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Biomedical subjects

M A Popovsky

Publications and source records attributed to M A Popovsky.

At least 55 records · Page 3Linked to original sources
PubMed1996

Assessment of blood donor privacy during health history interviews.

BACKGROUND: Given the personal nature of health history interviews, it is important to provide donors with both visual and auditory privacy. Privacy is affected by variables such as background noise, the use of visual screens, and the loudness of the donor's voice. STUDY DESIGN AND METHODS: In Phase I of this study, an interview station and waiting area were simulated. To measure auditory privacy, a speech intelligibility test was given to subjects with and without the use of a free-standing privacy screen and masking noise device. Phase II was a field trial designed to evaluate screens and masking noise. Background noise was measured during each blood collection operation, and donors completed a survey. RESULTS: In Phase I, speech intelligibility test scores ranged from 78 to 5.1 percent, depending on the type of visual screen and the number of masking noise devices used. In Phase II, with the use of screens, 94 percent of donors rated visual privacy as "good to excellent," compared with 74 percent who did so when no screens were used. At many blood drives, the background noise level exceeded the level of the masking noise. CONCLUSION: The use of visual screens increases donors' perception of visual privacy. The use of masking noise is effective only when the health history interview is conducted under conditions of low background noise levels.

Blood Donors↗
PubMed1996

The role of the transfusion medicine consultant.

Over the last 15 years, the field that was once known as blood banking has evolved into the discipline of transfusion medicine. Because of AIDS and a greater appreciation of other transfusion-transmitted diseases, attitudes toward transfusion therapy have changed significantly. Advances in the understanding of the pathophysiology of anemia and thrombocytopenia, as well as new tools for transfusion support have created new roles for the transfusion medicine physician. The transfusion medicine consultant has the opportunity to influence and improve transfusion safety, and contribute positively to cost containment by providing expertise as an educator, auditor of blood component usage, and providing leadership or oversight of therapeutic modalities (such as autologous transfusion, intraoperative red cell salvage, and therapeutic apheresis).

Blood Banks↗
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

Transfusion-associated circulatory overload in orthopedic surgery patients: a multi-institutional study.

Although recognized as a serious complication of hemotherapy, few data are available on the incidence of transfusion-associated circulatory overload (TACO). Detailed demographic and clinical information was obtained from records of 382 Medicare patients undergoing total hip or knee replacements (and receiving transfusions) from January 1992 to December 1993 at five Massachusetts hospitals. Seventy-eight percent of the patients were women with a mean age of 77 years. Thirty-two percent had co-morbidities including myocardial or coronary disease. Transfusion-related complications and comorbidities were identified and reviewed by transfusion experts. Patients were excluded from consideration if non-transfusion factors such as myocardial disease could have contributed to the development of acute pulmonary edema. Four (3 females, 1 male) patients (1.05%) developed TACO postoperatively. Mean age of these patients was 84 years (range, 75-101) versus 77 years for non-TACO. The mean intraoperative estimated blood loss was 375 mL. Each patient received only 1-2 units of red blood cells prior to onset of TACO, and in two cases only autologous blood was used. The mean positive fluid balance was 2,480 mL. The mean pretransfusion hematocrit prior to circulatory overload (CO) was 26.0 percent. Symptoms were reversed with diuretics. Length of stay was significantly prolonged by these incidents. TACO is a frequent and serious event in an orthopedic surgical setting. It is associated with advanced age, increased health care costs, and may occur in the setting of modest transfusion volumes. The utilization of conservative transfusion criteria and fluid management in the perioperative setting may decrease the incidence of this complication in this population.

Journal Article↗
PubMed1996

Long-term impact of recombinant human erythropoietin on transfusion support in patients with chronic renal failure.

Published reports on the impact of recombinant human erythropoietin (r-HuEpo) on transfusion requirements of patients with chronic renal failure have been limited to small populations and relatively brief follow-up. In this study we reviewed the effects of this drug on 86 patients with well-characterized transfusion requirements, followed for 18 months at seven dialysis centers. The median red blood cell transfusion requirements per patient per year decreased from 14 in 1987 and 1988 to 11 in 1989, when r-HuEpo was licensed in the United States (p <.01) and fell to 2 in 1990 (p <.01). The proportion of patients who became transfusion-independent increased from 34 percent in 1989 to 69 percent in 1990 (p <.001). These data demonstrate that r-HuEpo significantly decreases transfusion requirements of patients with chronic renal disease.

Journal Article↗
PubMed1995

Transfusion practices in human immunodeficiency virus-infected patients.

BACKGROUND: The reported immunomodulatory effects of transfusion raise concern about the potential for virus activation and tumor growth in human immunodeficiency virus (HIV)-infected patients. In the absence of "standards" of transfusion practice for such patients, a survey of transfusion policies among institutions specializing in the care of HIV-infected patients was performed to delineate current practices. STUDY DESIGN AND METHODS: A survey developed by the Transfusion Practices Committee of the American Association of Blood Banks was sent to 47 AIDS clinical trial units and 14 regional hemophilia centers in North America. RESULTS: Forty-three percent of centers completed the survey. Most centers observed more than 200 HIV-infected patients each. The key findings were that 1) 81 percent of centers used identical red cell transfusion criteria for HIV-infected and noninfected patients; 2) 52 percent used recombinant human erythropoietin as initial treatment for zidovudine-induced anemia, while 46 percent used recombinant human erythropoietin for anemia not associated with zidovudine; 3) 35 percent of centers used white cell-reduced blood components in lieu of cytomegalovirus (CMV)-seronegative components when administering transfusion(s) to CMV-seronegative patients; 4) 27 percent gamma-radiated cellular components, but no case of graft-versus-host disease had been observed; 5) > 85 percent of centers used monoclonal factor VIII for pediatric and adult hemophiliacs infected with HIV; 6) approximately one-third of centers routinely white cell-reduced cellular components; and 7) the most common reasons for white cell reduction included reduction of febrile reactions and CMV risk, reduction of platelet alloimmunization, and delay of immunomodulatory consequences of transfusion. CONCLUSION: There is marked heterogeneity in transfusion practice for HIV-infected patients. Modification of cellular components to achieve different objectives is routine in many centers.

Blood Transfusion↗
PubMed1995

Severe outcomes of allogeneic and autologous blood donation: frequency and characterization.

BACKGROUND: There are few published data on severe outcomes of the donation of blood for allogeneic or autologous use. It would be helpful if blood collectors could better characterize and/or predict the likelihood of significant complications of blood donation. STUDY DESIGN AND METHODS: Very severe outcome (VSO) was defined as an event requiring hospitalization. Approximately 4.1 million American Red Cross whole-blood donation records (July 1993-March 1994) were reviewed for the incidence and type of VSO. RESULTS: A total of 33 VSOs occurred for all donations. The incidence of VSOs for allogeneic donation was 1 (0.0005%) in 198,119 and that for autologous donation was 1 (0.006%) in 16,783 (p < 0.001). First-time donors were three times as likely to have a VSO. Donors > 40 years old had 87.9 percent of the VSOs, and donors > 60 years old had 48.5 percent. Vasovagal (66.7%) and anginal (12.1%) episodes were the most frequent complications, and 66.7 percent of reactions occurred at the blood collection site. The mean hospital stay was 1.9 days. CONCLUSION: VSO is an infrequent complication of all types of blood donation, but its occurrence may be associated with significant morbidity and cost. VSO is nearly 12 times as likely in autologous blood donors.

Adolescent↗
PubMed1994

Pseudoaneurysm of the brachial artery: a rare complication of blood donation.

BACKGROUND: Serious complications of blood donation are rare. Reported here is a significant vascular event that resulted from whole-blood phlebotomy and required surgical repair. CASE REPORT: A 49-year-old woman donated whole blood without incident in November 1992, but reported ecchymosis and tenderness in the antecubital area of the right arm immediately following the procedure (her medical history was unremarkable). Over the next several days, the ecchymosis extended to the axilla and she complained of numbness in all her fingers, particularly the thumb and adjacent two fingers of the involved side. Coincident to these findings, an egg-sized lump developed under the skin at the phlebotomy site. Her symptoms and the mass persisted for several weeks. Examination and ultrasound performed in January 1993 demonstrated a pulsatile mass over the brachial artery. The donor underwent an exploratory surgical procedure that revealed a 3.3 x 2.5 x 2.0-cm pseudoaneurysm of the brachial artery. Unlike a true aneurysm, this lesion was composed only of a blood clot that was compressing the outer wall of the artery. A pinpoint-sized hole was seen in the artery when the lesion was excised. The phlebotomy is believed to have caused blood to leak out of the artery, creating the lesion and exerting pressure on the median nerve. CONCLUSION: Pseudoaneurysm of the femoral artery is a well-documented complication of cardiac catheterization and other invasive arterial procedures, but this is the first known reported case following blood donation. Blood collectors should be made aware of this potentially serious complication of blood donation.

Aneurysm↗
PubMed1994

Donor follow-up of influenza vaccine-related multiple viral enzyme immunoassay reactivity.

False-positive enzyme immunoassay (EIA) tests in blood donors receiving influenza vaccine were first reported in 1991. We conducted follow-up testing for 6 months of those donors with multiply reactive, but unconfirmed EIA (at least 2 positives in anti-HCV-1.0, anti-HIV-1, and anti-HTLV-I assays) with a history of recent flu vaccine to determine the duration of false positivity. Of 133,000 donors tested, 16 met study criteria; all 16 were reactive for anti-HCV, 10 were reactive for anti-HIV-1, and 12 were reactive for anti-HTLV-I. Fifteen donors were available for follow-up testing (using the original screening and supplemental tests): 10 (67%) reverted to negative for the 3 tests and 5 remained false positive for various markers at last sampling (3-6 months after vaccination). The mean duration of false positivity for those reverting to negative EIA test status, was 4.2 months (range 2-7 months) indicating a transient phenomenon and supporting studies which suggest a role for IgM in the mechanism.

Adolescent↗
PubMed1993

A controlled trial of educational outreach to improve blood transfusion practice.

OBJECTIVE: To determine whether brief, face-to-face educational outreach visits can improve the appropriateness of blood product utilization. DESIGN: Randomized, controlled multicenter trial with 6-month follow-up. SETTING: Surgical and medical services of two pairs of matched community and teaching hospitals in Massachusetts. PARTICIPANTS: One hundred one transfusing staff surgeons and attending medical physicians. INTERVENTION: A professionally based transfusion specialist presented one surgical- or medical-service-wide lecture emphasizing appropriate indications, risks, and benefits of red blood cell transfusions; brief, graphic, printed educational guidelines; and one 30-minute visit with each transfusing physician. No data feedback was provided. Educational messages emphasized the lack of utility of the traditional threshold for red blood cell transfusions (hematocrit, 30%) and transfusion risks (eg, viral hepatitis). MEASURES: Proportion of red blood cell transfusions classified as compliant or noncompliant with blood transfusion guidelines, or indeterminate 6 months before and 6 months after an experimental educational intervention. RESULTS: Based on analyses of 1449 medical record audits of red blood cell transfusions that occurred 6 months before and 6 months after the educational intervention, the average proportion of transfusions not in compliance with criteria declined from 0.40 to 0.24 among study surgeons (-40%) compared with an increase from 0.40 to 0.44 (+9%) among control surgeons (P = .006). These effects were consistent across procedure type and specialty. On average, study surgeons in the postintervention period performed transfusions when hematocrits were 2.0 percentage points lower than before the intervention (28.3% preintervention vs 26.3% postintervention), and lower than in the control group (28.3% preintervention and postintervention; P = .04). Likely savings in blood use for surgical services probably exceeded program costs, even without considering reduced risks of infection. No effects were observed among transfusions occurring in medical services, possibly because of substantially lower transfusion rates and lower pretransfusion hematocrits. CONCLUSIONS: Brief, focused educational outreach visits by transfusion specialists can substantially improve the appropriateness and cost-effectiveness of blood product use in surgery. More data are needed regarding the durability of changes in practice patterns and the health and economic benefits of such interventions.

Blood Transfusion↗
PubMed1993

Anti-Uz found in mother's serum and child's eluate.

A saline-reactive antibody, anti-Uz, that reacted stronger with S+ than with S- red blood cells (RBCs) and failed to react with U- or ficin-treated RBCs has been previously reported. We describe an antibody of similar specificity in the postpartum serum of an untransfused woman and the eluate from her fourth child's cord RBCs. The mother's RBCs typed S-s+U+, He+(weak), and appeared to have normal glycophorin A and B content, as deter- mined by immunoblotting. The direct antiglobulin test (DAT) and the autocontrol were negative. Her serum reacted stronger with S + RBCs only in the antiglobulin phase, and failed to react with U- or ficin-treated RBCs. The antibody was adsorbed completely by S-s+U+ RBCs, proving that anti-S was not present. Monocyte monolayer assay results with S+s-U+ and S-s+U+ RBCs indicated that transfusion of incompatible blood would not result in significant hemolysis. The child's cord RBCs typed S-s+. The DAT was 3+ with anti-IgG, and an eluate prepared from these RBCs had the same reactivity as the maternal serum. The child showed no clinical signs of hemolytic disease of the newborn. In contrast to previous reports, these results suggest an immune form of anti-Uz.

Journal Article↗