Recombinant human erythropoietin facilitates autologous blood collections in children undergoing corrective spinal surgery.
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Adolescent↗
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Rapid diagnosis of bacterial sepsis with PCR amplification and microarray hybridization in 16S rRNA gene.
In this study, blood culture and PCR-microarray analysis were used to examine 172 cases of suspected septicemia. Primers and oligonucleotide probes, based on the sequences of bacterial 16SrRNA gene, were arrayed by imprinting on microarray slides. Blood specimens collected from 172 cases of suspected septicemia were cultured and then tested separately by PCR for the bacterial 16S rRNA. Of the 172 clinical cases, 17 cases tested positive by PCR. The number of positives identified by PCR (9.88%) was significantly higher than the number of positives identified by the blood culture (4.65%). When blood culture was used as control, the sensitivity of PCR was 100%, the specificity was 97.85%, and the index of accurate diagnosis was 0.979. When the 17 PCR positive specimens were further analyzed by hybridization against the microarrays, five were found to be probe positive for E. coli, four were positive for S. epidermidis, four were positive for CoNS, and two were positive for Bacillus and Propionibacterium, respectively. In the eight specimens showing positive results by both PCR and blood culture, the species determined by microarray analysis corresponded with the result obtained from blood culture. Detection of the bacterial 16SrRNA genes in clinical specimens by PCR and microarray analysis can be used to accurately diagnose neonatal sepsis. This method has a higher sensitivity and specificity than blood culture and can provide a rapid way for the etiological diagnosis of neonatal septicemia.
Bacillus↗
Effects of different concentrations of anticoagulant on the in vitro characteristics of autologous whole blood.
BACKGROUND: Routinely, 450 mL of blood is collected into 63 mL of CPDA-1, for a final anticoagulant:blood ratio of approximately 1:7 in a whole-blood autologous unit. If less than 300 mL of blood is to be collected, the AABB standards suggest that there should be a proportionate decrease in anticoagulant. Data from an autologous blood program showed a range in volume from 92 mL to 667 mL per bag, which reflects an anticoagulant:blood ratio of 2:1 to 1:10. STUDY DESIGN AND METHODS: To determine the effects of these ratios on the in vitro function of RBCs at various anticoagulant ratios, blood was collected into different amounts of anticoagulant, and various measurements were made during storage. RESULTS: The number of RBCs and the MCV remained constant over time, regardless of the anticoagulant dilution used. Plasma free Hb increased with time with all dilutions. At a 1:2 ratio, it rose from 734 mg per L on Day 1 to 1805 mg per L on Day 35, and at 1:8, it was 355 mg per L for Day 1 and 854 mg per L on Day 35. Plasma sodium decreased and the potassium increased over time with all dilutions. From Day 1 to Day 35, there was a nine-fold increase in potassium at both the 1:2 and 1:8 dilutions (2.4 to 22.9 mmol/L, 3.2 to 29.6 mmol/L, respectively). The LDH increased over time and the pH decreased in all of the dilutions. Osmotic fragility remained constant at the 1:8 dilution but decreased at all of the other dilutions with storage, with 44-percent fragility on Day 35 at the 1:2 ratio. The WBC and platelet counts decreased consistently over time. Overall, 1 percent of the autologous units were below the cutoff volume of 300 mL at which an adjustment of the anticoagulant volume is required. CONCLUSION: Plasma Hb and plasma potassium concentrations are considerably higher in low-volume units, which indicates that deviation from standard collection procedures is deleterious to RBCs.
Adenine↗
Umbilical cord blood progenitor cell transplantation. The International Conference Workshop on Cord Blood Transplantation, Indianapolis, November 1993.
Haemopoietic progenitor cells are present in umbilical cord blood (UCB) and have been used to restore haemopoiesis in children after myeloablative therapy. UCB may possess a number of advantages over bone marrow and peripheral blood as a source of allogeneic progenitor cells, e.g. a lower incidence of graft-versus-host disease and a decreased risk of transmission of infection and there is considerable interest in the establishment of large cord blood banks for use in unrelated transplants. The International Conference Workshop on Cord Blood Transplantation was held in Indianapolis in November 1993 and provided a timely opportunity to review the clinical and laboratory data relating to the use of UCB in transplantation. The results from 34 UCB transplants have been reported to the International Cord Blood Transplant Registry. Engraftment was achieved in 27 of 31 evaluable patients. Graft-versus-host disease > grade 1 occurred only in children transplanted from a one haplotype matched donor; 22 patients survive at a median of 1.5 years. Further sessions at the meeting reviewed the haemopoietic cell content of UCB, the capacity for expansion of early cells and the origin (fetal and/or maternal) and function of lymphoid cells within the graft. The conference ended with a discussion of the practicalities of cord blood banking including collection, cryopreservation, storage, HLA-typing and screening for genetic and infectious diseases.
Adolescent↗
Controlled clinical laboratory comparison of BACTEC plus aerobic/F resin medium with BacT/Alert aerobic FAN medium for detection of bacteremia and fungemia.
Blood specimens collected from adult patients with suspected sepsis in four medical centers were inoculated into BACTEC Plus/F and BacT/Alert FAN aerobic culture bottles. Both bottles of 7,401 bottle pairs contained the prescribed blood volume of 8 to 12 ml. Bottles were incubated in their respective instruments for a standard 7-day protocol or until the instruments signaled that they were positive. A total of 720 isolates that were judged to represent true infections were recovered from 338 patients; 451 isolates were recovered from both bottles, 143 were recovered from only the Plus/F bottle, and 126 were recovered from only the FAN bottle (P was not significant). Although more Histoplasma capsulatum isolates were recovered from Plus/F bottles (P < 0.005), there were no other statistically significant differences in recovery rates of individual species or groups of organisms between the two systems. Of 329 monomicrobic patient septic episodes, 244 episodes were detected by both blood culture systems, 40 were detected only by the BACTEC system, and 45 were detected only by the BacT/Alert system (P was not significant). There was no significant difference between the two systems in the detection of septic episodes among patients receiving antibiotic therapy at the time of blood cultures. Of the cultures found to be positive within the first 72 h of incubation, detection was on average earlier by the BACTEC system (16.9 h) than by the BacT/Alert system (18.7 h). Larger differences in average time to detection were seen with streptococci (10.7 h by the BACTEC system and 17.9 h by the BacT/Alert system) and yeasts (an average of 29.4 h by the BacT/Alert system versus 37.2 h by the BACTEC system). With the exception of the differences noted above, BACTEC Plus/F aerobic resin and BacT/Alert aerobic FAN blood culture bottles were comparable in their abilities to recover aerobic and facultative organisms.
Adult↗
Autotransfusion of drained blood after total knee arthroplasty.
Osteoarthritic knees were treated by cemented (20 knees) or uncemented (five knees) total knee arthroplasty. The drained blood of the first six postoperative hours was collected, filtered and autotransfused. The blood loss of 20 first postoperative hours averaged 970 ml in the cemented and 1360 ml in the uncemented arthroplasties. An average of 60% of the shed blood was returned to the patients. Transient fever reaction took place during the autotransfusion of three patients, all in the cemented arthroplasty subgroup. No other complications were recorded. The amount of drained blood and transfused blood was compared with a similar series of 16 arthroplasties, treated without autotransfusion. Autotransfusion of filtered blood appears safe and useful in arthroplasty of the knee. Marked reduction of foreign blood transfusion but no direct financial benefit was attained by autotransfusion in these cases. Autotransfusion after uncemented arthroplasty of the knee appears advisable, because of the lack of side-effects, possibly caused by acrylic monomers and because the bleeding (and collection of shed blood) was more extensive than after cemented arthroplasty.
Aged↗
Temporal and geographical trends of anti-HIV-1 antibodies screening among newborns in Italy, 1990-1993. Italian Collaborative Study Group for HIV Prevalence in Newborns.
To describe the dynamic of HIV-1 prevalence in Italian childbearing women and to estimate the future incidence of pediatric AIDS due to vertical transmission, dried-blood specimens collected from a consecutive sample of newborns in all Italian regions were examined for the presence of anti-HIV-1 antibodies (HIV-Ab) after the routine neonatal screening program was completed. Of 555,722 blood samples collected and examined for HIV-Ab between 1990 and 1993, 550 (0.099%) were positive. Nationwide, the HIV seroprevalence decreased between 1990 and 1992 (0.124% in 1990, 0.100% in 1991, 0.085% in 1992), and increased, as compared with that in the previous year, in 1993 (0.096%). In an univariate analysis, HIV seroprevalence was positively was positively associated with being born in regions having higher AIDS cumulative incidence and in metropolitan areas, but negatively associated with year of delivery. In a multiple logistic regression analysis, only the AIDS cumulative incidence level of the delivery area and being born in a metropolitan area remained independently associated with HIV seroprevalence. Our results show significant geographical variation in the spread of HIV infection among childbearing women in Italy and provide useful indications to target prevention and care strategies for HIV-infected women and their children and to estimate the potential impact of implementing programs aimed at preventing vertical transmission of HIV infection.
Adult↗
Collection and recruitment of CD34+ cells during large-volume leukapheresis.
Although sufficient progenitor cells for hematopoietic rescue following high-dose therapy may be obtained in a single leukapheresis, the majority of patients require multiple procedures. In an attempt to minimize the number of leukapheresis and maximize collection efficiency, we undertook large-volume leukapheresis in 17 patients with a variety of hematologic malignancies. Twenty-four procedures were performed over a 6-h period, with a mean of 21 L of blood processed. By employing a modified collection set, three separate 2-h collection bags were analyzed for a number of variables. CD34+ cells are collected at a steady rate throughout the procedure, with no evidence of exhaustion of progenitor cells. There was evidence of progenitor cell recruitment, with 1.4-fold more CD34+ cells in the collected product than were present in the blood at the beginning of the procedure. Initiation of leukapheresis was based on the blood CD34+ count, and this value was strongly correlated with the number of CD34+ cells in the collected product. The procedure is safe and relatively simple and minimizes the number of leukaphereses required to collect adequate progenitors for autologous transplantation.
Adolescent↗
Establishment of a schedule of optimal preoperative collection of autologous blood.
Autologous blood donation prior to elective surgery can protect patients from unnecessary exposure to allogeneic blood. However, the inappropriate use of autologous blood programs, which results in the collection of excessive quantities of blood or of the collection of any blood prior to low-risk surgical procedures, can be wasteful and potentially hazardous. All patients donating autologous blood at a large institution during a period of three months were studied in an effort to develop a schedule of optimal preoperative collection of autologous blood (SOPCAB), which is similar to a maximum surgical blood order schedule. Some 461 consecutive autologous donations from 264 patients were investigated. For certain surgical procedures, primarily the cardiac and orthopedic procedures, undercollection appeared to be the most common problem. For other procedures (laminectomies, nasal surgery), overcollection was more common. A model is presented for the careful scrutiny of autologous blood collection and use to allow for the creation of a SOPCAB for patients undergoing elective surgery.
Blood Specimen Collection↗
Blood conservation in neonatal and pediatric populations.
Blood conservation in infants and children has benefits even beyond those seen with the adult populations. For instance, acquired blood borne diseases such as cytomegalovirus not only cause illness but also can have deleterious effects on the growth and development of infants and children. Decreasing blood transfusions is especially important in preventing sensitization over a lifetime, which may require further transfusion and even organ transplantation. A less striking benefit, but one equally as significant, is decreasing the occurrence of graft-versus-host disease when blood conservation negates the need for multiple transfusions. The limitation of alternative transfusion practices in children and infants increases the benefits of blood conservation. Autologous blood donation may be an alternative to allogeneic transfusion in older children, but is not possible with neonates who may be born anemic and who experience a normal physiologic anemia during the first 2 months of life. Critical care nurses are instrumental in helping blood conservation by understanding blood salvaging techniques, including correct collection techniques, noninvasive monitoring, evaluation of diagnostic sample needs, and administration of erythrocyte-stimulating factors.
Adult↗
[Preoperative collection of autologous blood with recombinant human erythropoietin therapy].
The major problems in liquid storage of donated blood are the limitation of blood volume preserved and the time consumed. We studied on the usefulness of utilization of recombinant human erythropoietin (rH-EPO) for preoperative collection of autologous blood. Patients were divided into 2 groups: Group 1 (12 patients) received 3000 unit of rH-EPO intravenously every day. Group 2 (10 patients) was not treated with rH-EPO. All the patients were given ferrous sulfate 100 mg of iron orally every day. As a rule, 400 ml blood was donated two or three times a week for rH-EPO treated group, while, for control group 400 ml blood was collected once a week. Some patients did not donate 400 ml because of their critical condition. The blood volume preserved became 780.9 +/- 284.1 ml in Group 1, and 910.8 +/- 263.9 ml in Group 2. However, the number of days until operation were significantly shorter in Group 1 (8.7 +/- 3.6 days) than in Group 2 (26.2 +/- 11.2 days). Hemoglobin and Hematocrit levels recovered promptly in rH-EPO treated group. In control group, 2 patients complained of nausea and vomiting caused by severe anemia. On the other hand, no one with rH-EPO therapy did not show any side effects and complications. Our study indicates that the administration of rH-EPO enables us to collect an adequate volume of autologous blood preoperatively in a shorter period of time.
Anemia↗
Absence of bacteremia and endotoxemia despite contaminated dialyzate.
Fevers associated with hemodialysis have been attributed to the transfer of relatively large endotoxin molecules and/or bacteria from contaminated dialyzate across the dialyzing membrane. We evaluated 27 patients during hollow-fiber dialysis when, due to a malfunction, dialysis fluids contained bacteria and endotoxin at levels previously reported to be associated with pyrogenic reactions. Neither endotoxin nor bacteria was detected in 54 venous and arterial blood specimens collected at the termination of hemodialysis. Temperature elevations did not occur during or within 1/2 hr after dialysis. In an extended study, 20 dialyzers were collected after single patient use and the dialyzate compartment was filled with highly contaminated dialyzate, while the blood compartment was filled with sterile pyrogen-free saline. Following 5 to 7 days incubation, bacteria were present in the blood compartments of 4 of 20 dialyzers, probably due to contamination during dialyzer handling. However, the much smaller endotoxin molecule could not be detected in the absence of bacterial contamination. These results indicate that the intact cellophane membrane is an effective barrier to endotoxin and bacteria under clinical conditions.
Endotoxins↗
[Quality control of homologous blood collection activities: 5 years' experience].
Quality control (QC) of blood collection activities for transfusion is a regulatory requirement. The authors report on their experience in this field over the past 5 years. In their institution, this QC is based on both the recording and analyzing of predefined data, as well as the search for an active collaboration from each person involved in these activities. QC of medical selection relies on the assessment of several associated criteria: effectiveness of the information given to blood donors for recruitment, preparation of the medical interview and encouragement to perform regular donations; frequency of donors deferred after the medical interview; frequency of biological abnormalities detected at donation; results of the inquiries into the corresponding medical interviews following adverse transfusion reactions. The quantitative and qualitative evaluation of blood collection permits assessment of the quality of the blood collection program, collection procedures and directly derived blood products. Quality assessment of facilities and equipment is also included in this QC. Results have been improving in recent years, especially regarding medical selection. In particular, an increase in the mean donation rate of donors, a decrease in biological abnormalities detected at donation and an absence of adverse transfusion reactions attributed after inquiry to an inadequate medical interview have been noticed. A decrease in both shortage and outdating of labile blood products likewise indicates an improvement of blood collection planning. However, this QC reveals deficiencies in the information given to donors and a lack of analysis of the data specific to first time donors. In order to further improve the efficiency of QC, these results now require comparison with similar data collected on a nation-wide scale.
Anemia↗
Blood cultures: principles and techniques.
Detecting the presence of microorganisms in blood is an important function of the clinical microbiology laboratory. With prompt isolation, identification, and antimicrobial susceptibility testing of bacterial isolates, the clinician can modify the selection and dosage of the antimicrobics used initially to treat a suspected septicemia. Principles and techniques for blood collection, culture, examination, and reporting are reviewed.
Anti-Bacterial Agents↗
Concentrations of cyclosporin A and its metabolites in human tissues postmortem.
We report concentrations and distribution of cyclosporine A (CsA) and individual metabolites associated with various organ tissues and whole-blood specimens collected at autopsy from seven transplant patients who received CsA therapy. Solid-phase extraction (SPE) and specific high-performance liquid chromatographic (HPLC) procedures were used to separate and quantitate the cyclosporines. Patterns of deposition were unique for the various tissue types. Metabolites M17, M1, M18, and M8 (in addition to CsA) were the principal compounds detected in significant quantities. On a per weight basis, the sum concentration of CsA and metabolites in organ tissues was up to 53 times greater than in companion whole-blood specimens. Metabolite M17 prevailed in most tissues, except in fat and pancreas, where CsA was predominant. Overall, pancreas specimens contained a greater concentration of cyclosporines (per kilogram of tissue), followed consecutively by spleen, liver, fat, kidney, lung, bone marrow, heart, and whole blood. No CsA-related compounds were detected in brain or spinal cord tissue.
Amino Acid Sequence↗
Influence of post haemodialysis sampling on Kt/V result.
The recommended Kt/V is 1.2. Unfortunately there is no written policy for nurses on the procedure for taking blood urea nitrogen samples post haemodialysis. The aim of this study was to establish the Kt/V variability of haemodialysis patients depending on the method of collection of post-haemodialysis blood urea nitrogen. Twenty-two patients were analysed. A Kt/V was performed every 15 days during a period of 2 months. It was taken five times on each patient: 30 minutes before the end of a haemodialysis session (Kt/V30), at the end of haemodialysis (Kt/V1), after slowing flows (50 ml/min) for 2 minutes (Kt/V2) and after the blood circuit had been returned to the patient at 5 and 15 minutes respectively. (Kt/V5, Kt/V15). The Kt/V results were: Kt/V1 1.23 +/- 0.2 Vs Kt/V2 1.14 +/- 0.19 (p < 0.003); Kt/V5- 1.05 +/- 0.19 (p < 0.002 Vs Kt/V2); Kt/V15 1 +/- 0.16 (p < 0.05 Vs Kt/V5); Kt/V30 1.12 +/- 0.21 (pNS Vs Kt/V2). In conclusion, there was a large variability in the Kt/V depending on the method of collection of the blood urea nitrogen sample post-haemodialysis.
Bias↗
The economics of blood: gift of life or a commodity?
OBJECTIVES: To calculate the costs of blood collection, testing, storage, and transfusion in Greece. METHODS: Costing information was collected from two large public hospitals, in Athens and Crete, that also act as blood banks. Given that private health care accounts for 40 percent of total health spending, the same costs were also considered in a private setting by collecting key reagent cost data from a leading private hospital in Athens. Mainly direct costs were considered (advertising campaigns, personnel, storage and maintenance, reagent costs, transportation costs from blood bank to end-use hospitals, and cross-matching and transfusion costs in receiving hospitals) and some indirect costs (opportunity cost of blood donorship). RESULTS: Captive donorship accounts for over 50 percent of the national blood supply. A unit of blood transfused would cost between Euro 294.83 and Euro 339.83 in public hospitals and could reach Euro 413.93 in a private facility. This figure may be an underestimate, as it excludes opportunity costs of blood transfusion for patients and the healthcare system. CONCLUSIONS: Blood has a significant cost to the health system. Policy makers and practitioners should encourage its rational use, build on current policies to further improve collection and distribution, encourage further volunteer donorship in Greece, and also consider alternatives to blood where the possibility exists.
Altruism↗
The evidence that lead increases the risk for spontaneous abortion.
BACKGROUND: Reports from a period spanning more than a century, and covering occupationally exposed women in several countries, support an increase in pregnancy loss from high maternal lead exposures. Nevertheless, most studies conducted among populations with low/moderate exposures have provided little evidence of an association with pregnancy loss, or in particular, spontaneous abortions. METHODS: A critique of these low/moderate level studies reveals small sample sizes, problems in definition or ascertainment of outcome, lack of control for confounding, and/or deficiencies in the exposure assessment. For estimating exposure, either an ecologic measure was used, or individual biologic specimens were taken but attention was not paid to the timing of measurement of lead levels in these samples. A prospective study that overcame most of the deficiencies of previous studies enrolled pregnant women in Mexico City with low-to-moderate-level lead exposures, collected blood specimens during their first trimester, and ascertained spontaneous abortions by week 20. A key design element of this study was the use of incidence-density-matched controls in order to achieve comparable opportunity for the outcome and comparable timing of exposure measurements. The latter is especially important because blood lead levels are altered by pregnancy. RESULTS: In the prospective Mexico City Study, a striking dose-response relation between blood lead and risk of spontaneous abortion was found: the odds ratio for spontaneous abortion was 1.8 (95% confidence interval = 1.1-3.1) for every 5 microg/dL increase in blood lead. CONCLUSIONS: Low-to-moderate lead exposures may increase the risk for spontaneous abortion at exposures comparable to U.S. general population levels during the 1970s and to many populations worldwide today; these are far lower than exposures encountered in some occupations. Further research is needed to confirm the association, to delineate the role of maternal vs. paternal exposures, and to assess increases in menstrual variability as an explanation for this finding.
Abortion, Spontaneous↗