American journal of clinical pathology
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Am. J. Clin. Pathol. · Jan 1997
Laboratory tests in evaluation of acute febrile illness in pediatric emergency room patients.
The rising costs of health care and the movement for health care reform have focused attention on methods of cost containment. Of routine laboratory and radiologic procedures, complete blood cell count (CBC) and determination of serum electrolyte values rank as high as 2nd and 9th in overall cost. We retrospectively studied use of the clinical laboratory to aid diagnosis of an acute infectious event in a pediatric emergency department population. ⋯ In addition, we correlated the administration of antibiotics with the various hematologic parameters and discovered that WBC > 15,000, regardless of cause, almost uniformly resulted in treatment (positive predictive value, 93.5%; likelihood ratio, 5.60). These findings support the use of automated hematology analyzer-derived measurements and question the use of manual differential counts, unless specific issues are to be addressed. Furthermore, the findings seem to support more reliance on clinical impression and less on laboratory values.
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Am. J. Clin. Pathol. · Nov 1996
Fellowship training programs in blood banking and transfusion medicine: results of a national survey.
This report details the results of a 1995 survey of the 40 fellowship training programs in blood banking and transfusion medicine in the United States approved by the Accreditation Council for Graduate Medical Education. Fellows primarily enter transfusion medicine training after completing a pathology residency, and are subsequently employed in an academic or university setting, or a blood donor center. ⋯ Research is an important part of most fellowship programs, and a majority of program directors felt that some formal training in clinical medicine should be a part of fellowship training in transfusion medicine. The information obtained from this survey should be helpful to both fellowship applicants and program directors in delineating important aspects of fellowship training in blood banking and transfusion medicine.
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Am. J. Clin. Pathol. · Jul 1996
Comparative StudyPrecision, accuracy, and managed care implications of a hand-held whole blood analyzer in the prehospital setting.
Hand-held portable clinical analyzers permit the rapid measurement of whole blood electrolytes, glucose, blood urea nitrogen (BUN) and hematocrit. Knowledge of these values in the field might aid radio telemetry emergency department physicians in the field treatment and triage of patients. The purpose of this study was determine if the analyzer could function in the hostile prehospital environment. ⋯ There was excellent correlation between field and hospital emergency department values. Clinical pathologists extend their oversight and consider encouraging emergency physicians to obtain field blood chemistry values in research studies aimed at improving medical treatment and patient triage in the prehospital setting. We speculate that these results might be important to managed care groups because knowledge of blood chemistry values in the field might provide physicians with objective, criteria-based data on which to triage patients to the emergency department, to an ambulatory care setting, or to a community health center with attendant cost savings.
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Am. J. Clin. Pathol. · Jul 1996
Changes in blood coagulation during and following cardiopulmonary bypass: lack of correlation with clinical bleeding.
Although previous studies have documented a wide variety of derangements in laboratory measurements of blood coagulation and platelets during cardiopulmonary bypass, limited data are available concerning the magnitude of these changes and any association with excessive bleeding. To determine whether abnormalities in commonly available laboratory tests for the evaluation of coagulation, fibrinolysis and hemostasis correlate with postoperative blood loss and transfusion requirements as measures of clinical outcome, 47 consecutive patients undergoing coronary artery bypass grafting with hypothermic cardiopulmonary bypass (CPB) were studied prospectively at 12 time points before, during, and following CPB. Routine blood coagulation tests, coagulation factor levels (fibrinogen, V, VII, VIII, and IX) and fibrinolysis (FDP) became abnormal within 15 minutes after patients were placed on CPB, remained abnormal for the duration of CPB, and recovered at varying rates after discontinuation of CPB. ⋯ Twenty-eight percent of patients had mediastinal output > or = 100 mL per hour during the immediate postoperative period, and were considered to be "bleeders." There were no clinically relevant differences in any of the laboratory measurements between patients with normal postoperative blood loss and those defined as bleeders. Thus, the absence of significant correlations between various laboratory measurements of hemostasis and actual postoperative bleeding indicates that these laboratory derangements are transient, are not predictive of clinically important hemostatic abnormalities, and should not be used in isolation to guide the use of blood components in these patients. Furthermore, although bleeders received more blood components, there was surprisingly little effect on the coagulation factor levels measured.
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Am. J. Clin. Pathol. · Feb 1996
Case ReportsCalcifying fibrous pseudotumor of pleura. A report of three cases of a newly described entity involving the pleura.
A newly recognized distinctive fibrous soft tissue lesion called "calcifying fibrous pseudotumor" (CFPT) was recently described in the soft tissues of the extremities, trunk, scrotum, groin, neck, or axilla. To date, CFPT has not been described in the pleura. The authors reviewed the clinical, radiologic, and pathologic features of three cases. ⋯ Calcifying fibrous pseudotumor is distinct from other pleural lesions such as fibrous tumor of pleura, calcified granulomas, calcified pleural plaques, and chronic fibrous pleuritis as well as intrapulmonary lesions such as hyalinizing granuloma, inflammatory pseudotumor, and amyloid. As in the soft tissues, local excision appears adequate therapy for CFPT of the pleura. If these lesions behave in a similar fashion to CFPT of soft tissues, one might expect a low frequency of local recurrence.