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Biomedical subjects

B Lichtiger

Publications and source records attributed to B Lichtiger.

At least 19 recordsLinked to original sources
PubMed1998

Transfusion support using filtered unscreened blood products for cytomegalovirus-negative allogeneic marrow transplant recipients.

It has been suggested that leukoreduced unscreened blood products can be used as an alternative to components from cytomegalovirus (CMV)-seronegative donors in order to prevent transmission of CMV from transfusions for CMV-seronegative marrow transplant recipients with CMV-seronegative donors, but confirmatory data are lacking. A retrospective chart review was undertaken for patients undergoing allogeneic transplantation over a 4-year period during which blood products were filtered for CMV-seronegative patients with CMV-seronegative donors when CMV-seronegative components were not available. Forty-five CMV-seronegative patient-donor pairs were identified. Only one patient developed CMV disease (pneumonia) and no other patients developed an infection. In this group of patients, the rate of CMV infection was 2.7% (95% CI, 0-8%) by life-table analysis. We conclude that filtered unscreened blood products as partial transfusion support for CMV-seronegative marrow transplant recipients were associated with a low incidence of CMV infection, justifying further evaluation of filtered blood products as total transfusion support for this patient population. However, since CMV infections still occur, continued surveillance by periodic culture or other techniques is warranted.

Adolescent↗
PubMed1998

Evaluation and comparison of three mobilization methods for the collection of granulocytes.

BACKGROUND: Cancer chemotherapeutic regimens have become more potent and myeloablative. As a consequence, morbidity and mortality due to opportunistic infections have become a major challenge. The provision of adequate doses of viable granulocytes has thus become an important approach for circumventing the problem. A schedule for collecting therapeutic numbers of cells with minimal donor toxicity has yet to be established. STUDY DESIGN AND METHODS: An investigation of three mobilization schedules for the collection of granulocytes for transfusion--granulocyte-colony-stimulating factor (G-CSF) 5 micrograms per kg daily; G-CSF 5 micrograms per kg every other day, and prednisone 60 mg given orally (20 mg doses at 17 hours, 12 hours, and 2 hours before the collection). RESULTS: A total of 464 apheresis procedures involving 163 healthy donors were analyzed. Prednisone caused a small increase in the white cell (WBC) counts over the collection days, while G-CSF every other day and daily schedules improved WBC counts to 145 and 160 percent, respectively (p = 0.004). Similarly, administration of G-CSF daily and every other day mobilized higher yields of granulocytes over the collection days, compared to the prednisone schedule (170% and 180% vs. 105%; p = 0.02). CONCLUSION: Compared with prednisone, higher WBC yields were achieved by G-CSF stimulation; G-CSF given every other day is as effective as daily G-CSF administration for the recruitment of granulocytes, which makes the mobilization procedure more cost-effective.

Administration, Oral↗
PubMed1998

Costs of blood transfusion: a process-flow analysis.

PURPOSE: To determine the cost of transfusing 2 units (U) of packed RBCs at a comprehensive cancer center. METHODS: We performed a process-flow analysis to identify all costs of transfusing 2 U of allogeneic packed RBCs on an outpatient basis to patients with either (1) solid tumor who did not undergo bone marrow transplantation (BMT), (2) solid tumor who underwent BMT, (3) hematologic malignancy who did not undergo BMT, (4) hematologic malignancy who underwent allogeneic BMT, or (5) hematologic malignancy who underwent autologous BMT. We conducted structured interviews to determine the personnel time used and physical resources necessary at all steps of the transfusion process. RESULTS: The mean cost of a 2-U transfusion of allogeneic packed RBCs was $548, $565, $569, $569, and $566 for patients with non-BMT solid tumor, BMT solid tumor, non-BMT hematologic malignancy, allogeneic BMT hematologic malignancy, and autologous BMT hematologic malignancy, respectively. Sensitivity analysis showed that total transfusion costs were sensitive to variations in the amount of clinician compensation and overhead costs, but were relatively insensitive to reasonable variations in the direct costs of blood tests and the blood itself, or the probability or extent of transfusion reaction. CONCLUSION: The costs of the transfusion of packed RBCs are greater than previously analyzed, particularly in the cancer care setting.

Accounting↗
PubMed1997

Treatment of neutropenia-related fungal infections with granulocyte colony-stimulating factor-elicited white blood cell transfusions: a pilot study.

Neutropenia-related fungal infections can be life-threatening despite antifungal therapy. We evaluated the role of recombinant granulocyte colony-stimulating factor (rG-CSF)-elicited white blood cell (WBC) transfusions in patients with neutropenia-related fungal infections. Adult patients with hematologic malignancies, absolute neutrophil counts (ANC) <500/microl and fungal infections refractory to amphotericin B, received daily transfusions of rG-CSF-elicited and irradiated WBC transfusions from related donors. Donors received 5 microg/kg/day of rG-CSF subcutaneously. Donors achieved a mean ANC of 29.4 x 10(3) per microliter. The mean yield of neutrophils per transfusion was 41 x 10(9) (range, 10-116). Fifteen patients received a median of eight transfusions (range, 3-16). Fourteen patients had received rG-CSF for a median of 12 days. The median ANC baseline was 20/microl. Eleven patients had favorable responses and eight of them remained free of infection 3 weeks after therapy. Favorable responses occurred among patients with better Zubrod performance status (median, 3 vs 4) and shorter duration of both profound neutropenia (median, 15 vs 25 days) and active infection (median, 8 vs 17 days). The mean 1- and 24-h post-transfusion ANCs were 594/microl (range, 98-1472/microl) and 396/microl (range, 50-1475/microl), respectively. Adverse reactions were observed in nine of 35 donors and in the recipients of six of 130 transfusions. rG-CSF-elicited WBC transfusions may be a safe and promising approach for treating neutropenia-related fungal infections.

Adolescent↗
PubMed1997

Assessing the efficiency of leukoreduction of cellular blood components. Use of a simplified formalin-fixation and batch-counting method.

To simplify the quality control procedure used to determine the efficiency and consistency of bedside leukoreduction, a counting protocol using prefiltration and postfiltration aliquots fixed in 10% formaldehyde was designed. To assess the reliability of the values obtained by counting the formalin-fixed samples, a parallel study was performed using our standard protocol of counting fresh propidium iodide-stained samples in a Nageotte chamber under a fluorescent microscope. A total of 30 single-donor platelet concentrates and 30 units of packed red blood cells were analyzed in parallel using the standard and formalin-fixation methods. Furthermore, the aliquots fixed in formaldehyde were split and counted at 1, 3, and 30 days. The results showed no significant quantitative difference between the two methods. Of note is that the counts in formaldehyde-fixed samples at 1, 3, and 30 days were consistent among themselves. The formaldehyde fixation of samples obtained for quality control of leukoreduction allows blood collection and storage at 4 degrees C and batch counting when and where convenient.

Blood Component Removal↗
PubMed1996

Clinical toxicity and laboratory effects of granulocyte-colony-stimulating factor (filgrastim) mobilization and blood stem cell apheresis from normal donors, and analysis of charges for the procedures.

BACKGROUND: Apheresis of granulocyte-colony-stimulating factor (filgrastim)-mobilized blood stem cells from normal donors is now being used in place of a marrow harvest in transplantation. How the adverse effects of and charges for this procedure compare with those of the standard marrow harvest is not known. STUDY DESIGN AND METHODS: Forty consecutive normal subjects who received filgrastim 96 micrograms/kg) subcutaneously twice daily for 4 to 6 days in preparation for apheresis were monitored prospectively by clinical and laboratory evaluation. RESULTS: Sixty-two percent of the subjects required oral analgesics. None discontinued filgrastim prematurely. Bone pain (82%), headache (70%), fatigue (20%), and nausea (10%) were reported. Filgrastim caused a mean eightfold increase in neutrophil counts, a mean twofold increase in lymphocyte counts, a mean twofold rise in alkaline phosphatase and lactate dehydrogenase levels, and minor changes in serum potassium, magnesium, and uric acid. Adverse events and laboratory effects resolved within 7 days after apheresis. No apheresis stem cell donor required transfusion or hospitalization, and only one required an additional clinic visit after completion of apheresis. By comparison, a retrospective analysis of 33 normal marrow donors demonstrated that all received transfusion(s), 3 were hospitalized, 3 required additional clinic visits after the marrow harvest. The median total charges related to the two procedures were comparable (p = 0.43), although the charges were significantly lower for donors requiring only one apheresis procedure (p = 0.002). CONCLUSION: Filgrastim mobilization and apheresis of blood stem cells constitute a safe, well-tolerated, and comparable or less expensive alternative to the traditional marrow harvest.

Adolescent↗
PubMed1996

Use of irradiated blood components: practice parameter.

Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare but fatal potential complication of transfusions. It is mediated by immunocompetent donor lymphocytes that cannot be eliminated by the recipient. Patients at risk for developing TA-GVHD are those who have a profound deficiency in cell-mediated immunity or those who share histocompatibility antigens with the donor and do not recognize the donor cells as foreign. Irradiation of cellular blood components is currently the only acceptable method for prevention of TA-GVHD. This practice guideline identifies the patient population who should receive irradiated blood components and describes the technical aspects of blood component irradiation that may affect the safety of the final product.

Blood Cells↗
PubMed1996

Prevention of transfusion-associated cytomegalovirus infection. Practice parameter. American Society of Clinical Pathologists.

This practice guideline represents the opinions and recommendations of the author(s), the American Society of Clinical Pathologists (ASCP) Practice Parameters Committee and the ASCP Board of Directors regarding the appropriate strategies for each clinical condition or laboratory test discussed in this guideline. This guideline is designed primarily as an educational resource for physicians in the provision of quality medical services. Adherence to this guideline is completely voluntary and does not necessarily assure a successful medical treatment or result. This practice guideline should not be considered inclusive of all proper procedures and tests or exclusive of other procedures or tests that are reasonably directed to obtaining the same results. The physician should apply his or her own professional judgment to the unique clinical circumstances presented by the particular procedure or test. Physicians are encouraged to document the reasons for whatever procedure or test they use (whether or not in conformance with this guideline). Physicians should also take care to consider other medical and scientific advances that are available after the date of adoption of this guideline. This practice guideline was developed exclusively for the purposes set forth above and not for use in connection with matters involving reimbursement, credentialing, or utilization review.

Adult↗
PubMed1995

Autologous deposit of blood by oncology patients: an evaluation of actual use and wastage.

BACKGROUND: Transfusions of autologous deposited blood have continued to grow since the 1980s. Together with the growth in the deposit of autologous blood, issues such as appropriateness of indications, reimbursement, cost effectiveness, etc., have emerged and require addressing. Also, the patient's concerns about safety of the blood supply must be taken into account. METHODS: We conducted a 20-week study to determine the collection and transfusion/wastage of autologous blood and the need to transfuse additional allogeneic units of packed red blood cells. The disposition of every autologous unit was followed until its disposal. RESULTS: One hundred fifty-seven patients deposited 260 units of autologous blood. Of these, 144 units (55.4%) were transfused whereas 44.6% were discarded. In addition, 25 or 157 patients (15.9%) received an additional 58 units of allogeneic blood. CONCLUSION: These data demonstrate that there are surgical procedures where autologous blood is drawn unnecessarily whereas others could afford a higher number of autologous blood deposits. Physicians may be pressured by patients into ordering autologous blood deposits, to allay fear of patients about safety of the blood supply. It is important that health care professionals undergo periodic education to be able to address patient's apprehension about safety of the blood supply.

Adolescent↗
PubMed1994

Monitoring the safety of transfusion practices in the U.S.

The public demands and deserves the safest blood products to be available when and where needed. Although absolute safety in the blood supply is a desirable goal, many intervening factors may have a bearing on its final quality. In the process of obtaining blood, the procedure for donor selection/exclusion acquires pivotal relevance. Then, once the blood product is taken to the processing laboratory, there is a need that tightly and narrowly defined parameters for component preparation, infectious disease testing, handling and storage be in place and strictly adhered to. Notwithstanding these measures to increase the safety and quality of blood, the most critical factor remaining in the whole operation is the one related to physician behavior and discipline as far as appropriate criteria for the use of blood products are concerned. Transfusion Medicine Physicians must keep a constant vigilance that the appropriate criteria for transfusion are utilized in 100% of cases. This, can only be achieved by an intense and continuous scrutiny and evaluation of every request for transfusions for every patient 24 hours a day, 7 days a week basis. This approach has allowed that we identify physicians who need help and understanding as to the appropriate use of blood products, as well as information about other equally effective options and alternatives. Misconceptions about whole blood, directed donations, unusual requests for fresh frozen plasma, without the documentation of abnormalities of the coagulation profile are rapidly intercepted and aborted. These unusual and unfounded requests are forwarded to the Department of Quality Assurance to further follow up and monitoring of physician behavior in this aspect.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Transfusion↗
PubMed1994

Extracorporeal circulation as a blood conservation technique for extensive pelvic operations.

Difficult pelvic operations for malignancy or complex benign conditions can be associated with extensive blood loss. Religious beliefs that preclude transfusion and the known risks of homologous blood have prompted investigators to seek alternatives to transfusion. We used the Haemonetics-V50 Cell Separator (Haemonetics Corporation) to provide for extracorporeal circulation of the patient's own blood with associated normovolemic hemodilution as a means of conserving blood during operations. This technique was used in eight patients undergoing extensive pelvic operations. The procedure was accepted by Jehovah's Witnesses and was well tolerated by all patients. Estimated blood loss ranged from 75 to 2,000 milliliters. One instance of mild intraoperative disseminated intravascular coagulation was encountered. Two patients were given homologous transfusions. While clinical judgment is necessary to determine the safety of complicated operations, this technique is useful in expanding surgical options for some patients who object to blood transfusion.

Blood Loss, Surgical↗
PubMed1993

Platelet crossmatches of single-donor platelet concentrates using a latex agglutination assay.

A latex agglutination assay was evaluated for the purpose of identifying compatible platelet donors for alloimmunized recipients. Assay reagents were prepared by adsorbing detergent-solubilized, donor-specific platelets to polystyrene latex beads. Semiquantitative results for up to 30 donors can be completed in less than 1 hour. These reagents retained their immunoreactivity for at least 3.5 months. A retrospective study has established the assay's upper limit of compatibility. The prospective study evaluated transfusions to a group of multiply transfused patients. Part I evaluated 143 crossmatched, single-donor platelet transfusions given to 50 patients. In 96 percent of the cases, a positive crossmatch was associated with an unsuccessful transfusion outcome; in 84 percent of the transfusions, a negative crossmatch predicted a satisfactory platelet increment. The overall predictability, sensitivity, and specificity were 87, 62, and 99 percent, respectively. Part II evaluated 105 transfusions given to the 43 patients (of 50) in whom no incidence of fever, sepsis, or bleeding could be documented. A positive crossmatch was 96-percent efficient in predicting an unsuccessful transfusion, whereas a negative crossmatch was associated with an adequate platelet increment following 89 percent of the transfusions. The overall predictability was 91 percent, the sensitivity was 72 percent, and the specificity was 99 percent. Within-run and between-run variations were 6.3 and 6.2 percent, respectively. These results demonstrate that detergent-solubilized platelet antigens, immobilized on latex particles, can be used in a cost-effective crossmatching procedure.

Adult↗
PubMed1992

Identification of previous erythrocyte alloimmunization and the type and screen at a large cancer center. A 4-year retrospective review.

A review of 4 years of hemolytic transfusion reactions and evidence for erythrocyte alloimmunization (RBC-A) was conducted from September 1, 1985 to August 31, 1989 to assess retrospectively the safety of pretransfusion testing using the type and screen (T & S) with immediate-spin crossmatch (IS-XM). All transfusion reaction reports were reviewed for reported "possible hemolytic transfusion reaction" and RBC-A, as identified by the reviewing pathologist. Three hemolytic transfusion reactions (HTR) and eight RBC-A were found for the 4 years. During the review period, 92,759 units of packed RBC were transfused to 22,317 patients. Of these, 76,257 (82.2%) units of packed RBC had IS-XM, 12,414 (13.4%) had an antiglobulin crossmatch, and 4088 (4.4%) were issued without crossmatch. Of the immediate reactions, two were caused by clerical errors, and one was of undetermined cause. The eight RBC-A were discovered during subsequent pretransfusion testing in the Transfusion Service and classified as anamnestic responses to prior transfusions or pregnancies. The eight RBC-A were attributed to the following antibodies: three anti-Jka, one anti-E, one anti-FYa plus unidentified antibody, one anti-Fya, one anti-Jkb, and one anti-Fy3. The low rate of HTR and prior RBC-A detected posttransfusionally in a large cancer center such as this may be used to support the conclusion that the use of T & S with IS-XM is a reasonably safe procedure.

Blood Component Transfusion↗
PubMed1991

Fibrin glue for partial nephrectomy.

Fibrin glue, a mixture of concentrated autologous fibrinogen and bovine-derived thrombin, was used to achieve hemostasis during 7 partial nephrectomies. After transected vessels were suture ligated, topically applied fibrin glue filled all renal defects with an adherent clot that resulted in immediate hemostasis. There was no case of delayed hematoma or abscess formation, and no complications were referrable to the use of fibrin glue. Although fibrin glue is no substitute for early vascular control and careful surgical technique, its ability to stop venous oozing from the cut surface of renal parenchymal tissue dramatically facilitates hemostatic control.

Fibrin Tissue Adhesive↗
PubMed1991

Highly oncolytic adherent lymphocytes: therapeutic relevance for leukemia.

We have generated and characterized a highly oncolytic adherent lymphocyte subset (A-LAK) from eight leukemic patients with non-lymphocytic leukemia (NLL) in remission and one NLL patient in relapse. Our studies demonstrated that A-LAK was superior in its oncolytic activity (tested in a 3-h 51Cr release assay) to conventionally prepared (LAK) and non-adherent (NA) IL-2 cultures. No activity was observed by this highly oncolytic subset against normal bone marrow (BM). A-LAK also displayed highest proliferative activity in 7-11 day cultures (5- to 58-fold expansion) in comparison to LAK (0.7- to 2.7-fold) or NA (1.0- to 2.6-fold) cultures. Analysis of phenotype of unseparated, NA and adherent (A-LAK) lymphocytes 24 h after IL-2 activation showed that the A-LAK was composed predominantly of high intensity (bright) CD11a+ (LFA-1) lymphocytes (75 +/- 4.8%) when compared to the other two populations (12 +/- 2.1%). Similarly, A-LAK contained higher proportion of CD11b (CR3 receptor)-positive lymphocytes (39 +/- 2.1%) than unseparated and NA lymphocytes (11 +/- 1.4%). Double marker phenotypic studies showed that A-LAK cultures were heterogeneous and distribution of individual lymphocyte subsets differed among NLL patients. While in A-LAK culture of some patients the CD56+, CD3- natural killer (NK) cell subset was predominant, CD3+, CD56- lymphocyte subset was prevalent in others. Highest A-LAK lytic activity was always correlated with highest NK cell content. Characterization studies (using the complement-depletion technique) showed that independently of the distribution of lymphocytes in A-LAK cultures, CD16+, CD56+, CD3- NK cell subset displayed highest oncolytic effect. CD5+ subset also participated in cytotoxic function. These observations indicated that A-LAK may represent a new therapeutic approach to treatment of leukemia.

Adult↗
PubMed1991

In vitro response of peripheral blood mononuclear cells to phytohemagglutinin and interleukin-2.

The serological determination of class II antigens is still a mandatory test prior to allotransplantation. It is known that these antigens are normally expressed on B lymphocytes and monocytes. The B lymphocytes that constitute 10% to 15% of total blood lymphocytes are the cells currently used for HLA-DR typing. To avoid HLA-DR typing difficulties, or even impossibilities that are frequently encountered among some patient groups, we studied the response of peripheral blood mononuclear cells--as an alternative source of cells for class II antigen typing--to in vitro mitogen and interleukin-2 activation and propagation. Although the patients included in this study were selected having previously known HLA-DR typing difficulties, all could be adequately typed by this method.

B-Lymphocytes↗
PubMed1991

Leukocyte-poor blood components: issues and indications.

Leukocyte-poor blood components (LPBC) have now become part of the armamentarium of available transfusable blood components. Indications for the use of LPBC vary in accordance with the underlying clinical condition, as well as the intended objectives of the transfusion therapy. Technological advances have made it possible to prepare LPBC using rather simple procedures. However, any manipulation of blood components and the additional use of filters, washing, rinsing solutions, etc. inevitably result in additional costs to the patient, the health-care institution, or third-party payers. Requests for LPBC involve the preparation of RBC or platelets, leuko-depleted by at least one log. Transfusion of LPBC must be done in a logical fashion that meets the needs of the patient. Currently, LPBC is indicated for patients with a history of nonhemolytic febrile transfusion reactions to delay alloimmunization to HLA antigens and avoidance of cytomegalovirus (CMV) infection.

Blood Component Removal↗