bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differences in Mortality of Black and White Patients Enrolled in the Program of All‐Inclusive Care for the Elderly
Authors: Tan Erwin J. , Lui Li‐Yung , Eng Catherine , Jha Ashish K. , Covinsky Kenneth E. 
Published: March 2003

OBJECTIVES:BTo examine the relationship between race and mortality in frail community‐dwelling older people with access to a program providing comprehensive access and coordination of services. DESIGN:A longitudinal cohort study. SETTING:Twelve nationwide demonstration sites of the Program of All‐Inclusive Care for the Elderly (PACE) from 1990 to 1996. PACE provides comprehensive medical and long‐term care services for nursing home–eligible older people who live in the community. PARTICIPANTS:Two thousand two white patients and 859 black patients. MEASUREMENTS:Patients were followed after enrollment until death or the end of the follow‐up period. Time from enrollment to death was measured with adjustment of the Cox proportional hazards model for comorbid conditions, functional status, site, and other demographic characteristics. RESULTS:Black patients were younger than white patients (mean age 77 vs 80, P < .001) but had worse functional status (mean activity of daily living (ADL) score 6.5 vs 7.2, P < .001) on enrollment. Survival for black and white patients was 88% and 86% at 1 year, 67% and 61% at 3 years, and 51% and 42% at 5 years, respectively (unadjusted hazard ratio (HR) for black patients = 0.77; 95% confidence interval (CI) = 0.67–0.89). After adjustment for baseline comorbid conditions, functional status, site, and demographic characteristics, black patients still had a lower mortality rate (HR = 0.77; 95% CI = .65–0.93). The survival advantage for black patients did not emerge until about 1 year after PACE enrollment (HR for first year after enrollment = 0.97; 95% CI = 0.72–1.31; HR after first year = 0.67; 95% CI = 0.54–0.85, P‐value for time interaction < .001). During the first year of enrollment, black patients were more likely to improve and less likely to decline in ADL function than white patients (P < .001). CONCLUSION:In PACE, a system providing access to and coordination of comprehensive medical and long‐term care services for frail older people, black patients have a lower mortality rate than white patients. This survival advantage, which emerges approximately 1 year after PACE enrollment, may be related to the comprehensive access and coordination of services provided by the PACE program. J Am Geriatr Soc 51:246–251, 2003.
The effect of citrate, calcium, and magnesium ions on the potassium movement across the human platelet membrane
Authors: Weis‐Fogh U. S. 
Published: March 2003

The intracellular K+ concentration in platelets is reduced during storage in citrated plasma. As shown previously, pH has a marked influence on this reduction. The effect of citrate and Ca2+ and Mg2+ on the K+ permeability of the membrane and on the active K+ transport across the membrane was investigated.Platelets were incubated in dialyzed plasma at 37 degrees C, pH 5.5 to 7.9, with and without added Ca2+ and Mg2+ and citrate. After 60‐ to 120‐minute incubation, a steady state was reached, and ouabain was added to inhibit the active K+ transport. In the pH interval 5.5 to 6.2 citrate, Ca2+ and Mg2+ had no influence on either the active K+ transport or the K+ permeability. Between pH 7.1 and 7.9, Ca2+ and Mg2+ decreased the permeability, whereas citrate increased it. At pH 7.9, citrate had a depressing effect on the active transport. These results indicate that a low citrate concentration and a pH below 7 are important for maintaining a high intracellular K+ of platelets during storage in plasma.
A prospective study of symptomatic bacteremia following platelet transfusion and of its management
Authors: Chiu E. K. W. , Yuen K. Y. , Lie A. K. W. , Liang R. , Lau Y. L. , Lee A. C. W. , Kwong Y. L. , Wong S. , Ng M. H. , Chan T. K. 
Published: March 2003

BACKGROUND: The danger of bacteremia due to contaminated platelets is not well known. There are also no established guidelines for the management of febrile reactions after platelet transfusion.STUDY DESIGN AND METHODS: To determine the risk of symptomatic bacteremia after platelet transfusion, 3584 platelet transfusions given to 161 patients after bone marrow transplantation were prospectively studied. Platelet bags were routinely refrigerated for 24 hours after transfusion. Septic work‐up was initiated for a temperature rise of more than 2 degrees C above the pretransfusion value within 24 hours of platelet transfusion or a temperature rise of more than 1 degree C that was associated with chills and rigor. Diagnosis of bacteremia after platelet transfusion was made only when the pairs of isolates from the blood and the platelet bags were identical with respect to their biochemical profile, antibiotic sensitivity, serotyping, or ribotyping.RESULTS: Thirty‐seven febrile reactions, as defined above, occurred. Bacteremia subsequent to platelet transfusion was diagnosed in 10 cases. There was a 27‐percent chance (95% CI, 15–43%) that these febrile reactions represented bacteremia that resulted from platelet transfusion. For a subgroup of 19 patients with a temperature rise of more than 2 degrees C, the risk of bacteremia was 42 percent (95% CI, 23–64%). Septic shock occurred in 4 of the 10 bacteremic patients. A rapid diagnosis was possible because the involved bacteria were demonstrated by direct Gram stain of the samples taken from the platelet bags of all 10 patients.CONCLUSION: Significant febrile reactions after platelet transfusion are highly likely to be indicative of bacteremia. Routine retention of platelet bags for subsequent microbiologic study was useful in the investigation of these febrile reactions. Empiric antibiotic therapy is indicated.
Monocyte chemoattractant protein production in red cell incompatibility
Authors: Davenport RD , Burdick M , Strieter RM , Kunkel SL 
Published: March 2003

BACKGROUND: Mononuclear phagocytes play a central role in hemolytic transfusion reactions by erythrophagocytosis and production of inflammatory mediators. Factors that affect the number or function of monocyters would be expected to alter the clinical course of hemolytic transfusion reactions, and thus the production of monocyte chemoattractant protein‐1 (MCP‐1), a recently described chemotactic and activating cytokine specific for monocytes, was investigated in two distinct settings of red cell (RBC) incompatibility.STUDY DESIGN AND METHODS: Fresh heparinized whole blood was incubated with ABO‐ compatible or ‐incompatible RBCs. Isolated peripheral blood mononuclear cells were incubated with anti‐D‐coated or uncoated RBCs. MCP‐1 was measured in the plasma or culture medium by enzyme‐linked immunosorbent assay. MCP‐1 gene expression was detected by Northern blot analysis of buffy coat or mononuclear cell total RNA. RESULTS: Significant levels of MCP‐1 protein in plasma or medium were detected 24 hours after the addition of incompatible RBCs, but not in the first 6 hours. Nonimmune hemolysis of added RBCs did not stimulate MCP‐1 production. The inactivation of complement by heat treatment of plasma prior to the addition of RBCs to whole blood did not prevent MCP‐1 production. Nor did neutralizing antibodies to tumor necrosis factor prevent MCP‐1 production in ABO incompatibility. MCP‐1 production was associated with increased steady‐state levels of white cell MCP‐1 mRNA, which occurred more rapidly in ABO than Rh incompatibility. CONCLUSION: The monocyte‐ specific chemotactic cytokine MCP‐1 is produced by peripheral blood leukocytes in response to RBC incompatibility. MCP‐1 may act in a positive feedback loop to recruit and activate monocytes during hemolytic transfusion reactions, thus contributing to the maintenance of these reactions.
Modeling the growth of Yersinia enterocolitica in donated blood
Authors: Gibb A.P. , Martin K.M. , Davidson G.A. , Walker B. , Murphy W.G. 
Published: March 2003

Background: Sepsis and death subsequent to the transfusion of blood containing Yersinia enterocolitica is an increasing problem. The organisms probably originate from bacteremia in the donor and can subsequently multiply at low temperature.Study Design and Methods: Reported here are experiments with a strain of Y. enterocolitica associated with a case of transfusion‐associated bacteremia.Results: It was found that the rapid early killing of Y. enterocolitica injected into donated blood does not require viable phagocytes and can be explained by complement‐mediated killing. Complement resistance in Y. enterocolitica is known to be plasmid‐coded. It is expressed at 37°C, but not at 20°C, and is favored by calcium‐deficient culture media. Y. enterocolitica organisms induced to express complement resistance were still killed in donated blood, though the initial rate was slower. Such organisms multiplied in plasma at 37°C, but were killed after 6 hours of incubation at 20°C, presumably because complement resistance genes are switched off at this temperature.Conclusion: This experiment is thought to reflect the natural history of Y. enterocolitica contamination of blood, in which complement‐resistant organisms in the donor blood encounter lower temperatures after donation. These observations suggest that the practice of plasma depletion may have contributed to the increased incidence of mortality due to Y. enterocolitica contamination of donated blood.
Fatal outcome in a patient with autoimmune hemolytic anemia associated with an IgM bithermic anti‐ITP
Authors: Ramos R.R. , Curtis B.R. , Eby C.S. , Ratkin G.A. , Chaplin H. 
Published: March 2003

BACKGROUND: Several cold autoantibodies (usually IgG) with IT specificity have been reported previously, as have autoantibodies with joint I and P blood group specificities (IP1, ITP1, iP1, IP). A fatal outcome associated with an IgM cold autoantibody of ITP specificity is reported. CASE REPORT: A 54‐year‐old man suffered from progressively severe cold autoimmune hemolytic anemia for 9 months. Hemoglobin concentration ranged from 6 to 7 g per dL (60–70 g/L) and reticulocytes from 3 to 5 percent (0.030‐0.050). The direct antiglobulin test was weakly positive for IgM and strongly positive for C3d. The serum contained a cold agglutinin that reacted strongest with cord i red cells (RBCs) > adult I RBCs > adult i RBCs, which is consistent with IT specificity. The Donath‐Landsteiner test was positive; the reaction was neutralized by globoside. The serum reacted weakly or was negative with RBCs from five group p blood donors, which suggests anti‐ITP specificity. Dithiothreitol treatment of the serum abolished the cold agglutinin reactivity, which suggests that the anti‐IT was IgM. The patient received > 40 RBC transfusions and failed to respond to oral steroids, oral cytoxan, high‐dose pulse intravenous steroids, and plasma exchange at room temperature and at 35 degrees C. He died of sepsis following an unsuccessful trial of chlorambucil. Autopsy revealed unsuspected disseminated non‐Hodgkin's lymphoma.CONCLUSION: Serologic studies are consistent with our patient's having a single IgM cold autoantibody with IT and P specificities (anti‐ITP) and requiring both specificities on the same RBC to permit maximal antibody expression.
FPTT is a low‐incidence Rh antigen associated with a “new” partial Rh D phenotype, DFR
Authors: Lomas C. , Grassmann W. , Ford D. , Watt J. , Gooch A. , Jones J. , Beolet M. , Stern D. , Wallace M. , Tippett P. 
Published: March 2003

BACKGROUND: Several Rh D phenotypes with partial D antigens are recognized. Some partial D antigens are associated with low‐incidence Rh antigens. New partial D antigens are revealed by an atypical pattern of reactions with anti‐D.STUDY DESIGN AND METHODS: The reactions of D variant cells with panels of monoclonal anti‐D and with antibodies to low‐incidence antigens were compared to those of known D categories to identify a new Rh D phenotype. The inheritance of partial D antigens was studied by Rh phenotyping of the families of the probands. Standard serologic methods were used and family data were analyzed.RESULTS: A new Rh D phenotype, to be called DFR, was identified in 17 probands, two of whom had made anti‐D. The partial D antigen carries epD3, epD4, and epD9 and lacks epD8. The presence of other D epitopes is ambiguous; different answers were obtained for the same sample with different monoclonal anti‐D of the same apparent epitope specificity. The immunoglobulin class of the anti‐D was important: IgG were more successful than IgM monoclonal anti‐D in detecting the partial D of DFR. Family studies showed that DFR traveled with Ce more frequently than with cE. The low‐incidence antigen FPTT (International Society of Blood Transfusion number 700048) was found on all DFR samples. Family studies demonstrated that FPTT is, as suspected, part of the complex Rh system.CONCLUSION: The partial D of the Rh D phenotype, DFR, is recognized by its pattern of reactions with monoclonal anti‐D and its association with the low‐incidence antigen FPTT, FPTT has now been numbered Rh50.
Anti‐hepatitis C virus (anti‐HCV) seroconversion in patients undergoing hemodialysis: comparison of second‐ and third‐generation anti‐HCV assays
Authors: COUROUCÉ A.‐M. , MARREC N. LE , GIRAULT A. , DUCAMP S. , SIMON N. 
Published: March 2003

BACKGROUND: The results obtained in sequential specimens from recently infected subjects generally provide the best means of comparing the sensitivity of assays.STUDY DESIGN AND METHODS: The sensitivity of second‐ and third‐generation assays for antibody to hepatitis C virus (HCV) was compared on sequential specimens, generally collected at monthly intervals from 45 patients undergoing hemodialysis who seroconverted for HCV between 1980 and 1990.RESULTS: Fifteen patients (33%) were positive earlier in the third‐generation enzyme‐linked immunosorbent assay (ELISA), with a mean difference of 17 days (range, 7–30) between the last negative and the first positive specimens. At the first rise in alanine aminotransferase, and at its peak, 63 and 91 percent of the patients, respectively, were anti‐HCV positive in the third‐generation ELISA. Third‐generation recombinant immunoblot assay (RIBA) reacted at the same time as third‐generation ELISA. Of the first specimens that were positive in second‐generation ELISA, 44 percent reacted and 56 percent were indeterminate in third‐generation RIBA, while 10 percent reacted, 72 percent were indeterminate, and 18 percent did not react in second‐generation RIBA. From the beginning to the end of the follow‐up, antibody to c33c was the most prevalent, followed in descending order by antibody to c22‐3, antibody to c100‐3, and antibody to NS5: 56, 54, 26, and 18 percent, respectively, at time 0, and 100, 86, 83, and 31 percent, respectively, 12 months later.CONCLUSION: Third‐generation assays (both ELISA and RIBA) were more sensitive than second‐generation assays in the diagnosis of HCV infection, in that positive results were obtained earlier and a higher proportion of specimens were confirmed positive in RIBA testing
Hypotensive reactions to white cell‐reduced plasma in a patient undergoing angiotensin‐converting enzyme inhibitor therapy
Authors: Fried M.R. , Eastlund T. , Christie B. , Mullin G.T. , Key N.S. 
Published: March 2003

Background: Hypotensive reactions to platelet transfusions performed with white cell (WBC)‐reduction filters with negatively charged surfaces have been reported recently in patients taking angiotensin‐converting enzyme (ACE) inhibitors. Experimental studies have shown that the filter material can activate bradykinin, which may cause symptoms in patients with reduced bradykinin catabolism. Symptomatic adverse reactions after the administration of fresh‐frozen plasma (FFP) through a WBC‐reduction filter have not been reported in a patient on ACE Inhibitor medication.Case Report: A 58‐year‐old man with congenital coagulation factor V deficiency and hypertension treated with an ACE inhibitor was admitted for rehabilitation after orthopedic surgery. On 3 consecutive days, he received FFP through a WBC‐reduction filter; within minutes of the beginning of each infusion, he experienced a drop in blood pressure, facial erythema, abdominal pain, and anxiety. When the infusions were stopped, symptoms quickly abated without treatment. Multiple prior transfusions of unfiltered FFP and FFP filtered through a WBC‐reduction filter made by a different manufacturer, as well as subsequent transfusions of unfiltered FFP, had not produced such reactions.Conclusion: Facial flushing, hypotension, and abdominal pain after FFP administration in a patient on ACE inhibitor medication appeared to be associated with a specific type of WBC‐reduction filter. This association and other reported studies suggest that special caution is warranted when patients who are treated with ACE inhibitors receive blood components administered through WBC‐reduction filters capable of generating bradykinin.
Bacterial contamination rates following processing of bone marrow and peripheral blood progenitor cell preparations
Authors: Padley D. J. , Koontz F. P. , Trigg M. E. , Gingrich R. D. , Strauss R. G. 
Published: March 2003

Background: The performance of cultures to assess possible bacterial contamination of bone marrow and peripheral blood progenitor cell preparations is required by the standards of the American Association of Blood Banks.Study Design and Methods: Consecutive (n = 893) bone marrow and peripheral blood progenitor cell preparations were cultured for assessment of possible contamination by microorganisms.Results: Consecutive bone marrow and peripheral blood progenitor cell preparations (n = 893) were cultured; the overall positive rate detected was 2.5 percent (22/893). The isolates predominantly were skin contaminants (gram‐positive cocci) and so‐called water‐borne organisms (gram‐negative rods). The 6.0‐percent rate of positivity in 317 bone marrow preparations was higher than the 0.5‐percent rate in 576 peripheral blood progenitor cell preparations (p < 10(‐6)). Culture‐ positive preparations were transfused to 16 patients at this institution; however, none of these transfusions led to documented sepsis with the contaminating organism.Conclusion: The culture method described here complies with the standards of the American Association of Blood Banks. Contamination can be detected in both bone marrow and peripheral blood progenitor cell preparations. When contaminated preparations are transfused, there are few complications that can be attributed to the contamination.
Exchange transfusion the hard way: massive hemolysis following transplantation of bone marrow with minor ABO incompatibility
Authors: Greeno E. W. , Perry E. H. , Ilstrup S. J. , Weisdorf D. J. 
Published: March 2003

Background: Bone marrow transplantation using donors with minor ABO incompatibility may result in the rapid production of donor‐derived red cell isohemagglutinins, causing hemolysis of recipient red cells.Case Report: The transplant of sibling‐donor marrow with minor ABO incompatibility (group O donor marrow to group A recipient), using FK‐ 506 as an immunosuppressant to prevent graft‐versus‐host disease, is reported. Following early myeloid engraftment, the recipient developed hemolysis of her entire A red cell population between Day 8 and Day 11. This brisk hemolytic anemia was due to rapid donor lymphoid engraftment that resulted in the explosive production of donor‐derived anti‐A.Conclusion: Patients undergoing the transplantation of marrow from donors with minor ABO incompatibility in which the donor cells can produce isohemagglutinins against the recipient's red cells must be kept under vigilant observation for the possible development of severe hemolysis, particularly in the setting of profound T‐cell suppression without B‐cell suppression.
Differentiation between human red cells of Pk and p blood types using Pseudomonas aeruginosa PA‐I lectin
Authors: Sudakevitz D. , Levene C. , Sela R. , Gilboa‐Garber N. 
Published: March 2003

BACKGROUND: The red cells of almost all human beings bear P antigen. Type P1 cells (around 75% of the population) contain P1 antigen in addition to P, and type P2 cells (around 25% of the population) contain only P. The red cells of only a few individuals are devoid of P: these cells may be of either Pk‐positive (P1k and P2k[Pk]) or p type (the latter lack all the above‐described antigens of the P system). Differentiation between them is of clinical importance, but there is a shortage of specific reagents. This article offers reliable means for differentiation.STUDY DESIGN and METHODS: Agglutination of washed, papain‐treated red cells of all the P types by PA‐1 and soybean lectins and adsorption of the lectins onto the red cells were examined.RESULTS: PA‐1 strongly agglutinated papain‐treated red cells. Examination of its interactions with red cells having different P system antigens revealed that Pk (both P1k and P2k) red cells of O, A, and B blood types were agglutinated significantly faster than p red cells. The agglutination intensities of Pk red cells of types O and A (most people) was considerably stronger than those of p red cells. P1 and P2 type red cell agglutination was intermediate (P1>P2). Adsorption tests with all the red cells, exhibited the same order of PA‐1 affinities for the P system blood types: Pk>P1,>p. The soybean lectin exhibited opposite behavior (p>Pl).CONCLUSION: The galactose‐binding lectins PA‐1 and soybean may facilitate the determination of Pk and p red cells.
Incidence of the Nak(a)‐negative platelet phenotype in African Americans is similar to that of Asians
Authors: Curtis B.R. , Aster R.H. 
Published: March 2003

Background: About 5 to 10 percent of Asians have platelets that lack the major membrane glycoprotein (GP) IV (CD36, GPIIIb) that carries the isoantigen Naka. The GPIV‐negative platelet phenotype is extremely rare among whites, but its frequency in persons of African ancestry has not yet been determined. Isoimmunization against GPIV can occur in GPIV‐ negative persons and can lead to platelet transfusion refractoriness. Therefore, the expression of GPIV on platelets from unrelated African Americans was studied.Study Design and Methods: Platelets were obtained from 250 African American and 280 white blood donors. Flow cytometry was used to determine the ability of these platelets to bind a monoclonal antibody that reacted with GPIV. Platelets that failed to react with this probe were tested with other GPIV‐specific monoclonal antibodies and with anti‐Naka, an isoantibody that recognizes an epitope on GPIV.Results: Platelets from 6 of the 250 African American donors (2.4%) lacked GPIV and failed to bind anti‐Naka, whereas platelets from all of the white donors were GPIV positive (p>0.05). No platelet‐reactive antibodies were identified in the serum of the GPIV‐ negative donors.Conclusion: The frequency of the GPIV‐negative platelet phenotype in African Americans is comparable to that in Asians and much greater than that in whites. Studies are needed to determine the frequency with which African Americans become isoimmunized to GPIV by transfusions and the possible contribution of this isoimmunization to platelet transfusion refractoriness in this population.