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PubMed1985

Laboratory evaluation of the Coulter "three-part electronic differential".

Comparisons were made between "electronic" white blood cell (WBC) differential counts based on nuclear volume, differential counts performed by an automated image analyzer, and conventional manual counts performed by experienced technologists in a routine laboratory setting. The correlation between methods was excellent for lymphocytes (r = 0.9) and granulocytes (r = 0.9), but none of the three methods that were tested produced good results in enumeration of mononuclear cells (r = 0.6). Approximately 85% of the samples on which differentials were requested for an inpatient population could be processed by the electronic counter. Although the electronic counter failed to flag all abnormal samples (there were 6% false negatives), the performance of technologists doing 200 cell differentials was similar. Rapidly generated "electronic differentials" might be a useful and cost-effective adjunct to inpatient hospital practice if certain suggestions were implemented.

Adult↗
PubMed1989

Directed blood procurement does not benefit patients who are enrolled in an autologous blood predeposit program.

Designated or directed blood transfusion (DD) is a controversial practice; its merits are currently debated on the basis of implications for the national blood supply and on the "safety" of directed blood compared with homologous blood. An equally compelling issue for the merits of DD is whether this practice results in its putative effect: to avoid volunteer homologous blood exposure. To study this, the authors reviewed 112 consecutive patients (73 orthopedic) who predeposited autologous blood for elective surgery. This group was compared with 17 patients (all orthopedic) who predeposited autologous blood and also requested storage of designated blood. Seven of 17 patients with DD subsequently received homologous blood, compared with 11 of 112 patients without designated blood (NDD, P less than 0.01) and 3 of 35 NDD orthopedic patients asked to predonate three or more units of blood, P = 0.015. DD and NDD patients were no different when analyzed for age, sex, or units blood stored; admission, nadir, or discharge hematocrit; autologous blood transfused; days in hospital; or surgical blood loss. The authors conclude that patient requests for DD are unjustified for elective surgical patients who are eligible to donate autologous blood because DD as practiced in this setting does not avoid subsequent homologous blood exposure. Maximizing autologous blood procurement is the preferred alternative for avoiding homologous blood transfusion.

Adolescent↗
PubMed1992

Factors associated with successful autologous blood donation for elective surgery.

Not all donors can donate the number of autologous blood units requested by their physicians before surgery, and donors are more frequently unsuccessful as more units are requested. Therefore, 368 autologous blood donors who were requested to donate 4 or more units during the 6-week period before surgery at one community blood center were studied. More men were able to donate 4 units with no deferrals for anemia than were women (86% [181 of 211] compared to 42% [48 of 115], P less than 0.001). Greater success also was observed among donors with an initial hemoglobin level greater than 125 g/L (12.5 g/dL), those with higher weight, and those with more advanced age. Multiple logistic regression analysis showed that only higher initial hemoglobin levels (odds ratio, 3.3 per 10 g/L [1 g/dL] increment) and male sex (odds ratio, 2.7) were independent predictors of successful donation of 4 or more units.

Adult↗
PubMed1995

Passive inhalation of cocaine.

Six healthy male volunteers were exposed to the vapor of 100 and 200 mg freebase cocaine heated to a temperature of 200 degrees C in an unventilated room (12,600-L volume) for a period of 1 h. No pharmacological effects were detected as a result of the exposure. Blood specimens collected immediately following exposure were negative for cocaine and metabolites. Urine specimens analyzed by gas chromatography-mass spectrometry contained peak concentrations of benzoylecgonine that ranged from 22 to 123 ng/mL. The peak excretion time for benzoylecgonine following passive exposure was approximately 5 h. The amount of cocaine inhaled by the subjects during passive exposure was estimated from room air measurements of cocaine to be approximately 0.25 mg. The total amount of cocaine (cocaine plus metabolites) excreted in urine by the six subjects ranged from 0.04 to 0.21 mg. For comparison, the six subjects also received an intravenous injection of 1 mg cocaine hydrochloride. Four of six subjects screened positive (300-ng/mL cutoff concentration) following the injection, indicating that the minimum amount of cocaine in these subjects necessary to produce positive results was approximately 1 mg. A second passive inhalation study was undertaken in which specimens were collected from research staff who assisted in a series of experimental studies with "crack" (freebase cocaine) smokers. The research staff remained in close vicinity while the crack smokers smoked three doses of freebase cocaine (12.5, 25, and 50 mg) over a period of 4 h. As a result, staff members were passively exposed to sidestream smoke from crack pipes and to breath exhalation from the crack smokers. Urine specimens from the staff members contained a maximum of 6 ng/mL benzoylecgonine. Only traces (less than 1 ng/mL) of cocaine were detected in any specimen. Overall, these studies demonstrated that individuals exposed to cocaine smoke under naturalistic or artificial conditions absorbed small amounts of cocaine that were insufficient to produce positive urine specimens at standard Department of Health and Human Services cutoffs. However, passive exposure conditions that would result in absorption of cocaine in amounts exceeding 1 mg could result in the production of cocaine-positive urine specimens.

Administration, Inhalation↗
PubMedDate not supplied

Benzodiazepines: toxic serum concentrations in positive enzyme immunoassay responses.

A total of 588 blood specimens collected in an emergency unit were screened for benzodiazepines (BZDs) using enzyme-multiplied immunoassay and gas chromatography. Two-hundred eighty-five samples were positive for BZDs, and 303 samples that were negative by EMIT included 20 samples with BZDs detectable by gas-liquid chromatography. A total of 15 BZDs were identified, and the most frequently occurring were nordiazepam, bromazepam, diazepam, and alprazolam. Individual BZDs were found in 74% of cases, but some samples contained two, three, or even four BZDs. There is a risk of missing intoxication by BZDs with low therapeutic range and/or low cross-reactivity (alprazolam, bromazepam, flunitrazepam). There is a risk of misinterpreting a positive result for some BZDs with high therapeutic range and/or high cross-reactivity (nordiazepam), which may reflect a pharmacologically ineffective concentration. A semiquantitative analysis is inappropriate even when the identity of BZD is known. Immunoassays are the only methods presently available for use in emergencies, but physicians must be clearly informed of their limitations and interpret results with caution.

Alprazolam↗
PubMed1991

Assessment of the prevalence and risk factors for human immunodeficiency virus type 1 (HIV-1) infection among college students using three survey methods.

To evaluate the seroprevalence and risk factors for human immunodeficiency virus type 1 (HIV-1) infection among undergraduate college students, the authors simultaneously conducted three types of surveillance on a large university campus (27,902 undergraduates) in the Baltimore-Washington metropolitan area: a voluntary HIV-1 serosurvey with a linked risk assessment questionnaire (n = 3,394), a blinded serosurvey using blood specimens collected for routine purposes in the Student Health Center (n = 1,829), and a random sample risk assessment and case identification mail survey (n = 1,017 respondents of 3,000 solicited). The proportion of students belonging to a known risk group (a homosexual or bisexual man, intravenous drug user, or a sexual partner of a bisexual man, an HIV-1-infected person, a female prostitute, or an intravenous drug user) was 5.9% in the mail survey and 8.8% in the voluntary serosurvey. Whereas no infections were detected in the blinded serosurvey, two infected persons were identified in the mail survey (0.2%) and two in the voluntary serosurvey (0.06%), all among high-risk persons. Although derived from independent samples and subject to different biases, these three survey methods yielded a consistent pattern of HIV-1 epidemiology on this campus, whereby the overall prevalence of infection was low and confined to members of high-risk groups, despite the common occurrence of behaviors that might facilitate sexual transmission of HIV-1 among many other students.

Data Collection↗
PubMed1997

Evaluation of plasma levels of tumour necrosis factor alpha and interleukin-6 as rejection markers in a cohort of 142 heart-grafted patients followed by endomyocardial biopsy.

The rejection reaction after cell or organ transplantation has to be detected as early as possible in order to conduct optimal immunosuppressive treatment. Among the numerous events leading to rejection, cytokine production, especially of tumour necrosis factor alpha, is particularly important. Interleukin-6 and tumour necrosis factor alpha were investigated in 142 heart-grafted patients in order to define an early peripheral non-invasive marker of an acute rejection that could fit well with myocardial biopsy results. Cytokines were immunoenzymatically measured in blood specimens collected on the day of the endomyocardial biopsy. The values were compared to the grade of heart graft rejection established according to pathological criteria. Plasma interleukin-6 and especially tumour necrosis factor alpha determined on the day of the rejection diagnosis were significantly increased in the patient sample with moderate or severe rejection when compared with mean values of interleukin-6 and tumour necrosis factor alpha in the patient sample without rejection or with mild rejection (P = 0.04 and 0.001 respectively). Because high levels of tumour necrosis factor alpha may appear before histological signs, this biological marker could be useful in the follow-up of heart-grafted patients.

Adolescent↗
PubMed2001

The prevalence of hepatitis B, hepatitis C and human immune deficiency virus markers in multi-transfused patients.

All patients presenting with hereditary hemolytic anemia, (n = 143) over a period of 18 months were enrolled in a study to evaluate the prevalence of hepatitis B, hepatitis C and HIV in multi-transfused patients in Jordan, and to identify possible related risk factors. All patients were treated in the Thalassemia Unit at Princess Rahma Teaching Hospital. Relevant clinical data were collected. Blood specimens were taken from these patients and tested for HbsAg, HbsAb, hepatitis core IgMAb, hepatitis core IgGAb, HCVAb, and ELISA for HIV. Fifty-eight (40.5 per cent) of the specimens were HCVAb positive, while only five (3.5 per cent) of them were positive for HBsAg. None of the specimens were positive for HIV. The frequency of blood transfusion and the time of diagnosis before or after 1995, were investigated as possible risk factors for viral seropositivity. Only the time of diagnosis was a statistically significant risk factor for HCVAb positivity (OR = 4.49; p = 0.005). In conclusion, hepatitis C acquisition is a serious risk for multi-transfused patients in Jordan. Hepatitis B is relatively less common. Blood screening initiated after 1995 in Jordan has significantly reduced the risk of hepatitis C associated with blood transfusion.

Adolescent↗
PubMed1975

Filtration characteristics of three new in-line blood transfusion filters.

Three types of microemboli filters were examined with the scanning electron microscope. The single layer 40 mu pore filter traps aggregates in the pores. The aggregates are extruded and pass on with the blood and can be demonstrated in a Dacron wool filter downstream. The polyurethane foam filter is an in depth multiple pore filter of variable pore size. This filter allows many aggregates to escape through the pores in the beginning of a transfusion and these aggregates were seen in a Dacron wool filter downstream. As aggregates become trapped, the pore sizes decrease, filtration improves, and flow through the filter becomes reduced. The Dacron wool filter absorbs the particulate material to the fibers of wool. This filter has a large capacity and was not observed to leak aggregates even when subjected to high filtration pressures.

Animals↗
PubMed1983

Intraoperative autotransfusion. Experience in 725 consecutive cases.

Autologous intraoperative transfusion employing the Haemonetics Cell Saver is reported in 725 patients from a general hospital population, of which 75% were cardiovascular patients. The remaining cases included various orthopedic procedures, splenectomy, craniotomy, ectopic pregnancies, Caesarian sections, and exploratory laparotomy. On occasion, this method was utilized in trauma and in pediatric surgery. The product of washed red blood cells gave an average yield of 573 cc per case with an average hematocrit of 55 cc/dl available for autologous infusion. In 100 consecutive open heart procedures operated prior to the Cell Saver period, an average of 1.97 units of bank blood was utilized during operation, as compared with 0.75 units in 100 consecutive cases studied employing the Cell Saver (p less than 0.0001). Homologous blood utilization during cardiac surgery declined more than 50% with the use of the Cell Saver. Quality control was monitored scrupulously and included special precautions against air embolism, abnormal coagulation, and sepsis. The overall mortality rate was 2.8%, and in no instance was mortality or morbidity ascribable to the autologous transfusion. Numerous advantages offered by autotransfusion include prevention of sensitization of the recipient to various antigens in donor erythrocytes, leucocytes, platelets, and plasma, and avoidance of transfusion-transmitted diseases, especially viral hepatitis. Additionally, autologous blood, the only perfectly compatible product, provided immediate availability while conserving blood bank resources. In circumstances in which the intraoperative blood loss exceeded 1000 cc in the adult, its use was observed to be cost-effective. In the present study, autotransfusion proved safe, efficient, and in some instances life saving.

Blood Specimen Collection↗
PubMed1994

HIV-1 seroprevalence in chest clinic and hospital tuberculosis patients in New York City, 1989-1991.

OBJECTIVE: To describe more fully HIV-1 and tuberculosis (TB) coinfection in TB patients attending New York City Department of Health chest clinics (1989-1991) and one inner-city hospital (1990-1991). DESIGN: An unlinked serosurvey using HIV-1-antibody testing of remnant blood specimens collected for routine medical purposes. SUBJECTS: A total of 1414 clinic and 856 hospital patients. OUTCOME MEASURES: HIV seropositivity and TB infection/disease. RESULTS: A total of 327 (23%) of the clinic patients were HIV-1-positive, with a significantly higher seroprevalence in men (29 versus 15%, P < 0.001) and in young and middle-aged adults aged 30-50 years (P < 0.001). HIV-1 prevalence by TB diagnostic class was: class 2 (purified protein derivative-positive and chest radiograph-negative), 11% (64 out of 570); class 3 (active disease), 34% (197 out of 582); class IV (old/inactive disease), 30% (39 out of 130). Of the hospital patients 487 (57%) were HIV-1-positive. HIV-1 seroprevalence was 55% for those who were identified or believed to be HIV-1-negative on admission as indicated on the medical chart. HIV-1 seroprevalence in the clinic population decreased initially, but later increased, although not to study onset levels. CONCLUSIONS: There is considerable overlap between the TB and HIV epidemics in New York City; a part of the increasing TB incidence may be independent of HIV coinfection. The control of TB will necessitate prompt diagnosis of TB and HIV-1, appropriate TB treatment and/or chemoprophylaxis, and a greater commitment to tackle the social conditions associated with the spread of the disease.

Adolescent↗
PubMed2002

Ethnic disparity in HIV prevalence and zidovudine treatment among childbearing women and pediatric AIDS cases in California.

OBJECTIVE: To compare, by ethnicity, the prevalence of HIV and zidovudine treatment among a cross-sectional survey of childbearing women in California in 1998, and the number of pediatric AIDS cases from 1998 to 2001. METHODS: Blood specimens, collected via infant heel-stick for metabolic screening during the third quarter of 1998, were anonymously tested for HIV antibody. Positive specimens were subsequently tested for evidence of zidovudine therapy. Pediatric AIDS cases with diagnosis dates from 1998 to 2001 were obtained from the AIDS case registry. RESULTS: Of the 119 108 specimens tested, 77 (0.65 per 1000) were HIV-antibody positive. Most (37.7%) of the 77 HIV-positive specimens were from newborns of African-American mothers, followed closely by Latina mothers (35.1%). The absence of zidovudine therapy was highest for Latina and African-American women, 29.6 and 24.1%, respectively. Latino and African-American children accounted for the majority of California pediatric AIDS cases diagnosed between 1998 and 2001. CONCLUSION: Innovative approaches are needed to increase the rate of zidovudine therapy among African-American and Latina HIV-infected childbearing women. These could include a shorter-course zidovudine regimen or rapid HIV testing and counselling of women in late-term pregnancy.

Adult↗