bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence and Distribution of ABO and Rh (D) Factor among Blood Donors in the United Arab of Emirates
Authors: Abdelmonem M , Altayyari K , Wasim H , Saleh Abdelfattah M 
Published: November 2023

Abstract

Introduction/Objective
Karl Landsteiner discovered the ABO blood group system in 1900, which was the first human blood group system. The Rh blood group system was found forty years later. The antigens on the surface of red blood cells are used to classify people into ABO blood groups. In the ABO system, there are four types: A, B, AB, and O; in the rhesus system, there are two types: Rh-positive and Rh-negative. Blood group identification is critical for efficiently managing blood banks and blood transfusion services to avoid serious transfusion reactions.

Methods/Case Report
The study was performed on a total of 5996 healthy blood donors in the United Arab of Emirates (UAE). ABO and Rh (D) groupings were performed on all donors' samples by the gel electrophoresis technique. Data on the frequency of ABO and Rh(D) blood groups were reported in numbers and percentages.

Results (if a Case Study enter NA)
The study revealed that type O is the most prevalent blood group in the United Arab Emirates (43.83%), followed by A at 26.68% and B at 23.90%, with AB having the lowest prevalence at 5.58%; O
&gt; A &gt; B &gt; AB. Our study found that 92.57% of the donor population was Rh-positive, whereas 7.43% was Rh- negative. The IA, IB, and IO allele frequencies were determined using the Hardy-Weinberg rule of equilibrium. The gene frequencies are calculated to be 0.1942 for IA (p), 0.1438 for IB (q), and 0.6620 for IO (r). O (r) has the most
value in UAE, followed by A (p) and B (q); O &gt; A &gt; B. OO constituted 43.83% of the homozygous types, AA 3.77%, and BB 2.06%. The heterozygous types were 25.71% for AO, 19.03% for BO, and 5.58% for AB.

Conclusion
The study gives reliable ABO gene frequency statistics and information on the distribution of ABO blood group Rh groups of various alleles in the United Arab Emirates. This knowledge aids in the efficient management of the blood bank's inventory. It will aid transfusion services in anticipating future health issues and improving blood transfusion practice.
The study is the first to give reliable ABO gene frequency statistics and information on the distribution of ABO blood group Rh groups of various alleles in the United Arab Emirates. This knowledge aids in the efficient management of the blood bank's inventory. It will aid transfusion services in anticipating future health issues and improving blood transfusion practice.
Ectoparasitosis induced severe anemia: a rare cause of severe iron deficiency anemia
Authors: Kokabee M , Murrell D , Otero Espinal D , Levine R 
Published: November 2023

Abstract

Introduction/Objective
Ectoparasites generally infest human’s head and body. It is primarily asymptomatic, however, it can cause iron deficiency anemia on rare occasions, even in developed countries. Bird mites can feed on the blood of people who live near infested pigeons or other infested animals.

Methods/Case Report
We present a 53 years old homeless male who lives in the New York City’s streets. He was brought to the emergency department by EMS due to ataxia and not being able to stand. Upon arrival, he was covered with countless small ectoparasites later identified as bird mites according to an exterminator.
Decontamination and stabilization of patient was begun. No active bleeding or sign of trauma was identified. Complete blood count (CBC) was performed and hemoglobin (Hb) of 2.2 g/dL with Hematocrit of 9.2 % was confirmed after repeat on a second sample. Mean corpuscular volume (MCV), red blood cell (RBC) count, reticulocyte percent and red cell distribution width (RDW) was 73.3 fl, 1.26 M/uL, 3.3 % and 19.9 % respectively. Iron study was not performed initially. White blood cell and Platelets count were normal. Hemoglobin electrophoresis was negative for hemoglobinopathies. After initial transfusion of 2 packs of RBC, the Hb was 3.4 g/dL. He started to have seizures and was intubated. He was transferred to ICU. Ferritin level was checked after transfusion and was still markedly decreased (10.9 ng/mL). He received 6 packs of RBC in total (within 10 hours) and Hb reached 8.7 g/dL, and 48 hours after intubation he was extubated. The patient discharged himself against medical advice the next day.

Results (if a Case Study enter NA)
NA

Conclusion
With increasing homelessness, physicians should be aware that ectoparasitosis: 1) is a rare cause of iron deficiency anemia, and 2) because of the gradual onset of the anemia, rapid correction with a massive transfusion is neither warranted nor advised.
Difficulties in identifying antibodies of high frequency antigens: A case report of anti-Holley antibody
Authors: Muldoon J , Gabbard A P , LePage N L , Bielen K 
Published: November 2023

Abstract

Introduction/Objective
The Dombrock blood group system consists of the Dombrock (Do), Gregory (Gya), Holley (Hy), and Joseph (Joa) antigens, of which, the Gya, Hy, and Joa represent high prevalence antigens. Anti-Hy antibodies have been implicated in hemolytic transfusion reactions and hemolytic disease of the fetus and newborn.

Methods/Case Report
We report a 22-year-old black female who presented with extensive burns following trauma. At admission the patient typed O, D-positive with a negative indirect antibody test (IAT). After receiving multiple units of red cells, plasma, and platelet products (&gt;100 units total) the patient’s IAT, direct antiglobulin test (DAT) polyclonal, DAT IgG, and DAT C3 became seropositive (day 15 of ongoing transfusions). Elution was negative at all tested phases. An antibody rule-out panel was performed with pan-reactivity at polyethylene glycol (PEG)- anti-human globulin (AHG) (2+), Low ionic strength saline (LISS)-AHG (weak +), Ficin-AHG (2+), and negative with dithiothreitol (DTT)-PEG-AHG. Common DTT sensitive antigens were ruled out. Antigen typing displayed mixed field reactions secondary to transfusions. Hy-Jo(a-) confirmed cells were non-reactive at immediate spin and PEG-AHG. The patient was Dob positive, ruling out a null phenotype. Molecular testing could not be confirmed with serologic testing due to the extensive number of transfusions. Subsequent crossmatching demonstrated 1+ reactivity. The patient clinically tolerated the incompatible units. Her IAT resolved on day 29 of ongoing transfusions and remained negative throughout subsequent testing and transfusion.

Results (if a Case Study enter NA)
NA

Conclusion
Identification of antibodies to high frequency antigens is challenging due to the limitation of antigen negative sera in the setting of pan-reactive cells. Furthermore, blood contaminated with donor product limits the ability to perform serologic testing in the setting of mixed field reactivity. This case highlights the difficulty in identifying antibodies to high frequency antigens as well as the limitations in patient testing after extensive transfusion.
Quality Analysis of Lupus Anticoagulant Testing: Indeterminate and Interference
Authors: Bell Timothy , Gil Morayma Reyes , Duckworth Lauren (Ashley) , Mannion Peter , Alnaqshabandi Sarah , Bhattarai Narendra 
Published: November 2023

Abstract
Lupus anticoagulant (LA) testing is a commonly performed test within hemostasis laboratories. Criteria for diagnosing a LA based on the International Society on Thrombosis and Hemostasis are: prolonged phospholipid-dependent (PD) clotting test, evidence of an inhibitor, evidence the inhibitor is PD, and exclusion of specific inhibitors. At our academic institution, we analyzed Lupus anticoagulant results to establish common sources of drug interference (DI), identify causes of indeterminate results, and evaluate if repeat testing was performed on patients with an initial indeterminate test. At this institution, Lupus anticoagulant evaluation includes activated partial thromboplastin time (aPTT), Anti-Xa activity, Thrombin Time (TT), diluted Russell Viper Venom Time, hexagonal phase phospholipid assay, and Platelet Neutralization Procedure. Samples with Anti-Xa activity &gt;0.1 IU/mL and/or elevated TT are treated with hepzyme; if the Anti-Xa activity or TT does not correct, testing is not completed. Samples with elevated aPTT undergo an immediate and incubated mixing study (MS). Samples are considered positive (POS) for LA if there is a positive screening test (+ST), +MS, and evidence of PD in at least one assay. Tests are resulted as indeterminate (IND) with a +ST and either +MS or +PD. LA results are reported as unlikely (UNL) if only a single phospholipid panel is positive without +ST or +MS, and negative (NEG) if the ST, MS, and PD assays are all negative. Patients with indeterminate LA testing are recommended to have repeat LA testing after 12 weeks. A total of 3025 cases were identified over the 18-month period (July 2020 – December 2021). The majority of cases were interpreted as NEG (2310; 76%) followed by 8% POS (229), 6% IND (174), and 1% UNL (34). While the majority of IND met the ST (99%) and PD (71%) criteria, only 32% were +MS, indicating failure of an inhibitor detection in the mixing study is the major factor preventing an IND from becoming positive. Within the IND group, only 25% (43) underwent the recommended repeat LA testing. The results of repeated 43 IND tests are as follows: 16 NEG, 4 POS, 19 IND, 3UNL, 1 DI. While a significant proportion of IND repeated testing became negative, a majority remained IND, arguing for more comprehensive LA testing. This quality study demonstrates the majority of patients at this institution who receive an interpretation of IND LA do not undergo the recommended repeat testing, underscoring the importance of follow-up and education to standardize care. Prospective studies maybe needed to elucidate the clinical significance of IND LAs. Additionally, 278 (9%) cases were canceled due to drug interference, the majority (192; 69%) due to direct oral anticoagulants (DOAC). Testing for LA in patients actively receiving DOACs should be discouraged. Alternatively, methods to remove DOAC interference should be standardized.
Development of a Machine Learning Decision Support System for Clinical Flow Cytometry
Authors: Lownik Joseph , Mahov Simeon , Lopategui Jean , Alkan Serhan , Gibb David , Merchant Akil , Kitahara Sumire 
Published: November 2023

Abstract
High parameter flow cytometry is a highly utilized tool in both research and clinical settings for accurate immunophenotyping in immunology, oncology, and many other disciplines. With increasing dimensionality, manual analysis of data becomes more complex and time consuming. Over the past decade, several automated methods have been developed for cell population clustering and dimensionality reduction of high parameter flow cytometry data which have sped up and simplified the discovery of cell populations not observed by manual gating strategies. However, the input and output of such tools are stochastic in nature, thus making their results difficult to reuse with novel samples such as diagnostic patient samples. Several groups have recently attempted to utilize machine learning algorithms to analyze clinical flow cytometry data. These studies focused on training machine learning models with a goal of predicting a specific diagnosis for each sample. This approach can be limiting when the diagnostic features are not perfectly met to predict a specific diagnosis as well as the absence of the patient's clinical data. To our knowledge, no studies have utilized machine learning to identify and classify individual cells based on their raw fluorescence signature to various cellular populations, whether normal or abnormal, to aid a diagnostician to interpret their significance in a clinical context. In this study, we utilized a data set of ~240 million individual cells from ~9,500 flow cytometry files from 2,300 patients to train a machine learning model to predict cell population classifications as annotated by expert hematopathologists. These annotations were implemented into an end-to-end machine learning based decision support system allowing for rapid, automated analysis of high dimensional flow cytometry data with an output aiding the diagnostician in the generation of a diagnosis. A clinical validation highlighted the robustness of this methodology with 100% sensitivity and 94% specificity in the identification of abnormal B-cell populations on a cohort of 1,500 patients. This decision support system also identifies abnormal T-cell and myeloid cell populations with 100% sensitivity. Overall, the decision support system saves significant time as it removes the need for manual gating and analysis, and aids the diagnostician in identifying discrete cell populations and offering descriptive information about any abnormal populations identified.
Strategies for validation of a low-volume BCR::ABL p190 assay in the clinical laboratory
Authors: Hernandez Patricia , Kowalewski Rodney , Stroup Brooke , Hrabusicky Lori , Parikh Bijal 
Published: November 2023

Abstract

Background
The low prevalence of samples positive for the BCR::ABL p190 (e1a2) fusion transcript (&lt;1/week) can be a barrier for molecular test validation. The Cepheid Xpert BCR-ABL Ultra p190 Assay is a single-use cartridge-based RUO assay designed for the quantitative detection of BCR::ABL p190 from fresh specimens. The following study describes our validation strategy to overcome this barrier for implementing a quantitative molecular LDT.

Methods
This study was conducted in a hospital clinical laboratory setting between 2019 to 2023. RNA was extracted and frozen from peripheral blood (PB) and bone marrow (BM) samples that were sent in parallel to a reference lab for BCR::ABL p190 testing. High positive diagnostic specimens (&gt;10% p190/ABL1) were presumptively identified as BCR::ABL FISH positive and p210 negative. Diagnostic specimens were diluted in known negative PB or BM to achieve %p190/ABL1 in various quantitative ranges. Reverse transcription, amplification, and quantitative real-time PCR were performed in a single reaction format (Cepheid Xpert cartridge®). For accuracy determinations, reported results of clinical samples from the reference lab were compared to the obtained values from our validation using extracted RNA only. Banked proficiency testing (PT) material was used to supplement qualitative and quantitative accuracy. For precision, Invivoscribe (IVS) control material (San Diego, CA) diluted in seven levels (12.5% to 0.0031%; 4-fold increments) and Maine Molecular Quality Controls (MMQCI, Saco ME) at 10%, 1%, 0.1%, 0.02%, 0% were run by at least three technologists and rotated amongst the 16 instrument modules. To evaluate linearity, IVS controls at 15 levels (100% to 0.003%; 2-fold increments) were assayed in triplicate. Limit of detection (LoD) was the minimum concentration at which the detection rate is 100% in 10 independent runs. For analytical specificity, high-positive p210 specimens (&gt;10%) were evaluated for detection of p190.

Results
a total of 169 samples were analyzed (33 BM, 32 PB, 5 PT samples, 73 IVS controls, and 26 MMQCI controls). We found a correlation (linearity) between reference lab results and clinical/ control samples (R-squared ~0.88, P &lt; 0.01). Overall Cohen’s kappa concordance for qualitative accuracy analysis was 0.80 (CI 95% 0.65-0.95). Sensitivity, specificity, and accuracy were 91%, 92%, and 91%, respectively. This assay showed precision in all levels of dilution (IVS and MMQCI samples) as previously established. LoD was 0.02%. Samples with high level of p210 /ABL remained negative with the p190 assay.

Conclusion
in the setting of low-volume assays optimized for fresh samples, such as for the detection of BCR::ABL p190, dilutions of clinical samples, banked frozen RNA extracts, PT samples, and commercial controls are important tools for validation of a quantitative LDT.
A stochastic multicompartment model of hemostasis and oxygenation during trauma resuscitation as a platform for in silico trials of transfusion
Authors: Vieni Casey , Yazer Mark , Seheult Jansen 
Published: November 2023

Abstract
Uncontrolled hemorrhage accounts for up to 40% of trauma related mortality, and approximately 30% of trauma related deaths occur in the hospital within the first 1-4 hours of injury. The Advanced Trauma Life Support (ATLS) guidelines still recommend initial resuscitation with crystalloid fluid as an integral part of maintaining or restoring hemodynamic stability, but are starting to recognize the role of early resuscitation with blood products in patients with evidence of Class III and IV hemorrhage, in line with recent clinical trial and observational data. Although there is a growing body of evidence that early transfusion with blood products may be associated with improved survival compared with crystalloid infusion, the optimal transfusion strategy still remains unclear and is being actively investigated in clinical trials. In silico models of resuscitation offer a means to evaluate the effectiveness and safety of resuscitation protocols, including effects on body fluid compartment volumes, tissue oxygenation, and hemostatic factors. Here we describe our work extending earlier deterministic models of trauma resuscitation to incorporate hemodynamic, hemostatic, resuscitation, biomarker, and tissue-oxygenation domains into a single comprehensive model. Additionally, this model expands upon previous deterministic models to create a stochastic computational model of hemostatic resuscitation that accounts for variations in blood component composition and temporal features of transfusion therapy. Using this stochastic model, an in silico trial was piloted to compare conventional component therapy, i.e. red cell, platelet and plasma components, to cold-stored whole blood using the following starting assumptions: patient weight of 81.3±21.8 kg, hematocrit of 41.8±4.3%, initial bleeding rate between 50 and 150 mL/min, systolic blood pressure of 125±18 mmHg, fibrinogen of 293±88 mg/dL, international normalized ratio of 1.0±0.1 and platelet count of 239±62x109/L, with blood component and whole blood constituent distributions based on laboratory quality control data. This in silico trial demonstrated that resuscitation with whole blood was associated with a 28-minute reduction in the time spent in the critical window defined by platelet count &lt;50x109/L, INR≥2, hemoglobin &lt;9 g/dL and fibrinogen &lt;150 mg/dL compared with conventional component resuscitation over the course of a 4 hour simulation (p&lt;0.001 based on median regression). We demonstrate how stochastic models of hemostatic resuscitation can be used to perform in silico trials of resuscitation strategies. Our work can guide inclusion and exclusion criteria for future clinical trials and facilitate identification of patient subgroups most likely to benefit from certain resuscitation strategies. This work was partially funded by the AABB Foundation (formerly the National Blood Foundation).
Recycling Opportunities in a High Volume Academic Clinical Chemistry Laboratory
Authors: Glover Raeshun , Booth Garrett , Wiencek Joesph R 
Published: November 2023

Abstract
Many sectors of industry, including the biomedical sector, have quantified waste, and created sustainability strategies to mitigate its environmental impact. One of these strategies utilizes the waste hierarchy, a model which ranks the concepts reduce, re-use and recycle in order of the most to least sustainable practice. However, to date, the clinical laboratory has seldom been evaluated for total waste production and mitigation strategies and additional public reporting of the physical amount of waste produced in these areas are lacking in the literature. In this study, we aimed to identify specific wastes produced from performing the CMP over the course of a year in our automated clinical chemistry laboratory and what proportion would be recyclable. The total in- and outpatient testing volumes as well as volumes of quality control and calibrations needed to perform the CMP at our institution were collected retrospectively from 07/14/2021 - 07/14/2022. We further identified disposables waste items such as calibrator kits, quality control kits, patient blood specimen tubes, shipping packaging and reagent wedge kits that are necessary to perform the CMP. In addition, to obtain a conservative and consistent evaluation to the total amount of waste produced from the CMP, the average weights for components of the reagent test wedge kits which includes plastic wedges, cardboard shipping boxes, and paper package inserts were calculated. These weights in conjunction with total testing volumes was used to determine the total, recyclable, and non-recyclable waste produced from these disposable items. A total of 1089.2 kg of reagent kit wastes were estimated to be produced by performing the CMP over the course of a year. Of this waste, cardboard shipping boxes and paper package inserts were determined to be recyclable (233.6 kg) and the plastic reagent wedges were determined to be non-recyclable (855.5 kg) as they were not labelled with the universally recognized recycling code, were composed of proprietary plastic material, and contained biohazardous contaminants. Overall, 21.4 % of the total specific waste weight was found to be recyclable. The CMP is a small subset of the clinical chemistry test menu that produces a considerable amount of recyclable and non-recyclable waste.
Did interventions in a massive transfusion protocol program change transfusion practice?
Authors: Devera Ronald , Gorham Jim 
Published: November 2023

Abstract
Current literature supports improved clinical outcomes in the setting of trauma when a Massive Transfusion Protocol (MTP) adheres to transfusion at, or close, to a 1:1 ratio (RBC:Plasma). At our institution, between 2008 and 2015, the number of MTP activations increased ten-fold, accompanied by increased wastage of blood products and stress on the transfusion service. In response, in 2016-2018, we undertook an extensive root-cause analysis, and deployed multiple interventions, including clinician education and multiple process changes to the MTP, which succeeded in reining in inappropriate activation of the MTP, as we have previously published.
Heretofore, we have not addressed whether these interventions also affected the ratio of blood products transfused during MTPs activated at our institution. Here, we test the hypothesis that the changes deployed in 2016-2018 were associated with improved adherence to the desired 1:1 ratio.
The study is a retrospective analysis of massive transfusion data collected from 2008 to 2022. We reviewed RBC and Plasma units transfused to all patients receiving blood products through the MTP during this period. All patients transfused seven or more RBC and/or Plasma units following MTP activation were included in the study (total n = 443). Activations were classified by year. For each patient, the (RBC:Plasma) ratio transfused was calculated and assessed for adherence to a 1:1 ratio, with a ratio of 2:1 or greater classified as “suboptimal”. Our institution does not use Whole Blood.
MTP usage at our institution gradually increased from 2008, when the MTP was established, to 2016, when the MTP procedure was revised. Suboptimal transfusion ratios (RBC:Plasma) also increased from 2008-2016. Between 2008 and 2013, 15% of patients received suboptimal ratios following MTP activation. In 2014-2016, suboptimal ratios were observed in 25% of MTPs. Following multiple interventions, the frequency of MTP activation dropped precipitously, as described, and was accompanied by a decrease in the percentage of suboptimal ratios; in 2020 to 2022, 11% of MTPs involving seven or more transfused units had a suboptimal ratio.
In summary, the dramatic increase in activations of the MTP observed between 2008 and 2016 at our medical center was accompanied by an increase in suboptimal RBC:Plasma transfusion ratios. Interventions deployed between 2016 and 2018 led not only to reduced blood wastage, and lower stress of BB staff, but also to improved adherence to best transfusion practices, in the form of appropriate (RBC:Plasma) ratios transfused during MTPs.