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J D Milam

Publications and source records attributed to J D Milam.

At least 19 recordsLinked to original sources
PubMed2000

A java-based application for differential diagnosis of hematopoietic neoplasms using immunophenotyping by flow cytometry.

We describe the implementation of a Java-based application for differential diagnosis of hematopoietic neoplasms using immunophenotyping by flow cytometry. The current version of this Java applet includes the knowledge-base for 33 hematopoietic neoplasms and 43 diagnostic immunophenotyping markers. Java, a new object-oriented computing language, helps facilitate development of this applet, a platform-independent module that can be implemented on the World Wide Web. As the Web rapidly becomes more accessible to users around the world, Web-based software may eventually form the core of decision-support systems in clinical settings. Java-based applications, such as the one described in this paper, are expected to contribute significantly in this area.

Antigens, CD↗
PubMed2000

A relational database for diagnosis of hematopoietic neoplasms using immunophenotyping by flow cytometry.

A relational database was developed to facilitate the diagnosis of hematopoietic neoplasms using results of immunophenotyping by flow cytometry. This database runs on personal computers and uses backward-chaining search to arrive at conclusions. Results of immunologic marker studies are processed by the database to obtain a set of differential diagnoses. The current version of this database includes diagnostic immunophenotyping pattern for 33 hematopoietic neoplasms. We tested this database using 92 clinical cases from 2 tertiary care medical centers. The database ranked the actual diagnosis as 1 of the top 5 differential diagnoses in 93% of the cases tested. The user can modify the database contents to suit individual needs. This database has been posted on the World Wide Web for direct access. We propose that this user-friendly database is a potential tool for computer-assisted diagnosis of hematopoietic neoplasms.

Antigens, CD↗
PubMed1998

Practice parameter for the use of red blood cell transfusions: developed by the Red Blood Cell Administration Practice Guideline Development Task Force of the College of American Pathologists.

A practice parameter has been developed to assist physicians in the therapeutic use of red blood cell transfusions. The developers of this parameter used the best available information from the medical literature, as well as clinical experience and the extensive reality testing required by the College of American Pathologists for approval. In acute anemia, a fall in hemoglobin values below 6 g/dL or a rapid blood volume loss of more than 30% to 40% requires red blood cell transfusions in most patients. However, tissue oxygenation provides a better indication of physiologic need in situations where invasive monitoring provides this information. When these data are not available, heart rate and blood pressure measurements and the nature of bleeding (active, controlled, uncontrolled) supplement the hemoglobin value in guiding the transfusion decision. In sickle cell disease and thalassemias, red blood cells are transfused to prevent acute or chronic complications. Red blood cell transfusions are used in chronic anemias unresponsive to pharmacologic agents based on the patient's symptoms. Guidelines must be altered for neonates who require an increase in hematocrit to above 0.30 to 0.35 when respiratory distress is present. Indications for red blood cell transfusion for the pregnant or postpartum patient are similar to those for the nonpregnant patient. Risks of transfusion, particularly transmissible disease and incompatibility, remain but have been reduced. Thus, red blood cell transfusion continues to be a powerful therapeutic tool when used judiciously and carries less risk than in the recent past.

Adult↗
PubMed1996

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. Program directors indicated that either the current level, or fewer, transfusion medicine specialists will be needed in the future. The educational content of fellowship training was examined, as well as aspects of proficiency and competency in several areas. 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.

Blood Banks↗
PubMed1996

Case reports: delayed hemolytic transfusion reaction in sickle cell disease.

This article reports the details of delayed hemolytic transfusion reactions in four patients with sickle cell disease. These cases demonstrate the characteristics of the reactions, the significant risks involved, and the principles useful in diagnosis and treatment. Patients with sickle cell disease are at particular risk for delayed hemolytic transfusion reactions because they may be transfused at intervals over many years; they frequently form alloantibodies because of antigenic differences from the donor population; and they may receive emergency care in different hospitals where transfusion records are not available. In addition, exchange transfusions, which are often used for patients with sickle cell disease and which were given in three of these cases, raise the risks through increased exposure to foreign erythrocyte antigens and through an increased volume of erythrocytes susceptible to hemolysis. It was concluded that the hazards of these transfusion reactions justify preventive measures, such as extended erythrocyte phenotyping of patients with sickle cell disease and extended phenotypic matching of transfused cells.

Adult↗
PubMed1996

A rule-based expert system for laboratory diagnosis of hemoglobin disorders.

OBJECTIVE: To illustrate the utility of a rule-based expert system in diagnosing hemoglobin disorders. DESIGN: A rule-based expert system was developed for diagnosing hemoglobin disorders. This expert system runs on IBM-compatible personal computers and uses a backward-chaining search strategy to draw conclusions. Laboratory data (ie, results of hemoglobin electrophoresis, quantitative measurements of hemoglobin F and hemoglobin A2 levels, and result of a sickle cell screen) are processed by the system using defined rules to obtain a set of differential diagnoses. Additional data, such as hematologic parameters, ethnicity of the patient, and the presence or absence of certain clinical signs and symptoms, aid in making a final diagnosis. The rules in the current version of this expert system include diagnostic criteria for 71 hemoglobin disorders. SETTING: Regional academic medical center. PATIENTS: We tested the system by using 58 survey sample cases offered by the College of American Pathologists during the period of January 1989 through December 1994. MAIN OUTCOME MEASURE: The established diagnosis for a given case must be included in the list of differential diagnoses suggested by the expert system. RESULTS: The expert system included the actual diagnosis as one of the top four differential diagnoses in 90% of the cases, whereas all the laboratories participating in the survey included it in 84% (mean) of the cases. CONCLUSION: We propose that this user-friendly expert system is a potential tool for computer-assisted diagnosis of hemoglobin disorders.

Clinical Laboratory Techniques↗
PubMed1995

Laboratory medicine parameter. Utilizing monospecific antihuman globulin to test blood-group compatibility.

When using polyspecific antihuman globulin (AHG) reagents to detect unexpected antibodies or for crossmatching, reactivity in the AHG phase may be due exclusively to the AHG anticomplement component. A lengthy evaluation may be needed to prove that the reactivity is caused by a "nuisance" antibody, one that is clinically insignificant. Clinically significant transfusion intolerance is rare when caused by blood group alloantibodies, which are detected only with AHG sera that contain anticomplement activity. Using monospecific anti-IgG AHG reagents to detect unexpected antibodies offers reliability while avoiding interference from some common and clinically insignificant IgM complement-fixing antibodies, and thereby saves time and expense.

Antibodies, Anti-Idiotypic↗
PubMed1990

Serial maternal blood donations for intrauterine transfusion.

Because of concern regarding viral disease transmission, 21 pregnant women who had been alloimmunized to various red-cell antigens donated 77 units of blood (range two to six donations) for intrauterine transfusion to their anemic fetuses. Patients received supplemental iron and vitamin therapy throughout the blood donation period. Before the first donation, the mean (+/- SD) maternal hematocrit was 34.4 +/- 2.8%, whereas at delivery it was 33.4 +/- 3.5%. Maternal hematocrit was noted to decline slightly between the first and second donations but returned to pre-donation values with subsequent donations. No adverse maternal or fetal effects occurred secondary to repeated donations. Use of maternal designated-donor red cells for intrauterine transfusion offers potential advantages over the use of random allogeneic red blood cell units.

Adult↗
PubMed1988

Cardiovascular surgery in patients with congenital plasma coagulopathies.

From 1978 to 1986, fifteen cardiovascular operations were performed on 13 patients with known congenital bleeding disorders. The patients (10 men and 3 women) had a mean age of 51.1 +/- 3.4 years. Four were seen with cardiovascular lesions and documented hemophilia A (Factor VIII deficiency); 3 had hemophilia B (Factor IX deficiency); 3 had Factor XI deficiency; 2 had von Willebrand's disease, and 1 had dysfibrinogenemia. All patients had a history of major hemorrhage after dental extractions or general surgical procedures, and had clearly documented coagulation disorders on hematological evaluation. Elective cardiovascular procedures performed in these patients included aortocoronary bypass grafting (eight), cardiac valve replacement or repair (five), aortic graft placement (one), and carotid endarterectomy (one). The mainstay of perioperative management included appropriate replacement therapy with blood components. Coagulation factor levels were measured routinely to guide therapy. There were no deaths. Two hemorrhagic complications necessitated reexploration. We conclude that in patients known to have congenital coagulation disorders, cardiovascular operations using systemic heparinization can be performed with minimal morbidity and mortality when carried out with preoperative and perioperative support from the hematology service, adequate replacement therapy using blood components, and careful monitoring of the coagulation status.

Afibrinogenemia↗
PubMed1986

Rare primary sarcomas of the heart.

Three patients with primary malignant cardiac neoplasms are described. All tumors were intracavitary myxomatous masses of the left atrium. Preoperative clinical diagnostic techniques did not indicate malignancy, but suggested mitral stenosis, cor triatriatum, and cardiac myxoma. Grossly, the tumors were sessile rather than pedunculated, and they invaded the underlying structures. Microscopically, although the tumors resembled benign cardiac myxomas, they exhibited mitotic activity and areas of necroses. Ultrastructural examination revealed a spectrum of differentiated mesenchymal cells that lacked the maturation features of cardiac myxoma cells. These gross, microscopic, and ultrastructural features, which suggested the tumors' malignant potential, should help in the early recognition and management of similar tumors.

Adult↗
PubMed1985

Use of sufficient hemodilution to prevent coagulopathies following surgical correction of cyanotic heart disease.

During surgical correction of cyanotic heart disease with associated polycythemia, sufficient reduction of hemoglobin and hematocrit values has proved effective in preventing postoperative coagulopathies. Three groups of surgical patients were studied: Group I--a control group consisting of 75 adults undergoing uncomplicated correction of acquired heart disease and requiring no blood or blood component transfusion; Group II--15 patients with tetralogy of Fallot whose intraoperative hemoglobin values remained above 10 gm/dl with conventional hemodilution techniques; and Group III--21 cyanotic surgical patients whose intraoperative hemoglobin values were lowered to less than 10 gm/dl with sufficient hemodilution. Group III was further broken down into a subgroup of six patients (Group IIIa) who underwent sequential laboratory determinations, as in Group I. In Group IIIa, postoperative coagulation function tests were only slightly more abnormal than in the nonpolycythemic control group (Group I). Patients in Group III (who had ample hemodilution) experienced 45% less bleeding and required 54% fewer blood components than those in Group II (who underwent conventional hemodilution).

Adolescent↗
PubMed1984

Use of deglycerolized red blood cells to prevent posttransfusion infection with cytomegalovirus in neonates.

In an effort to reduce the rate of posttransfusion infection with cytomegalovirus (CMV), 157 CMV-seronegative neonates were given deglycerolized red blood cells as their only source of red blood cells. Other blood products given to these patients received no special preparation. The 106 (67.5%) infants available for adequate evaluation received an average of 5.7 units (range, one to 39 units). Three hundred thirteen (51.4%) of the 609 transfused units were CMV-seropositive. When evaluated three months after their last transfusion, none of the 106 infants had virological or serological evidence of CMV infection. These results suggest that regardless of the serological status of the donor, deglycerolized red blood cells can reduce or possibly eliminate posttransfusion CMV infection and can serve as a safe alternative to CMV-seronegative blood. Freezing, depletion, and physical disruption of leukocytes may be responsible for the decreased infectivity of the deglycerolized product.

Birth Weight↗