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Critical care medicine 10/2012; 40(10):2927. · 6.37 Impact Factor
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ABSTRACT: BACKGROUND: The Pan Genera detection (PGD) test is used to screen platelet (PLT) products for bacterial contamination. We report the experience of using the PGD test on whole blood-derived PLTs (WBPs) at two large centralized transfusion services (CTS). STUDY DESIGN AND METHODS: Records of PGD test results were retrospectively reviewed. The PGD test was performed on individual WBP units or pools of WBPs ranging in size from 2 to 6 units at the time of issue. Bacterial culture was performed on PLT products with positive PGD tests, and at one CTS, the available cocomponents. RESULTS: A total of 70,561 WBP pools were screened with the PGD test. There were seven true-positive PGD tests and 242 false-positive tests (positive predictive value of PGD test, 2.81%). The overall contamination rate was 99 per 10(6) WBP pools (1:10,080; 95% confidence interval [CI], 40-204), and the false-positive rate was 3430 per 10(6) WBP pools (1:292; 95% CI, 3011-3890). All seven bacterial isolates were Gram positive. The median age of the individual WBP units in the seven contaminated pools was 5 days (range, 3-5 days) compared to 4 days (range, 1-5 days) in the false-positive pools (p = 0.0012). The same bacteria isolated from a positive PLT pool also grew in one red blood cell cocomponent. CONCLUSION: After testing more than 70,000 WBP pools at two large CTSs, the rate of contaminated WBP pools detected by the PGD test was 99 per 10(6) pools (1:10,080).
Transfusion 07/2012; · 3.22 Impact Factor
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ABSTRACT: The metropolitan Seattle area has utilized a centralized transfusion service model throughout the modern era of blood banking. This approach has used four laboratories to serve over 20 hospitals and clinics, providing greater capabilities for all at a lower consumption of resources than if each depended on its own laboratory and staff for these functions. In addition, this centralized model has facilitated wider use of the medical capabilities of the blood center's physicians, and a county-wide network of transfusion safety officers is now being developed to increase the impact of the blood center's transfusion expertise at the patient's bedside. Medical expectations and traffic have led the blood center to evolve the centralized model to include on-site laboratories at facilities with complex transfusion requirements (e.g., a children's hospital) and to implement in all the others a system of remote allocation. This new capability places a refrigerator stocked with uncrossmatched units in the hospital but retains control over the dispensing of these through the blood center's computer system; the correct unit can be electronically cross-matched and released on demand, obviating the need for transportation to the hospital and thus speeding transfusion. This centralized transfusion model has withstood the test of time and continues to evolve to meet new situations and ensure optimal patient care.
Transfusion 12/2011; 51(12 Pt 2):2750-7. · 3.22 Impact Factor
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ABSTRACT: Sickle cell disease (SCD) patients have dissimilar red blood cell (RBC) phenotypes compared to the primarily Caucasian blood donor base due, in part, to underlying complex Rh and silenced Duffy expression. Gene array-based technology offers high-throughput antigen typing of blood donors and can identify patients with altered genotypes. The purpose of the study was to ascertain if RBC components drawn from predominantly Caucasian donors could provide highly antigen-matched products for molecularly typed SCD patients.
SCD patients were genotyped by a molecular array (HEA Beadchip, BioArray Solutions). The extended antigen phenotype (C, c, E, e, K, k, Jk(a) , Jk(b) , Fy(a) , Fy(b) , S, s) was used to query the inventory using different matching algorithms; the resulting number of products was recorded.
A mean of 96.2 RBC products was available for each patient at basic-level, 34 at mid-level, and 16.3 at high-level stringency. The number of negative antigens correlated negatively with the number of available products. The Duffy silencing mutation in the promoter region (67T>C) (GATA) was found in 96.5% of patients. Allowing Fy(b+) products for patients with GATA increased the number of available products by up to 180%, although it does not ensure prevention of Duffy antibodies in all patients.
This feasibility study provides evidence that centers with primarily Caucasian donors may be able to provide highly antigen-matched products. Knowledge of the GATA status expands the inventory of antigen-matched products. Further work is needed to determine the most clinically appropriate match level for SCD patients.
Transfusion 08/2011; 52(2):381-8. · 3.22 Impact Factor
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ABSTRACT: Anemia is an early indicator of many diseases, yet blood donors with low hematocrit (Hct) often receive inadequate information about its medical importance. We sought to understand the types of information that are and should be provided to these donors.
Two companion studies were performed. The first investigated blood center practices for care of donors with low Hct including deferral length, information provided, and cutoff values used when referring donors for medical attention. The second was a randomized prospective pilot study comparing behavior of deferred donors receiving an "older" pamphlet providing a list of iron-rich foods or a "newer" pamphlet providing descriptions of common causes of anemia and advice for seeking medical attention.
More than 70% of centers defer donors for 1 day. Only 6% defer donors for more than 2 weeks. Most centers provide written and/or verbal information about low Hct. Only 35% have a cutoff value defining significant anemia that requires additional medical attention. In the study of donors with low Hct, significant disease was identified within 3 months after deferral in 2 of 104 subjects: metastatic lung cancer and acute lymphocytic leukemia. Only donors receiving the newer pamphlet reported that it "definitely improved" their ability to speak with their doctor about anemia.
The diagnosis of anemia in blood donors may be an indicator of significant undiagnosed disease. There are wide variations in how centers care for and educate donors with anemia. Donors with anemia should be provided improved and consistent educational information.
Transfusion 10/2010; 51(5):929-36. · 3.22 Impact Factor
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ABSTRACT: Transplantation with umbilical cord blood for haematological malignancy and other diseases has increased over the last two decades. The parameters that affect clinical outcome have been intensely studied in this relatively new clinical setting. Although originally thought to not be critical for transplant success, human leucocyte antigen (HLA) matching of the patient and cord blood donor is now considered one of the most important indicators of outcome. Because clinical studies of cord-blood transplantation are often not large enough to detect subtle differences, the HLA matching algorithm in cord blood transplantation (CBT) is not clearly defined. This article will focus on HLA matching in CBT in relation to engraftment, graft versus host disease, relapse and survival. Outstanding questions in the field, such as the contribution of HLA-C, -DQ, as well as the appropriate level of HLA matching and cord unit selection will be discussed.
Best practice & research. Clinical haematology 06/2010; 23(2):179-87. · 3.13 Impact Factor
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Meghan Delaney,
Erin Meyer,
Christine Cserti-Gazdewich,
Richard L Haspel,
Yulia Lin,
Anna Morris,
Katerina Pavenski,
Walter H Dzik,
Mike Murphy,
Sherrill Slichter,
Grace Wang,
Larry J Dumont,
Nancy Heddle
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ABSTRACT: As evidence-based medicine assumes increasing importance, there is a need for high-quality reporting of clinical studies. A recent review of clinical platelet (PLT) studies indicated variability in reporting. We undertook a critical analysis of PLT transfusion studies to determine the quality of reporting.
A systematic MEDLINE search for clinical studies of PLT transfusion was performed to identify articles. Relevant observational studies (OBS) were critiqued using the STROBE checklist and randomized controlled clinical trials (RCTs) using the CONSORT checklist. Studies were further evaluated with a PLT-specific checklist developed by the authors. Observations were analyzed descriptively and using Pareto analysis.
A total of 772 articles were identified by the search. Eighty-six articles (23 RCTs and 63 OBS) met eligibility criteria. All RCTs, and a similar number of OBS (24), were randomly selected for analysis. Studies reported the scientific background and rationale, key results, and outcomes. OBS frequently did not consider bias and confounders. RCTs frequently did not explain bias, interim analyses, stopping rules, success of blinding, or weaknesses of multiple analyses. The PLT-specific critique found many studies adequately reported basics of the PLT product, PLT increment, and transfusion reactions. Studies frequently failed to report specific details of PLT compatibility, details of product preparation, and use of other blood products.
Recently published articles of clinical PLT transfusion share common strengths and weaknesses. The quality of reporting may be improved by providing guidelines to authors and journal editors that list the essential elements of a well-reported clinical study of PLT transfusion.
Transfusion 05/2010; 50(10):2135-44. · 3.22 Impact Factor
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Meghan Delaney
Blood 11/2009; 114(19):3980-1. · 9.90 Impact Factor
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ABSTRACT: The optimal use of dedicated fungal and mycobacterial blood culture bottles, such as the BACTEC Myco/F Lytic bottle, has not been well defined in clinical practice.
To compare the performance of Myco/F Lytic and standard blood culture in clinical practice in an urban tertiary care hospital setting and to implement a strategy for optimal use of Myco/F Lytic culture.
Retrospective review of laboratory records.
Myco/F Lytic culture did not increase detection of yeasts. Nor did it decrease time to detection except for Candida glabrata, where mean time to positivity dropped from 2.6 +/- 1.1 days in standard to 1.8 +/- 0.8 days in Myco/F Lytic culture. Therefore, an algorithm was developed in which Myco/F Lytic culture was reserved primarily for detection of mycobacteria in patients with severely depressed CD4 counts. Implementation of this algorithm led to a sustained 3-fold reduction in Myco/F Lytic blood culture usage.
Retrospective analysis suggests substantial clinical equivalence of standard blood and Myco/F Lytic culture for detection of yeast. A multifaceted educational approach based on this data led to a sustained change in physician ordering practices and more cost-effective use of resources.
Archives of pathology & laboratory medicine 02/2009; 133(1):93-6. · 2.58 Impact Factor
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Meghan Delaney,
Corey S Cutler,
Richard L Haspel,
Beow Y Yeap,
Steven L McAfee,
Bimalangshu R Dey,
Eyal Attar,
Grace Kao,
Edwin P Alyea,
John Koreth,
Vincent T Ho,
Susan Saidman,
Deborah Liney,
Doreen Sese,
Robert J Soiffer,
Thomas R Spitzer,
Joseph H Antin,
Karen K Ballen
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ABSTRACT: Double-cord-blood transplantation (DCBT) offers an option for patients receiving reduced-intensity transplants. These unique transplants have two donors, both of whom are usually HLA mismatched at one to two loci.
Fifty-three patients were recipients of a reduced-intensity DCBT. Cords were at least 4/6 allele-level HLA-A, -B, and -DR match with the patient and each other with a minimum combined cell dose of more than 3.7 x 10(7) total nucleated cells per kg. Twenty-one patients received cyclosporine/mycophenolate mofetil and 32 patients received sirolimus/tacrolimus (SIR/TAC) for graft-versus-host disease prophylaxis. The effect of allele level HLA typing on clinical endpoints of overall survival (OS), disease-free survival (DFS), engraftment, and acute graft-versus-host disease (aGVHD) were assessed.
Neutrophil (p = 0.001) engraftment and platelet engraftment (p = 0.027) were significantly faster in patients who have closer Class I (HLA-A, -B, -C) matching. Neutrophil engraftment was faster in patients who had closer HLA-B matching to their combined cords (p = 0.007). There was a low incidence of aGVHD overall, especially in the SIR/TAC group. Class I HLA matching had no effect on aGVHD. HLA-DR and -DQ had no effect on engraftment or aGVHD.
Class I allele matching, and HLA-B matching specifically, were associated with faster neutrophil engraftment. High-resolution HLA matching did not affect OS or DFS.
Transfusion 02/2009; 49(5):995-1002. · 3.22 Impact Factor
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Medicine and health, Rhode Island 09/2003; 86(8):252-5.
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ABSTRACT: We describe the autopsy of a chromosomally normal multiple-anomaly fetus with left side-restricted malformations, terminated after routine screening ultrasound. Autopsy findings were remarkable for severe left-sided craniofacial malformations including a cleft left frontal calavarial bone and an oblique facial cleft. Internal examination showed multiple left-sided malformations including severe left ventricular hypoplasia and interrupted aortic arch. A hypoplastic left lung, an accessory spleen, and an absent left kidney and left ureter were also discovered. Some features of the Smith-Lemli-Opitz Syndrome (SLOS) are found in this fetus, yet the occurrence of left side-restricted anomalies indicates that developmental mechanisms responsible for body laterality are involved. Potential mechanisms leading to this constellation of anomalies include a ciliary defect, side-restricted chromosomal mosaicism, or a teratogenic insult, affecting developmental morphogens, including sonic hedgehog. The sonic hedgehog pathway is important in the molecular mechanisms underlying SLOS and in laterality development in the early embryo.
Pediatric and Developmental Pathology 10(2):117-20. · 0.99 Impact Factor
