Blood resource management.
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Biomedical subjects
Publications and source records attributed to J B Henry.
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Preoperative cross match guidelines were developed from a review of elective surgical hemotherapy. Six elective surgical procedures were studied prospectively to determine the effectiveness of the recommendations. All six procedures demonstrated a substantial reduction in preoperative cross match ordering during the study period, although for only one procedure was the guidelines' recommendation followed strictly. For those procedures that rarely required hemotherapy, an ABO-Rh typing and an antibody detection test were recommended as a preoperative study without a cross match. Through education of the clinical staff, successful establishment of these guidelines can lead to substantial monetary savings, reduced blood outdating, and a decreased blood bank workload with a more appropriate allocation of the technologists' time and effort.
Effective utilization of clinical laboratories requires that underutilization, overutilization, and malutilization be appreciated and eliminated or reduced. Optimal patient care service, although subjective to a major extent, is reflected in terms of outcome and cost. Increased per diem charges, reduced hospital stay, and increased laboratory workload over the past decade all require each laboratory to examine its internal operations to achieve economy and efficiency as well as maximal effectiveness. Increased research and development, an active managerial role on the part of pathologists, internal self-assessment, and an aggressive response to sophisticated scientific and clinical laboratory data base requirements are not only desirable but essential. The importance of undergraduate and graduate medical education in laboratory medicine to insure understanding as well as effective utilization is stressed. The costs and limitations as well as the accuracy, precision, sensitivity, specificity, and pitfalls of measurements and examinations must also be fully appreciated. Medical malpractice and defensive medicine and the use of critical values, emergency and routine services, and an active clinical role by the pathologist are of the utmost value in assuring effective utilization of the laboratory. A model for the optimal use of the laboratory including economy and efficiency has been achieved in the blood bank in regard to optimal hemotherapy for elective surgery, assuring superior patient care in a cost effective and safe manner.
Casts represent an important, diagnostic component of urinary sediment, and may signal renal parenchymal disease in asymptomatic individuals. Accurate, precise identification of certain casts may be difficult due to poor visualization by current technics. Casts from freshly voided urine specimens, cytocentrifuged and stained by the Papanicolaou method, can be visualized optimally from permanent slide preparations. The genesis of these casts and their diagnostic potential related to renal disease and acute renal allograft rejection are discussed.
The Coleman 91 nephelometer provides rapid, simple amylase and lipase assays, which are particularly suited to emergency requests. Linearity of amylase compares favorably with that of the Phadebas assay, and comparable precision was obtainable with serum and urine. Normal ranges for serum amylase are slightly higher than those based on the amyloclastic end-point assay. The serum lipase assay shows improved linearity over titrimetric procedures, although kinetics remain variably non-linear. Occasional sera show discordantly elevated nephelometric lipase and normal titrimetric lipase. Precision of the nephelometric lipase assay is somewhat lower than that of amylase; normal ranges are considerably higher than those based on titrimetry. Extremely lactescent sera may yield falsely low nephelometric amylase and lipase activities: these sera must be serially diluted to achieve actual values.
Occasional patient sera showing normal or minimally elevated lipase activity in the 6-hour titrimetric assay and discordantly high lipase activity in the 6-minute nephelometric assay were encountered. Most of these sera had normal amylase activity. They represented about 1% of outpatient sera subjected to amylase assay. A few sera with discordant lipase activities showed elevated amylase activities and were from patients with the diagnosis of pancreatic dysfunction. Nephelometric lipase assay in these sera showed pronounced nonlinear kinetics; in the most discordant cases a gradual decay of initially high activity to zero occurred. Elevated nephelometric lipase activity was lost inordinately in serial dilution of serum or on serial reduction of undiluted assay volume. In tracer experiments, two of these sera liberated no significant amount of free fatty acids after extensive "de-emulsification" of the nephelometric substrate mixture. This nonlipolytic "deemulsifying" activity was found to be relatively heat-stable in one serum. The nature of this activity remains obscure. A simple and effective protocol is suggested to detect and identify these aberrant nephelometric lipases in the routine laboratory.
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The clinical diagnosis of acute renal allograft rejection in immunosuppressed recipients can often be predicted or confirmed on the basis of characteristic urinary cytologic findings. Use of cytocentrifugation permits a simple, rapid, reproducible and semiquantitative means of preparing cytologic urinary specimens of diagnostic quality from small quantities of urine. The cytodiagnosis of acute renal rejection was established before or on the same day a clinical diagnosis of rejection was made in the majority of renal transplant cases studied over a 12-month period. Renal tubular cells were found to be the exfoliated cells of greatest value in predicting an acute rejection episode, and their persistence has prognostic importance.
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Several laboratory methods are currently available for the detection of barbiturates, but few are suitable for emergency use, The authors evaluated use of an ultraviolet spectrophotometric method as a screening procedure and compared the results with results obtained by other barbiturate methods (colorimetric, gas-liquid chromatographic, and immunochemical), Procedure time was approximately 40 minutes, sensitivity 0.2 mg/dl, precision (coefficient of variation) 5.4%, recovery 97.8% for phenobarbital, and there was good correlation with results obtained by gas-liquid chromatography and the EMIT system for phenobarbital. The authors recommend ultraviolet spectrophotometry as an excellent screening procedure for assessing the severity of barbiturate intoxication.
Although elevated prostatic acid phosphatase activity (ACP) in vaginal fluid is compatible with recent coitus, the finding of spermatozoa in vaginal fluid is usually considered the diagnostic indicator for semen. When 80 alleged rape cases during an 18-month period were reviewed and the results of cytologic examination for the presence of spermatozoa compared with quantitative ACP determinations, the latter appeared to be a more reliable and sensitive indicator of semen. The normal range of ACP in semen, as well as persistence of ACP in vaginal fluid, was also defined. It is concluded that vaginal fluid ACP is a reliable and sensitive method for identification of semen. Furthermore, the results confirm that quantitative ACP determination of vaginal fluid specimens may substantiate the allegation of rape with respect to time.
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