American journal of clinical pathology
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Am. J. Clin. Pathol. · Dec 1991
Laboratory hemostatic abnormalities in massively transfused patients given red blood cells and crystalloid.
Most of the literature on massive transfusion concerns whole blood replacement, whereas clinically, packed red blood cells are commonly given. To determine when hemostatic abnormalities occur in patients resuscitated primarily with packed red blood cells and crystalloid, the cases of 39 consecutive patients who were transfused with 10 or more red blood cell units of any kind within 24 hours were reviewed. After transfusion with 20 or more units of red blood cell products of any kind (packed red blood cells, cell-saver units, or whole blood), 75% (3 of 4) of patients had platelet counts less than 50 x 10(9)/L, compared to 0 of 29 patients given less than 20 units (P less than 0.001). ⋯ Importantly, probably clinically significant prothrombin time and partial thromboplastin time prolongations occurred consistently after transfusion of 12 units of relatively plasma-free red blood cells in unselected patients at an urban trauma hospital. These data suggest that coagulation factor replacement is necessary in patients who receive 12 or more units of packed red blood cells or cell-saver blood, and platelet replacement is necessary in patients who receive 20 or more units of any red blood cell product. A prospective study is needed to determine whether the expected abnormal clinical bleeding indeed occurs in patients with such laboratory coagulation abnormalities and to determine when plasma transfusion is indicated in patients massively transfused with red blood cells.
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Am. J. Clin. Pathol. · Nov 1991
Lipase and pancreatic amylase activities in tissues and in patients with hyperamylasemia.
Lipase, pancreatic amylase, and total amylase activities were measured in nondiseased and diseased human pancreatic tissues and in six different locations of the human digestive system. In addition, it was determined whether serum lipase and pancreatic amylase tests could replace the total amylase test to improved diagnostic efficiency in the evaluation of acute pancreatitis in hyperamylasemia patients. Nondiseased pancreatic tissue contained 4.5 times more lipase activity than total amylase activity. ⋯ However, in every patient pancreatic disease would have been detected by the elevation of either lipase or pancreatic amylase levels. Diagnostic efficiency for pancreatic disease using serum pancreatic amylase, lipase, and total amylase tests was 94.1%, 76.5%, and 64.7%, respectively. These data suggest that lipase and pancreatic amylase tests are specific for the pancreas and might be considered replacements for total amylase as the stat or routine laboratory test for the diagnosis of pancreatic tissue injury.
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Am. J. Clin. Pathol. · Jul 1991
Composite lymphoma. A clinicopathologic analysis of nine patients with Hodgkin's disease and B-cell non-Hodgkin's lymphoma.
Nine patients had composite lymphoma in which Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) involved the same anatomic site. Two of these patients had relapses of their tumors. In one, the initial biopsy specimen contained follicular and diffuse large cell NHL with unclassifiable HD, but the relapse showed diffuse large cell NHL with nodular sclerosis HD. ⋯ In two specimens, the malignant cells were negative for Leu-M1 and LCA (with positive internal controls). Composite lymphomas composed of HD and NHL are unusual, and cases of coexistent HD of the non-lymphocyte-predominant subtype and NHL are even less common. The results of the current study and a review of the literature indicate that this phenomenon usually involves a B-cell NHL that coexists with HD, perhaps further suggesting a close relationship between the malignant cells of HD (RS and H cells) and B lymphocytes.
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Am. J. Clin. Pathol. · Mar 1991
Issues in cerebrospinal fluid management. CSF Venereal Disease Research Laboratory testing.
Three policies for decreasing unnecessary cerebrospinal fluid (CSF) management Venereal Disease Research Laboratory (VDRL) tests were compared. The first policy attempted to educate physicians about the use of serologic tests for diagnosing neurosyphilis but allowed the CSF VDRL to be performed either as a screening test or as a retrospective test. The second policy required that the CSF VDRL be performed as a retrospective test without regard to the patient's serologic status. ⋯ The optional and required retrospective policies decreased the CSF VDRL rate to 13.0% and 8.5%, respectively, but the percentages of seropositive patients for whom these procedures were performed were only 7.3% and 12.9%. The third policy decreased the CSF VDRL test rate to 1.8% (P less than 0.001) with seropositivity improving to 90%. To assure serologic tests are obtained in the evaluation of neurosyphilis, requirement for seropositivity must be implemented with the use of retrospective CSF VDRL testing.
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Am. J. Clin. Pathol. · Oct 1990
Comparative StudySafety and cost-containment data that advocate abbreviated pretransfusion testing.
Abbreviated pretransfusion testing, although permitted by American Association of Blood Banks Standards for unimmunized patients, is not widely practiced. Concerns remain about optimal antibody screening methods, antibodies missed by deleting the antiglobulin crossmatch, and cost-effectiveness. The authors prospectively tested 3,380 serum samples for blood type, antibody screen, and antiglobulin crossmatch. ⋯ Among these (negative antibody screen, positive crossmatch), only 0.03% (1 of 3.380) had a clinically significant alloantibody (anti-Kpa); 0.27% (9 of 3,380) had antiglobulin crossmatch positive with polyspecific antisera but negative with anti-IgG; and 0.12% (4 of 3,380) had positive crossmatch because of passive anti-A. By cost accounting of labor and reagents, 84 per unit would be saved using abbreviated versus complete pretransfusion testing. Blood banks now performing complete pretransfusion testing should reconsider abbreviated crossmatching for unimmunized patients as a safe, efficacious means of cost-containment.