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Biomedical subjects

P D Mintz

Publications and source records attributed to P D Mintz.

At least 19 recordsLinked to original sources
PubMed1995

Peripheral blood stem cell collection in a patient with chronic myelogenous leukemia and a high circulating nucleated red cell fraction.

A high level of circulating nucleated red blood cells (NRBC) in patients with chronic myeloproliferative syndromes could potentially complicate peripheral blood stem cell (PSC) collection. The mononuclear NRBC might comprise a significant fraction of the total mononuclear cells in the final product. We report a successful PSC collection in a patient with more NRBC than WBC in the peripheral blood. A 27-year-old man with chronic myelogenous leukemia underwent eight PSC collection procedures, seven using the Cobe Spectra (Spectra) and one using the Fenwal CS3000 Plus (CS). PSC product manipulations to remove NRBC were unnecessary. As assessed by post-collection NRBC: WBC ratio as a percent of the initial ratio, Spectra selectively harvested mononuclear leukocytes over NRBC. The collected products had a mean NRBC: WBC ratio that was 3.4% of the peripheral blood ratio. Adequate numbers of mononuclear leukocytes were collected with less than 6% NRBC contamination. The single CS procedure resulted in a comparable NRBC reduction efficiency as the Spectra. We conclude that PSC harvest using automated blood cell separators from patients with a high level of circulating NRBC may result in a product with an acceptable number of NRBC.

Adult↗
PubMed1995

Quality assessment and improvement of transfusion practices.

A successful quality assessment program simultaneously creates, sustains and documents excellence in patient care. As clinical practices evolve, it helps to assure their continuing improvement. The program strives to eliminate unnecessary transfusions as the cornerstone of transfusion safety. It should be conducted in a professional, nonadversarial, and educational manner.

Adult↗
PubMed1995

The use of leukocyte-reduced blood components.

Many of the risks and discomforts associated with blood transfusion may be avoided by removing the contaminating leukocytes from cellular blood components. Leukocyte reduction prevents many febrile reactions that occasionally occur following red cell transfusion and prevents some febrile reactions following platelet transfusion. Prophylactic use of leukocyte-reduced components may prevent primary HLA alloimmunization, which is a principle cause of the refractoriness to platelet transfusion seen in many multiply transfused, thrombocytopenic patients. Leukocyte-reduced components are equally effective in the prevention of CMV as seronegative blood.

Bacterial Infections↗
PubMed1994

Removal of an infected right atrial mass in a patient with sickle cell disease.

The use of indwelling central catheters for hyperalimentation, chemotherapy, and long-term venous access is increasing. We report the successful removal of an infected right atrial mass associated with the use of a central catheter in an adult with sickle cell disease. The clinical options for the treatment of infected atrial thrombus as well as the challenge of performing cardiopulmonary bypass in patients with sickle cell disease are briefly discussed.

Adult↗
PubMed1994

The use of recombinant human erythropoietin and cultured epithelial autografts in a Jehovah's Witness with a major thermal injury.

Haemostatic debridement, recombinant-human erythropoietin and cultured epithelial autografts have been used successfully in a Jehovah's Witness with a major burn injury. Tourniquet ischaemia complemented by a topical haemostatic agent minimized excisional blood loss, while recombinant-human erythropoietin accelerated erythropoiesis, thereby correcting postburn anaemia. Cultured epithelial autografts provided coverage of the granulating wounds without creating donor sites.

Adult↗
PubMed1994

Independent roles for platelet crossmatching and HLA in the selection of platelets for alloimmunized patients.

BACKGROUND: Although HLA-matched platelets are frequently requested for alloimmunized patients, recent evidence has indicated that 1-hour posttransfusion platelet increments in these patients are specifically sensitive to crossmatch compatibility. STUDY DESIGN AND METHODS: To determine the extent of advantage gained by use of single-donor apheresis (SD) platelets selected on the basis of HLA match when crossmatch-compatible SD platelets were available, a total of 220 platelet transfusions given in the absence of individually determined significant nonimmune factors were analyzed in a well-characterized cohort of platelet-refractory patients. Platelets were selected by solid-phase crossmatch from a small donor pool of relatively poor HLA matches or, upon request, ordered as HLA-matched and later crossmatched. RESULTS: Alloimmunized patients responded better to SD platelets selected on the basis of HLA than to pooled platelet concentrates or SD platelets selected at random, although most of the benefit was limited to the 57-percent subset of good HLA matches. Crossmatch-compatible SD platelets provided similar posttransfusion platelet increments independent of the HLA match. None of 31 crossmatch-incompatible SD platelets transfused provided an adequate increment, including 13 that were ordered as HLA-matched platelets. CONCLUSION: No benefit could be demonstrated from requesting that SD platelets be HLA-matched when crossmatch-compatible SD platelets were available.

Blood Grouping and Crossmatching↗
PubMed1994

Effect of freezing on the in vivo recovery of irradiated red cells.

BACKGROUND: Transfusion-associated graft-versus-host disease can be prevented by gamma radiation of blood components. The increased use of blood components donated for patients by their family members has resulted in an increased demand for the storage and handling of irradiated units, and the ability to freeze the cells would allow storage beyond their current expiration date. STUDY DESIGN AND METHODS: To assess the effect of freezing and deglycerolization on irradiated red cells, studies of autologous radiolabeled red cell recovery were performed using normal volunteers. Each unit of CPDA-1 red cells was immediately divided into two equal volumes. Further handling of each half was identical except that one was irradiated (3500 cGy). The units were grouped under three protocols: I, irradiated on Day 0 and frozen on Day 5 (n = 4); II, irradiated on Day 7, rejuvenated, and frozen on Day 14 (n = 5); and III, irradiated on Day 14, rejuvenated, and frozen on Day 18 (n = 3). All cells were frozen for 3 to 10 months at -80 degrees C. RESULTS: Irradiated and control units showed no significant differences in supernatant potassium or hemoglobin. Autologous 24-hour posttransfusion recoveries (mean +/- SD) for the three groups were: I, 89.7 +/- 5.6 percent (control, 90.6 +/- 3.2%); II, 85.3 +/- 5.7 percent (control, 83.7 +/- 3.0%); and III, 79.5 +/- 1.4 percent (control, 82.6 +/- 5.2%). CONCLUSION: Irradiated red cells can be frozen after being stored under various conditions and can still meet established guidelines requiring 75-percent recovery 24 hours after transfusion.

Blood Preservation↗
PubMed1994

A method for estimating the delivery temperature of intravenous fluids.

Despite rigorous efforts to monitor and control the fluid temperature within a warmer, the actual delivery temperatures of intravenous (i.v.) fluids at a patient infusion site are not assessed in current clinical practice. A method which correlates the warmer temperature with the delivery temperature will provide the appropriate quality assurance framework. For fluids administered through typical 0.260- and 0.300-cm-diameter polyvinyl chloride (PVC) i.v. tubing, we developed such a method by directly measuring the delivery temperatures for saline, 6% hydroxyethyl starch (HES), 5% albumin, plasma, and packed red cells (PRC) using intratubing thermocouple wire probes. A kinetic analysis of the data yielded the following relationship governing temperature equilibration for fluids in i.v. tubing: f = L/(24 Q + L), where f represents the equilibration fraction, L the tubing length (cm), and Q the flow rate (mL/min). The equilibration fraction f is defined as (Ti - Td)/(Ti - Ta), where Ti, Td, and Ta represent the initial fluid temperature, the delivery temperature, and the ambient air temperature in centigrade, respectively. Both the fluid type and the variability in tubing construction had negligible effects on the delivery temperature. Under given conditions of Q and L, the relationship enables the calculation of the temperature equilibration fraction f and, subsequently, the delivery temperature. Furthermore, the i.v. tubing length or the particular L/Q may be calculated for a desired target temperature and the corresponding f. We conclude that, despite many complicating variables, one can effectively assess and even control the delivery temperature of i.v. fluids administered through typical i.v. tubing.(ABSTRACT TRUNCATED AT 250 WORDS)

Infusions, Intravenous↗
PubMed1993

Clinical and blood bank factors in the management of platelet refractoriness and alloimmunization.

Numerous independent and interdependent factors are involved in the posttransfusion platelet response. Factors such as ABO match and platelet age are related to circumstances potentially under the control of the blood bank physician and therefore may permit circumvention by an active transfusion service. On the other hand, factors such as fever or sepsis may be unavoidable, being related more to the individual patient or clinical condition. To evaluate which factors could be circumvented, we prospectively followed the 1-hour corrected count increments (CCIs) for 962 single-donor apheresis platelet transfusions to 71 refractory hematologic oncology inpatients, with concomitant recording of implicated factors. Stepwise regression analysis allowed for determination of which concurrent and confounding clinical-, patient-, and blood bank-related factors significantly affected the CCIs. Although many implicated factors proved to be independently associated with an increased or decreased CCI, we found that no single variable consistently explained the CCI variation across the patient population. Each patient appeared sensitive to one or a few particular factors, but because of marked intraindividual variation, it was not possible to identify a priori which factors were important for a given patient. The single exception was a solid-phase red blood cell adherence assay used to cross-match platelets, but only for alloimmunized patients. We also evaluated the utility of requesting HLA-matched platelets from the local suppliers and maintained a clear distinction between platelets simply ordered as HLA matched and actually HLA-identical platelets. Accounting for the confounding clinical-, patient-, and blood bank-related factors, the cross-match assay was a better predictor of an adequate CCI than ordering platelets as HLA matched.

Blood Banks↗
PubMed1993

Graft versus host anti-Rho(D) following minor Rh-incompatible orthotopic liver transplantation.

Hemolysis caused by ABO antibodies after ABO-compatible, nonidentical solid organ transplantation has been previously reported. The passenger B lymphocytes within the donor organ presumably generate an acute, primarily red cell-directed graft vs. host (GVH) response. Graft survival may also be compromised. GVH Rh antibodies have also been described, primarily in renal transplants. Only three cases, two only in abstract form, have been reported thus far describing GVH Rh antibodies in liver transplant patients, to which we add a fourth. A 62-year-old blood group A Rho(D)-positive woman with cirrhosis underwent orthotopic liver transplantation from a group A Rho(D)-negative, previously Rho(D)-sensitized donor and subsequently developed acute, self-limited hemolysis requiring four units of packed red cells. Anti-Rho(D) was identified in both serum and red cell eluate. An antibody detection test, identification, and assessment of the antibody reactivity score from the pretransplant donor specimen may identify patients at risk for hemolysis due to GVH Rh antibodies.

Antibodies↗
PubMed1993

Performance characteristics of Ultratherm fluid warmer.

Ultratherm Infusion Fluid Warmer Model 3703-1 (Ultratherm) is a disposable device approved by the Food and Drug Administration to warm fluids including blood and nutritional fluids. It has no temperature monitor or audible alarm and uses air-activated chemical heating elements in direct contact with loops of intravenous (i.v.) tubing. We studied the warming of blood and saline by Ultratherm using intratubing thermocouple wire probes. Internal warmer chamber temperature reached 58 degrees C within 40 min of activation, and a plateau of approximately 65 degrees C reached in 1 h was sustained over the next 5 h. Free hemoglobin measurements on 47 degrees C and 53 degrees C blood samples obtained as blood exited the warmer at 30 mL/h demonstrated 0.6% and 7% hemolysis, respectively. Room temperature blood at 500 mL/h and refrigerated blood at 100 mL/h were warmed to approximately 36 degrees C. Refrigerated blood at 500 mL/h was not warmed above 19 degrees C. At flow rates of 500, 100, and 30 mL/h, room temperature saline reached 34 degrees C, 45 degrees C, and 52 degrees C, respectively. The unmonitored, high, internal warmer chamber temperatures preclude the use of Ultratherm with blood or any fluids potentially damaged by excessive heat, and its use should be limited strictly to clear fluids. The utility of the warmer, even with clear fluids, is further limited to room temperature fluids, to a time interval between 1 and 6 h following activation, and to flow rates between 100 and 500 mL/h.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood↗
PubMed1992

Undertransfusion.

Explore the source record for details and available documents.

Attitude↗
PubMed1991

Detection of anti-A in neonatal serum.

The thirteenth edition of the standards of the American Association of Blood Banks did not require the use of A1 red cells (RBCs) or an indirect antiglobulin test (IAT) to detect anti-A in neonatal serum, whereas the fourteenth edition mandates both. The present study was conducted to help document the need for these changes. Incomplete expression of the A antigen in neonatal patients can contribute to the accumulation of unabsorbed maternal anti-A that is capable of mediating the immune destruction of transfused adult RBCs. Sera from 50 group A neonatal infants of group O mothers were tested for anti-A by using RBC segments of A1 and A2 units of AS-1 RBCs less than 14 days old and also with A1 reagent RBCs. Of 22 sera in which anti-A was detected by RBCs from the A1 units with an IAT, anti-A was detected by RBCs from the A2 unit in only 1 and by the reagent RBCs in 17. In 19 (86%) of the 22 neonatal patients in whose sera anti-A was detected, the antibody was found only with the use of anti-human globulin in the IAT. It is concluded that testing to detect circulating anti-A in neonatal patients should include an IAT, and that it is preferable to use A1 RBCs for the initial evaluation.

ABO Blood-Group System↗
PubMed1991

Red cell survival studies in a patient with anti-Tca.

A radiolabeled, allogenic red cell survival study was performed on a patient who lacked the Cromer-related antigen Tca and who had developed the corresponding antibody. Red cell survival was 92% at 1 hour and 88% at 24 hours. Monocyte monolayer assays (MMA) and IgG subclass determinations were performed on samples from: (1) 1965, the period of initial antibody formation; (2) approximately two years before the red cell survival study; and (3) four months after the study. All samples reacted w+ to 1+ by the antiglobulin test. The earliest sample contained IgG1, IgG2, and IgG4 anti-Tca. Because there were 20.5% reactive monocytes in the MMA (normal range 0-3%), this antibody may have produced extravascular red cell destruction. In contrast to the initial example, the samples before and after the red cell survival study both contained IgG2 and IgG4 subclasses with 1.3% and 2.2% MMA reactivity, respectively. The current pattern of antibody subclass, the lack of reactivity in the MMA, and a red cell survival of 88% at 24 hours indicate that short-term transfusion support would have been well tolerated. This contrasts to the in vitro results obtained with the earliest sample, which suggest a clinically significant antibody. This appears to be the first report of a red cell alloantibody that remained serologically reactive but underwent a loss of its IgG1 fraction, which appeared capable of red cell destruction based on the MMA results.

Aged↗