blood services (Guidelines for the Blood Transfusion Services in the UK “Red Book”) and met the Council of Europe Guidelines (Guide to the preparation, use and quality assurance of blood components). These results indicate that red blood cell stability is not adversely affected by exposure to the P‐CAPT™ filter, whether they are treated in SAG‐M solution at day 0 or day 1 or treated in plasma‐CPD at day 1.
P35 Two Cases of Anti‐D in DAR Individuals
Authors: Lee E. , Redman M. , Malde R. 
Published: September 2006

Introduction  Current monoclonal anti‐D reagents will react with most D‐variant RBCs. A small number of individuals with D variant phenotypes (e.g. IIIa, IV, V, VI, VII, DAU) appear to be stimulated to produce allo anti‐D more readily than others. DAR is characterised by the complete loss of at least nine of 37 RhD epitopes. We are reporting two cases of allo anti‐D in patients who have the DAR phenotype.Case history  Case 1: An African woman aged 20 was admitted for termination of pregnancy with no clinical history available. She was grouped as B, Ro. Her D phenotype using BioVue was weakly positive and also with anti‐D reagents RUM1 and MS201 by tube. The antibody screen was positive, and suggestive of anti‐D. Our laboratory found her RBCs strongly positive with RUM1 and MS201 anti‐Ds by tube and with DiaMed grouping cards. The Diagast D‐screen suggested a weak D antigen. No plasma was supplied for antibody identification. A weak anti‐D by tube LISS IAT was detected in a subsequent sample. The D status was identified by IBGRL as DAR. Case 2: A pregnant African female, aged 35 was grouped by the referring hospital as O, D+; the antibody screen was suggestive of anti‐D by Capture R. Our laboratory had tested her D status in Feb. 2003 after a miscarriage. We reported her as weak D with a negative antibody screen. No anti‐D Ig prophylaxis was given. In our laboratory the most recent sample grouped as O, Ro. Her RBCs gave strongly positive reactions with RUM1 and MS201 by tube and with DiaMed grouping cards. The Diagast D‐screen suggested weak D. Anti‐D was detected with a level of <0.1 IU mL−1. The D status was identified by IBGRL as DAR.Conclusion  Immunisation risk for DAR is estimated to be >1% per D+ transfusion, which is less than for anti‐K and anti‐c but similar to anti‐Fya and anti‐Jka. The incidence of DAR has been reported as one in 4233 from a population with ‘mixed ethnicity’ in Canada. There is no routine serological method to identify all partial D types. In these two cases the D‐screen indicated both were weak D, and the current monoclonal anti‐D typing reagents used gave positive reactions. Although both of the patients were immunised, the anti‐D in both cases was weak which concurs with our previous experience of anti‐D in partial D individuals. Molecular studies may help to provide further information about the likelihood of the risk of immunisation.
P04 In Vitro Evaluation of Buffy Coat Derived Platelet Concentrates in SSP+ Platelet Storage Medium
Authors: Beard M. , Garwood M. , Cookson P. , Bashir S. , Hancock V. , Pergande C. , Smith K. , Turner C. , Wiltshire M. , Thomas S. , Cardigan R. 
Published: September 2006

Introduction  As part of the process to improve the safety and quality of the platelet supply, the NBS is evaluating the use of platelet storage media (PSM). The objective of this study was to produce a platelet concentrate (PC) containing 70% SSP+ and 30% plasma, whilst maintaining platelet yield, and to evaluate their in vitro function. Study Design. Buffy coats were prepared using the standard NBS method and four (ABO matched) were pooled together with 250 mL of SSP+. Centrifugation was performed using optimised conditions for PSM and an Optipress used to express the PC through a Pall Autostop LD filter into a Pall ELX storage bag. Ten PCs were prepared, and platelet quality was assessed using in vitro assays for functionality and activation on days 1, 5, 7 and 9 of storage.Results

Parameter
Preparation day 1
Specification

Volume (mL)
307 (299–317)
150–350 (Local)

Residual WBC (×106 U‐1)
0.1 (0–0.2)
<1 (EU)

Platelet Content (×109 U‐1)
326 (259–387)
>240 (Red Book)

Median (range) n = 10.

The assay results were compared to platelets stored in 100% plasma from a previous study.

Day
SSP+
Plasma

1
5
7
9
1
5
7
9

pH
7.17‡
7.35
7.36†
7.34‡
7.13
7.36
7.32
7.24

pO2 (kPa)
4.9
5.8
6.4
6.0
6.3
5.4
5.8
6.6

HSR (%)
65
60‡
62
55†
76
71
65
71

ATP (μmol/1011 platelets
4.20
4.35
4.26
4.37
3.9
3.8
Not tested
3.6

%CD62P positive
15.6†
17.8
24.4‡
32.0‡
22.1
16.6
31.3
43.1

s‐CD62P (ng mL‐1)
35‡
56‡
67‡
80‡
79
97
106
121

%PMP
1.6†
1.8‡
2.1‡
2.9
5.6
6.0
5.9
5.1

C3ades arg (ng mL‐1)
67‡
250‡
360‡
481‡
34
1399
3206
5072

Median, n = 10, †P < 0.05, ‡P < 0.01 versus plasma (Mann‐Whitney U‐test).
HSR in SSP+ was 85% of day 1 value on day 9, predicting satisfactory in vivo viability.

Conclusion  Buffy coat derived PC in 70% SSP+ met the required specifications for platelet yield, residual leucocyte count, pH and volume. Platelet activation was lower in PCs stored in SSP+ and units stored in SSP+ maintain acceptable in vitro function during storage.