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PubMedDate not supplied

Chemical and hematological changes in stored CPD blood.

Blood was drawn from ten healthy volunteer donors into citrate-phosphate-dextrose (CPD) anticoagulant and placed on the quarantine shelf of the blood bank refrigerator. Plasma dextrose, sodium, potassium, chloride, bicarbonate, GOT, LDH, and hemoglobin as well as WBC, hematocrit, MCV, MCHC, whole blood pH, and ammonia were measured on all samples initially and at one, two, seven, 14, 21, and 28 days of storage at 4 C. Whole blood lactate also was analyzed serially on five of the units. An additional 27 units of CPD bank blood (two to 21 days of age), routinely processed, handled, and stored by the blood bank, were submitted to the same analyses on the day of administration to the patient. Five of these processed units, 21 days old, were resampled at 28 days. Results of the analyses are presented and discussed. The most pronounced changes were seen for dextrose, potassium, bicarbonate, lactate, LDH, ammonia, and hemoglobin. Plasma dextrose and bicarbonate declined in concentration while potassium, lactate, LDH, ammonia, and hemoglobin rose with storage. In general, changes in the regularly processed, singly sampled bank units were greater than those observed in the specially processed, quarantined units sampled serially. This study indicates that routine transportation, processing, and handling of bank blood may lead to increased biochemical alteration.

Ammonia↗
PubMedDate not supplied

Compatibility of common intravenous solutions with CPD blood.

Blood anticoagulated with CPD was mixed with lactated Ringer's solution, 5 per cent aqueous dextrose, 5 per cent dextrose in 0.225 per cent saline, 5 per cent dextrose in 0.9 per cent saline, and 0.9 per cent saline solution in varying concentrations and incubated at room temperature and 37 C. Clots formed in the blood-lactated Ringer's mixture after five minutes at a citrate:calcium molar ratio of 4:1 or lower. Aqueous dextrose-blood mixtures showed immediate clumping with gross hemolysis after 30 minutes incubation. Blood mixed with 5 per cent dextrose and 0.225 per cent saline hemolyzed within ten minutes incubation at 37 C. No hemolysis occurred in blood mixed with 5 per cent dextrose in 0.9 per cent saline or with 0.9 per cent saline. Traces of solutions labeled with Evans blue dye remained in intravenous administration tubing even 30 minutes after a simulated transfusion was begun. Lactated Ringer's solution and 5 per cent dextrose in 0.225 per cent saline should not be administered concurrently with blood. Lactated Ringer's solution may also be harmful when used to start transfusions as it rapidly produces clots when mixed with CPD blood.

Anticoagulants↗
PubMedDate not supplied

Adenine metabolism during and after exchange transfusions in newborn infants with CPD-adenine blood.

CPD-adenine blood (adenine in a final concentration of 0.25 mmol/1) was used in exchange transfusions in four newborn infants. The amount of adenine in one exchange transfusion ranged from 27 to 29 mumol per kg bodyweight. The maximum P-adenine concentration during the exchange transfusions ranged from 4 to 8 mumol/1 but decreased to pretransfusion levels 20 minutes after the exchange transfusions. During a 24-hour period following the exchange transfusions, the total urine excretion of adenine and 2,8-dihydroxyadenine corresponded to 0.5 to 1.3 per cent of the given adenine dose calculated on a molar basis. Accumulated data indicate that CPD-adenine blood can be used even in repeated exchange transfusions in newborn infants.

Adenine↗
PubMedDate not supplied

Additional studies concerning the metabolism of packed erythrocytes in CPD adenine.

Studies concerning the relationship between glucose level, hematocrit to which cells were packed (within three hours of initial collection) and adenosine triphosphate (ATP) concentration were undertaken in CPD supplemented with adenine (0.25 mM final concentration). It was found that apparently adequate ATP levels could be maintained in 90 per cent hematocrit packed units at 42 days only if glucose was present in amounts 1.5 times or greater than that provided by CPD. Less tight packing of the units to 70 and 80 per cent hematocrit maintained ATP at greater than 50 per cent of the initial level for a full 42 days of storage when 1.25 times the usual glucose concentration was present in the initial anticoagulant. No difference in 2,3-diphosphoglycerate or pH was found in any of the modified media under study.

Adenine↗
PubMedDate not supplied

Changes in agglomeration of human red blood cells in liquid storage in CPD media.

A procedure which may distinguish between old and new CPD blood units in liquid state is described. It is based on the observation of increased tendency to reversible agglomeration in old erythrocytes in liquid preservation. Erythrocytes clump together when they are mixed with low ionic strength solutions in pH range of 5.2 to 6.5. We found that liquid-stored erythrocytes show an augmented tendency to agglomerate in 0.24M sucrose, pH 7.2. The tendency increases with storage so that in the fourth week, more than 70% of the units show agglomeration under these conditions. The addition of minute amounts of sodium chloride may prevent agglomeration. As the cells age, higher salt concentration is required to prevent agglomeration. A short incubation of washed cells with adenosine may reverse the tendency of outdated erythrocytes to agglomerate, concomitantly with reestablishment of initial ATP level. However, depletion of the ATP of fresh cells with fluoride does not induce agglomeration. A 20 hour incubation of units at 37 C with CPD revealed an increased sensitivity of older units, with low ATP and positive agglomeration. This test may help in distinguishing between outdated and younger units in the blood bank.

Adenosine↗
PubMedDate not supplied

Hemoglobin function in stored blood. XIX. Inosine maintenance of 2,3-DPG for 35 days in a CPD-adenine preservative.

This study establishes that 10 mM inosine is a sufficient additive to maintain 2,3-DPG levels in blood for five weeks of storage in CPD-adenine. No previous experiments were done with CPD-adenine (0.25 mM) using a design which would give statistical proof of the optimal concentration of inosine needed for maintenance of normal hemoglobin function (2,3-DPG) for five weeks of blood bank storage.

Adenine↗
PubMedDate not supplied

Viability and function of platelet concentrates stored in CPD-adenine (CPDA-1).

The effective use of CPDA-1 as an anticoagulant in routine blood banking practice requires demonstration that platelet concentrates prepared in this solution meet both in vitro quality control standards and maintain posttransfusion viability and function after storage. In this study of 138 units of CPDA-1 platelet concentrates, the average platelet count was 8.0 +/- 0.2 x 10(10) with 81 per cent of the units having greater than 5.5 x 10(10) platelets. The mean poststorage pH was 6.68 +/- 0.03 and only four of the units had a pH of less than 6.0 (3%). Residual plasma volume averaged 75 +/- 1 ml. Platelet viability was determined in 16 normal volunteers by measuring survival of 51Cr-labeled autologous platelets after storage for 72 hours at 22 +/- 2 C. Platelet recovery averaged 50 +/- 4 per cent, while survival was 7.3 +/- 0.4 days for the 15 units with a pH above 6.0. Measurements of posttransfusion platelet viability and function were made in 12 paients with thrombocytopenia secondary to marrow failure. Their mean pretransfusion platelet count was 17,000 +/- 2,000/microliter, and their standardized template bleeding times were all greater than 30 minutes. Platelet recovery averaged 44 +/- 5 per cent and survival 3.3 +/- 0.5 days. In seven of the patients with the best posttransfusion increments, bleeding time was improved. Five patients with poor posttranfusion platelet increments showed no improvement in bleeding time with CPDA-1; two of these patients were also transfused with CPD platelets and had no response. Our studies indicate that platelet concentrates prepared in CPDA-1 meet in vitro quality control standards and after transfusion, maintain viability and function comparable to that of CPD collected platelets.

Adenine↗
PubMed1980

Continuous peritoneal dialysis (CPD)--an alternative to hemodialysis in acute renal failure after cardiovascular operations.

In our experience hemodialysis proved to be unsatisfactory in the treatment of acute renal failure after cardiovascular surgical intervention because of its negative influence on the often critical hemodynamic situation of the patients. In 21 cases we performed a continuous peritoneal dialysis (CPD) for 1 to 29 (mean 9.2) days by using a Tenckhoff catheter (16). Treatment was started when anuria occurred or when serum nonprotein nitrogen increased. Satisfactory volume equilibration was established by this treatment. A pathological increase of serum electrolytes could be prevented; serum potassium, in particular, did not exceed 5.6 mVal/l. No dysfunctions in acid-base balance occurred. The serum levels of nonprotein nitrogen decreased: Serum carbamid was diminished from 229 +/- 14 mg% to 160 +/- 10 mg% and serum creatinine from 7.7 +/- 0.6 mg% to 6.0 +/- 0.8 mg% (p < 0.05). Disturbances of hemodynamic and respiratory functions could be avoided by CPD. Peritoneal reactions were noted in 5 cases. In our opinion continuous peritoneal dialysis seems to be a suitable alternative to hemodialysis in the treatment of acute renal failure after open heart surgery.

Acute Kidney Injury↗
PubMed1985

Problems related to CPD preserved blood used for NEQAS trials in haematology.

A study of the results of the Belgian National External Quality Assessment Scheme (NEQAS) in haematology, revealed marked differences in MCV values obtained with instruments of different types. For this reason the citrate-phosphate-dextrose (CPD) preserved blood used as NEQAS material was analysed daily with a Coulter S-Plus IV and with a cross-calibrated Ortho ELT-800. The observed differences in MCV are apparently due to differences in measuring apparatus and also to the changing characteristics of the erythrocytes. Ageing of CPD blood during 1 to 4 days (postal delivery) influenced markedly the MCV as measured with the Ortho ELT systems. These time- and instrument-related factors influence the measurements, they interfere with the statistical evaluation of NEQAS results and can lead to errors in the evaluation of individual performers.

Blood Glucose↗
PubMed2006

How to make the RCPCH CPD guidelines work for you.

Continuing professional development (CPD) is defined as a systematic process of lifelong learning and professional development. Its aim is to enable career grade doctors (consultants, associate specialists, staff grades, and their equivalents) to maintain and enhance their knowledge, skills, and competence for effective clinical practice to meet the needs of children. This article is designed to assist and improve acquisition of CPD.

Clinical Competence↗
PubMed1980

The pH and titratable acidity of stored CPD blood.

Blood stored in citrate-phosphate-dextrose (CPD) solution for periods up to 20 days had a mean pH 6.71. The mean metabolic hydrogen ion excess was 32 mmol/litre and the mean respiratory hydrogen ion excess was 80 mmol/litre. These results for CPD blood are compared with those obtained on acid-citrate-dextrose blood. A prediction is made that clnically, only small variations in metabolic and respiratory acid-base balance would be produced directly due to the acid and base loads in transfused blood.

Acid-Base Equilibrium↗
PubMed1997

Inhibitory effects in the detection of 1 cpd jo targets superimposed to angular frequency stimuli or sinewave gratings.

Independence among channels processing different aspects of spatial information, including orthogonal stimuli, has been generally assumed in the literature. We tested independence between the processing of jo targets and the processing of either vertical sinusoidal gratings or angular frequency stimuli with suprathreshold summation. We found the detection of a jo target at 1 cpd to be affected in an inhibitory fashion by either background angular frequencies in the range of 3-96 cycles or sinewave gratings in the range of 0.8-3.0 cpd. These results demonstrate interactions both among orthogonal stimuli and among channels processing vertical sinewave gratings and jo target stimuli. Our discussion focuses on the hypothesis of frequency decomposition in polar coordinates.

Contrast Sensitivity↗
PubMed1998

Adequacy of CPD: comparing Kt/V and creatinine clearance.

Presently, adequate dialysis in continuous peritoneal dialysis (CPD) patients is assessed by monitoring urea kinetics (Kt/V) or by measuring the total creatinine clearance (CC). Target Dialysis Outcome Quality Initiative (DOQI) goals are a weekly Kt/V of at least 2.0, and a CC of at least 60 L/wk per 1.73 m2. One hundred and four CPD patients in the New Haven continuous ambulatory peritoneal dialysis (CAPD) unit had their most recent Kt/V and CC reviewed. Of these patients, 58.7% attained the DOQI goals for Kt/V and CC, 14.4% had an acceptable Kt/V but low CC, 11.5% had an acceptable CC but low Kt/V, and 15.4% had both low Kt/V and low CC. A CC > 60 L/week per 1.73 m2 was associated with a residual renal function of > 25 L/wk per 1.73 m2. For a Kt/V of > 2.0, good residual renal function was helpful but not essential. A question left unanswered is whether patients with a low Kt/V and an adequate CC or low CC and acceptable Kt/V need more dialysis.

Creatinine↗
PubMed2001

Lifelong learning, CPD and you.

The essence of clinical governance is continuing professional development (CPD) for all professional staff. A system is now in place to disseminate and support CPD throughout the NHS, from national to local level.

Education, Nursing, Continuing↗
PubMedDate not supplied

Increasing the dialysis volume and frequency in a fixed period of time in CPD patients: the effect on Kpt/V and creatinine clearance.

BACKGROUND: The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) has evidence- and opinion-based recommendations for weekly Kt/V(urea) and weekly total creatinine clearance (CC) in chronic peritoneal dialysis (CPD) patients. Using standard continuous ambulatory peritoneal dialysis technique, it is often difficult to achieve the suggested targets in anuric patients with large body mass. Thus, the use of automated peritoneal dialysis (APD) has been increasingly utilized to achieve adequate clearances. Automated dialysis is usually performed at night over an 8- to 10-hour period. The role of increases in dialysate volume and frequency of exchanges during this time period to achieve these target K/DOQI recommendations remains uncertain. We decided to study the effects of increasing the volume and number of exchanges in a fixed period of time in CPD patients. METHODS: In the New Haven CAPD unit, 29 patients maintained on APD were considered eligible for the study and 11 agreed to participate. The patients were characterized according to standard peritoneal equilibration test criteria. The patients were placed into two groups: group 1 included high (H) and high-average (HA), and group 2 low-average (LA) transporters. The patients were dialyzed at night for 9 hours with standard cycling technique, using 2.5% Dianeal (Baxter Healthcare, Deerfield, Illinois, USA) solution, with a cycle volume of 2,500 mL, and a 2,000-mL daytime dwell. Three studies were done on each patient using a total dialysis volume of 9.5 L (3 cycles), 14.5 L (5 cycles), and 19.5 L (7 cycles). Daily Kpt/V(urea) and daily CCp (peritoneal) (L/day/1.73 m2) were obtained. RESULTS: Six patients were H or HA (group 1) and 5 were LA transporters (group 2). For the group 1 patients, mean weight was 86.6 +/- 13.5 kg; Kpt/V(urea) was 1.68 +/- 0.21 using 9.5 L, 2.03 +/- 0.28 for 14.5 L (p < 0.05 compared to 10 L), and 2.28 +/- 0.28 with 19.5 L (p < 0.05 compared to 10 L and 15 L); mean weekly CCp was 45.43 +/- 7.63 L/1.73 m2 for 9.5 L (p < 0.05 compared to 14.5 L and 19.5 L), 51.17 +/- 7.07 with 14.5 L, and 54.67 +/- 10.08 for 19.5 L; ultrafiltration rates were not different in the three studies. For the group 2 patients, mean weight was 74.3 +/- 17.7 kg; mean weekly Kpt/V(urea) was 1.68 +/- 0.35 using 9.5 L, 2.10 +/- 0.42 for 14.5 L (p < 0.05 compared to 9.5 L), and 2.31 +/- 0.56 for 19.5 L (p < 0.05 compared to 9.5 L and 14.5 L); mean weekly CCp was 42.56 +/- 10.64 L/1.73 m2 for 9.5 L (p < 0.05 compared to 14.5 L and 19.5 L), 50.89 +/- 12.66 for 14.5 L, and 51.94 +/- 11.20 for 19.5 L; ultrafiltration was lower in the 9.5-L study than in the 14.5-L and 19.5-L studies, but was not different in the 14.5-L and 19.5-L studies. CONCLUSIONS: In both H/HA and LA transporters, Kpt/V(urea) and CCp rise significantly when the frequency of exchanges and total volume of dialysate are increased. Thus, the use of larger volumes of dialysate with cycling peritoneal dialysis may result in increased clearances of urea and creatinine.

Adolescent↗
PubMed2003

Lifelong learning in medical education: from CME to CPD.

Lifelong learning is a concept taken up by governments and educational institutions worldwide to acknowledge the need for continuous learning irrespective of the profession. In the context of medicine, lifelong learning has always been formally considered an ethical obligation of doctors although the term Continuing Medical Education (CME) is more commonly used than Continuous Professional Development (CPD). This article traces the history of continuous professional development from early years through current programs introduced worldwide.

Certification↗
PubMed1998

Chromosomal localization of the genes for human carboxypeptidase D (CPD) and the active 50-kilodalton subunit of human carboxypeptidase N (CPN1).

Human carboxypeptidase N is a 280-kDa tetrameric enzyme consisting of two 83-kDa regulatory subunits and two catalytic 50-kDa subunits. The 83-kDa subunit is a member of the leucine-rich repeat family of proteins and has been localized to chromosome 8p22-p23. The 50-kDa subunit is a member of the regulatory B-type carboxypeptidase family, which includes carboxypeptidases M, E/H, AEBP1, and a newly described member, carboxypeptidase D, which has three tandem active site domains. The human genes for carboxypeptidase D (HGMW-approved symbol CPD) and the 50-kDa subunit of carboxypeptidase N (HGMW-approved symbol CPN1) were localized to chromosomes 17 and 10, respectively, using the polymerase chain reaction with gene-specific primers and DNAs derived from somatic cell hybrids. The carboxypeptidase D gene was further localized to the centromeric region 17p11.1-q11.1/11.2 by use of a regional mapping panel derived from somatic cell hybrids containing different portions of chromosome 17.

Carboxypeptidases↗
PubMed1979

Erythrocyte agglomeration and survival studies in citrate-phosphate-dextrose (CPD) units.

We have previously reported increased tendency to agglomeration in CPD-stored erythrocytes. In the present study we investigated the deterioration pattern of fresh units, as detected by agglomeration, free hemoglobin levels, ATP levels, osmotic fragility, and certain enzymatic activities. When the negative test was converted to a positive one, the 24-h survival values of these units were determined by autotransfusion. A positive agglomeration occurred while viability was still above 70%. Fresh units had high ATP levels and negative agglomeration while old units had low ATP levels and positive agglomeration. However, in intermediate-storage units, no definite correlation between ATP and agglomeration was found. Agglomeration seems to reflect the degree of changes in stored erythrocytes. However, further studies are needed before this test may serve for prediction of post-transfusion viability.

Adenosine Triphosphate↗