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  • 1
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    Blood utilization and mortality in victims of gun violence
    Wiley ; 2018
    In:  Transfusion Vol. 58, No. 10 ( 2018-10), p. 2326-2334
    Details
    In: Transfusion, Wiley, Vol. 58, No. 10 ( 2018-10), p. 2326-2334
    Abstract: Blood transfusion can be lifesaving for patients with hemorrhage; however, transfusion requirements for victims of gun violence are poorly understood. STUDY DESIGN AND METHODS In an urban, Level 1 trauma center, 23,422 trauma patients were analyzed in a retrospective cohort study. Patients with gunshot wounds (GSWs) (n = 2,672; 11.4% of trauma patients) were compared to those with non‐GSW traumatic injuries from 2005 to 2017, to assess blood utilization. RESULTS The GSW cohort was approximately five times more likely to require transfusion (538 of 2672 [20.1%] vs. 798 of 20,750 [3.9%] ; p 〈 0.0001), and the number of blood component units transfused per patient was approximately 10 times greater (3.3 ± 13.5 vs. 0.31 ± 3.8 units/patient; p 〈 0.0001), compared to the non‐GSW cohort. The risk‐adjusted likelihood of requiring high‐dose transfusion was greater in the GSW cohort (odds ratio, 2.38; 95% confidence interval, 1.14‐5.80), and requirements were increased for all four blood components (red blood cells, platelets, plasma, and cryoprecipitate). Patients with GSWs had approximately 14 times greater overall mortality (653 of 2672 [24.4%] vs. 352 of 20,750 [1.7%] ; p 〈 0.0001]. Compared to non‐GSW penetrating injuries (e.g., stab wounds), those with GSWs had approximately four times higher transfusion requirements (3.3 ± 13.5 vs. 0.80 ± 3.8 units/patient; p 〈 0.0001), and approximately eight times greater overall mortality (653 of 2672 [24.4%] vs. 28 of 956 [2.9%] ; p 〈 0.0001). CONCLUSIONS Compared to other traumatic injuries, GSW injuries are associated with substantially greater blood utilization and mortality. Trauma centers treating GSW injuries should have ready access to all blood components and ability to implement massive transfusions.
    Type of Medium: Online Resource
    ISSN: 0041-1132 , 1537-2995
    URL: Issue
    URL: Article
    DOI: 10.1111/trf.2018.58.issue-10
    DOI: 10.1111/trf.14925
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 208417-X
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  • 2
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    Operational Recommendations for Scarce Resource Allocation in a Public Health Crisis
    Elsevier BV ; 2021
    In:  Chest Vol. 159, No. 3 ( 2021-03), p. 1076-1083
    Details
    In: Chest, Elsevier BV, Vol. 159, No. 3 ( 2021-03), p. 1076-1083
    Type of Medium: Online Resource
    ISSN: 0012-3692
    URL: Article
    DOI: 10.1016/j.chest.2020.09.246
    RVK:
    XA 36340
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 1032552-9
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  • 3
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    Association of blood donation with iron deficiency among adolescent and adult females in the United States: a nationally representative study
    Wiley ; 2019
    In:  Transfusion Vol. 59, No. 5 ( 2019-05), p. 1723-1733
    Details
    In: Transfusion, Wiley, Vol. 59, No. 5 ( 2019-05), p. 1723-1733
    Abstract: Blood donation results in a loss of iron stores, which is particularly concerning for young female blood donors. This study examines the association of blood donation and iron deficiency among adolescent and adult females in the United States. STUDY DESIGN AND METHODS A cross‐sectional analysis was performed using data from the 1999–2010 National Health and Nutrition Examination Survey (NHANES). Females who reported their blood donation history in the preceding year and had serum ferritin (SF) measurements were included. Analyses were weighted and stratified by adolescents (16–19 years; n = 2419) and adults (20–49 years; n = 7228). Adjusted prevalence ratios (aPRs) were estimated by multivariable Poisson regression. Standard errors were estimated by Taylor series linearization. RESULTS Geometric mean SF levels (ng/mL) were lower in blood donors compared to nondonors among adolescents (21.2 vs. 31.4; p  〈  0.001) and among adults (26.2 vs. 43.7; p  〈  0.001). The prevalence of absent iron stores (SF  〈  12 ng/mL) was higher in blood donors compared to nondonors among adolescents (22.6% vs. 12.2%; aPR = 2.03 [95% confidence interval (CI) = 1.45–2.85]) and among adults (18.3% vs. 9.8%; aPR = 2.06 [95% CI = 1.48–2.88] ). Additionally, the prevalence of iron deficiency anemia (SF  〈  26 ng/mL and hemoglobin 〈 12.0 g/dL) was also higher in blood donors compared to nondonors among adolescents (9.5% vs. 6.1%; aPR = 2.10 [95% CI = 1.13–3.90]) and among adults (7.9% vs. 6.1%; aPR = 1.74 [95% CI = 1.06–2.85] ). Similar results were observed in a sensitivity analysis restricted to adolescents aged 16 to 18 years. CONCLUSIONS Blood donation is associated with iron deficiency among adolescent and adult females in the United States. These national data call for further development and implementation of blood donation practices aimed toward mitigating iron deficiency.
    Type of Medium: Online Resource
    ISSN: 0041-1132 , 1537-2995
    URL: Issue
    URL: Article
    DOI: 10.1111/trf.2019.59.issue-5
    DOI: 10.1111/trf.15179
    Language: English
    Publisher: Wiley
    Publication Date: 2019
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    detail.hit.zdb_id: 2018415-3
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  • 4
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    Bacterial contamination of blood products in Africa
    Wiley ; 2021
    In:  Transfusion Vol. 61, No. 3 ( 2021-03), p. 767-780
    Details
    In: Transfusion, Wiley, Vol. 61, No. 3 ( 2021-03), p. 767-780
    Abstract: Bacterial contamination of blood components (notably platelets) remains a leading infectious risk to the blood supply. There has been extensive research in high‐income countries to characterize the risk of bacterial contamination along with adoption of strategies to mitigate that risk. By contrast, related data in Africa are lacking. Study Design and Methods An electronic survey was distributed to members of African Society of Blood Transfusion to assess existing or planned measures at African blood centers and hospitals to mitigate bacterial contamination of blood products. A literature review of studies pertaining to related transfusion‐associated risk in Africa was conducted to complement the findings. Results Forty‐five responses were received, representing 16 African countries. All respondents were urban, either in blood centers (n = 36) or hospital‐based transfusion services (n = 9). Reported measures included skin disinfection (n = 41 [91.1%]); diversion pouches (n = 14 [31.1%] ); bacterial culture (n = 9 [20%]); pathogen reduction (PR) (n = 3 [6.7%] ); and point‐of‐release testing (PoRT) (n = 2 [4.4%]). Measures being considered for implementation included: skin disinfection (n = 2 [4.4%] ); diversion pouches (n = 2 [4.4%]); bacterial culture n = 14 (31.1%); PR (n = 11 [24.4%] ); and PoRT (n = 4 [8.9%]). Of the 38 respondents who reported collection of platel ets, 14 (36.8%) and 8 (21.1%) reported using diversion pouches and bacterial culture, respectively. The literature review identified 36 studies on the epidemiology of bacterial contamination and septic transfusion reactions in Africa; rates of contamination ranged from 0% to 17.9%. Conclusions The findings suggest that prevention of bacterial contamination of blood components and transfusion‐associated sepsis in Africa remains neglected. Regional preventive measures have not been widely adopted.
    Type of Medium: Online Resource
    ISSN: 0041-1132 , 1537-2995
    URL: Issue
    URL: Article
    DOI: 10.1111/trf.v61.3
    DOI: 10.1111/trf.16262
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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    detail.hit.zdb_id: 2018415-3
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  • 5
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    Secondary bacterial culture of platelets to mitigate transfusion‐associated sepsis: A 3‐year analysis at a large academic institution
    Wiley ; 2020
    In:  Transfusion Vol. 60, No. 9 ( 2020-09), p. 2021-2028
    Details
    In: Transfusion, Wiley, Vol. 60, No. 9 ( 2020-09), p. 2021-2028
    Abstract: In 2019, the United States Food and Drug Administration published its final recommendations to mitigate bacterial contamination of platelets. We sought to evaluate our secondary bacterial culture (SBC) strategy in light of those recommendations. Study Design and Methods A retrospective analysis was conducted of SBC data (October 2016‐2019) at our institution. SBC was performed upon receipt (Day 3 after collection); 5 mL of platelet product was inoculated aseptically into an aerobic bottle and incubated at 35°C for 3 days. For 8 months, a 10‐mL inoculum was trialed. No quarantine was applied. All positive cultures underwent Gram staining and repeat culture of the platelet product (if available). A probable true positive was defined as concordant positive culture between the initial and repeat culture. The incidence of probable true‐ and false‐positive cultures were reported descriptively and differences evaluated by sampling volume. Results Over 3 years, 55 896 platelet products underwent SBC, yielding 30 initial positive results (approx. 1/1863 platelets); 25 (83.3%) signaled within 24 hours of SBC. The rates of probable true positive, false positive, and indeterminate for 5 mL were 0.027% (1/3771), 0.002% (1/45 251) and 0.018% (1/5656), respectively. The respective rates for 10 mL were 0.018% (1/5323), 0.07% (1/1521), and 0%. Seven of eight (87.5%) false‐positive SBCs occurred with a 10‐mL inoculum. No septic transfusion reactions were reported. Conclusion SBC continues to interdict bacterially contaminated units of platelets. Our findings suggest higher rates of false positivity using large‐volume inocula.
    Type of Medium: Online Resource
    ISSN: 0041-1132 , 1537-2995
    URL: Issue
    URL: Article
    DOI: 10.1111/trf.v60.9
    DOI: 10.1111/trf.15978
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 208417-X
    detail.hit.zdb_id: 2018415-3
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  • 6
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    Hemostatic profile and safety of pooled cryoprecipitate up to 120 hours after thawing
    Wiley ; 2018
    In:  Transfusion Vol. 58, No. 5 ( 2018-05), p. 1126-1131
    Details
    In: Transfusion, Wiley, Vol. 58, No. 5 ( 2018-05), p. 1126-1131
    Abstract: AABB standards state that cryoprecipitate should be transfused within 4 to 6 hours after thawing. We evaluated coagulation factor levels and sterility of thawed pooled cryoprecipitate to assess whether shelf life can be safely extended. STUDY DESIGN AND METHODS Donor cryoprecipitate pools (n = 20, 10 group A, 10 group O) were held at ambient temperature and sampled at 0, 4, 8, 24, 48, 72, 96, and 120 hours post‐thawing for fibrinogen, Factor (F)VIII, and von Willebrand factor (vWF) levels. Samples were tested at 0 and 120 hours for sterility (BacT/Alert system). Sixty additional cryoprecipitate pools were evaluated after 72 hours. Longitudinal differences in component levels were determined by linear fixed‐effects regression. RESULTS Group O cryoprecipitate had significantly lower FVIII (p = 0.002) and vWF activity (p = 0.006) compared to group A at 0 hours, but were not statistically different in fibrinogen levels (p = 0.33). Fibrinogen levels were stable over 5 days: 501 ± 81 mg/unit (mean ± standard deviation) at 0 hours to 506 ± 102 mg/unit at 120 hours (p = 0.73). Similarly, there was no decline in vWF activity: 200 ± 53 IU/unit at 0 hours to 209 ± 57 IU/unit at 120 hours (p = 0.084). The FVIII activity significantly declined on average by 9.6 IU (95% confidence interval, 5.5‐13.8) between 0 hours (111 ± 33 IU/unit) and 120 hours post‐thaw (101 ± 33) (p  〈  0.001). No organisms were detected when cryoprecipitate pools were cultured at 0 hours, but at 120 hours Staphylococcus epidermidis was identified from one pool, potentially a contaminant introduced during repeated sampling. No cultures were positive among the 60 additional cryoprecipitate pools assessed at 72 hours. CONCLUSION Extended cryoprecipitate storage at ambient temperature did not affect fibrinogen levels over 120 hours. Sterility of products held at ambient temperature for an extended period of time could be assessed by secondary culture.
    Type of Medium: Online Resource
    ISSN: 0041-1132 , 1537-2995
    URL: Issue
    URL: Article
    DOI: 10.1111/trf.2018.58.issue-5
    DOI: 10.1111/trf.14550
    Language: English
    Publisher: Wiley
    Publication Date: 2018
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  • 7
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    Complex regional pain syndrome and dysautonomia in a 14‐year‐old girl responsive to therapeutic plasma exchange
    Wiley ; 2016
    In:  Journal of Clinical Apheresis Vol. 31, No. 4 ( 2016-08), p. 368-374
    Details
    In: Journal of Clinical Apheresis, Wiley, Vol. 31, No. 4 ( 2016-08), p. 368-374
    Abstract: Reflex sympathetic dystrophy, also known as complex regional pain syndrome (CRPS), has recently been shown to be associated with autoantibodies against β2‐adrenergic and muscarinic M2 receptors. In addition to pain and sudomotor/vasomotor symptoms, dysautonomia is also observed in a subset of CRPS patients. Despite its severity, there are few effective therapies for CRPS described to date. We report a case of a 14‐year‐old girl with CRPS of her right leg and dysautonomia (gastroparesis, postural tachycardia) refractory to multiple therapies, successfully treated with therapeutic plasma exchange (TPE) with albumin replacement. The patient, who has serum anti β2‐adrenergic and muscarinic M2 receptor autoantibodies in addition to nicotinic acetylcholine receptor ganglionic autoantibodies, underwent an initial course of five TPEs over a 2‐week period. She demonstrated a clinical response to TPE as manifested by a rapid improvement in her fatigue and gastroparesis, with a gradual yet significant improvement in her leg pain and sudomotor/vasomotor flares. Following the loading procedures, the patient was treated with rituximab. She continues to require periodic TPE to maintain a remission, with additional immunosuppression being considered long term. Although further studies are needed, TPE (in combination with immunosuppression) may be an appropriate therapy for CRPS patients with detectable autoantibodies, as it is for better characterized diseases with autoantibodies against neuronal surface receptors such as myasthenia gravis or Lambert Eaton myasthenic syndrome. J. Clin. Apheresis 31:368–374, 2016. © 2015 Wiley Periodicals, Inc.
    Type of Medium: Online Resource
    ISSN: 0733-2459 , 1098-1101
    URL: Issue
    URL: Article
    DOI: 10.1002/jca.v31.4
    DOI: 10.1002/jca.21407
    Language: English
    Publisher: Wiley
    Publication Date: 2016
    detail.hit.zdb_id: 2001633-5
    detail.hit.zdb_id: 604912-6
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  • 8
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    Blood utilization and clinical outcomes in pancreatic surgery before and after implementation of patient blood management
    Wiley ; 2020
    In:  Transfusion Vol. 60, No. 11 ( 2020-11), p. 2581-2590
    Details
    In: Transfusion, Wiley, Vol. 60, No. 11 ( 2020-11), p. 2581-2590
    Abstract: Over the past decade, patient blood management (PBM) programs have been developed to reduce allogeneic blood utilization. This is particularly important in pancreatic surgery, which has historically been associated with high transfusion requirements and morbid event rates. This study investigated blood utilization and clinical outcomes in pancreatic surgery before, during, and after the implementation of PBM. Study Design and Methods A total of 3482 pancreatic surgery patients were assessed in a 10‐year retrospective cohort study (2009‐2019) at a single academic center. Baseline patient characteristics, transfusion practices, postoperative morbidity (infectious, thrombotic, ischemic, respiratory, and renal complications), mortality, and length of stay were compared between patients in the pre‐PBM (2009‐2013), early‐PBM (2014‐2016), and mature‐PBM (2017‐2019) time periods. Multivariable analysis assessed the odds for composite morbidity/mortality. Results Comparing the mature‐PBM to pre‐PBM cohorts, transfused units per 100 discharged patients decreased by 53% for erythrocytes (155 to 73; P 〈  .0001), 81% for plasma (79 to 15; P 〈  .038), and 75% for platelets (10 to 2.5; P 〈  .005). Clinical outcomes improved as well, with composite morbid event rates decreasing by more than 50%, from 236 in 1438 patients (16.4%) to 85 in 1145 patients (7.4%) ( P 〈  .0001). Mortality and length of stay remained unchanged. Compared to the pre‐PBM time period, early‐PBM was associated with a risk‐adjusted decrease in composite morbidity/mortality (OR 0.73; 95% CI 0.57‐0.93; P = .010), while mature‐PBM demonstrated a further incremental decrease (OR 0.44; 95% CI 0.33‐0.57; P 〈  .0001). Conclusions The implementation of PBM was associated with substantially decreased blood utilization in pancreatic surgery, without negatively impacting clinical outcomes.
    Type of Medium: Online Resource
    ISSN: 0041-1132 , 1537-2995
    URL: Issue
    URL: Article
    DOI: 10.1111/trf.v60.11
    DOI: 10.1111/trf.16063
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 208417-X
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  • 9
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    Analysis of Industry-Related Payments Among Physician Editors of Pathology Journals
    Oxford University Press (OUP) ; 2023
    In:  American Journal of Clinical Pathology Vol. 159, No. 2 ( 2023-02-01), p. 172-180
    Details
    In: American Journal of Clinical Pathology, Oxford University Press (OUP), Vol. 159, No. 2 ( 2023-02-01), p. 172-180
    Abstract: Gender inequities in editorial board representation and physician compensation are well documented, but few studies have focused on how editors of journals are compensated. Methods In this cross-sectional study, we examined industry-related compensation (from 2014 to 2020) among physician editors of 35 pathology journals using publicly available data from the Centers for Medicare & Medicaid Services Open Payments Database. Results Of the physician editors included, 135 (69.9%) were men and 58 (30.1%) were women. Similar percentages of men and women physicians who were eligible received payments (112/135 [83.0%] men and 51/58 [87.9%] women; P = .38, χ2 test). Of the total transfer of value ($211,192,532), 112 men received $192,727,555 (91.3%), and 51 women received $18,464,978 (8.7%). Mean total payment per person was $1,720,782 for men and $362,058 for women (P = .05). The payment range for men was $18-$47,568,400 and the range of payments for women was $31-$2,375,637. Conclusions The findings highlight significant gender inequities in industry-related payments to physician editors of pathology journals. The financial relationships of journal editors and industry deserve further study, particularly as they relate to advancing science and closing both workforce and patient care inequities.
    Type of Medium: Online Resource
    ISSN: 0002-9173 , 1943-7722
    URL: Article
    DOI: 10.1093/ajcp/aqac147
    RVK:
    YV 2000
    RVK:
    XA 18700
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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    detail.hit.zdb_id: 2039921-2
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  • 10
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    The Influence of Clinical and Biological Factors on Transfusion-Associated Non-ABO Antigen Alloimmunization: Responders, Hyper-Responders, and Non-Responders
    S. Karger AG ; 2014
    In:  Transfusion Medicine and Hemotherapy Vol. 41, No. 6 ( 2014), p. 420-429
    Details
    In: Transfusion Medicine and Hemotherapy, S. Karger AG, Vol. 41, No. 6 ( 2014), p. 420-429
    Abstract: In the context of transfusion medicine, alloimmunization most often refers to the development of antibodies to non-ABO red blood cell (RBC) antigens following pregnancy, transfusion, or transplantation. The development of RBC alloantibodies can have important clinical consequences, particularly in patients who require chronic transfusions. It has been suggested that alloimmunization is more common in some clinical circumstances and patient populations than in others. As such, individuals that develop alloantibodies are frequently referred to as ‘responders' in the medical literature. In contrast, individuals that do not develop alloantibodies despite repeated exposures to non-self blood group antigens have been referred to as ‘non-responders'. The purpose of this article is to review the phenomenon of RBC alloimmunization in the context of responders and non-responders to: i) establish a basic framework for alloimmunization as reported across several diverse patient populations; ii) more fully explore literature reports which support the concept of responders/non-responders regarding blood group antigen alloimmunization; iii) summarize the mechanisms that have been shown to predispose an individual to alloimmunization to determine how these factors may differentiate ‘responders' from ‘non-responders'; and iv) briefly discuss some practical approaches to prevent alloimmunization in patients who may be prone to alloantibody development.
    Type of Medium: Online Resource
    ISSN: 1660-3796 , 1660-3818
    URL: Article
    DOI: 10.1159/000369109
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2014
    detail.hit.zdb_id: 2100533-3
    detail.hit.zdb_id: 2100848-6
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