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Biomedical subjects

M Spivack

Publications and source records attributed to M Spivack.

At least 19 recordsLinked to original sources
PubMed1998

Randomized trial comparing packed red cell blood transfusion with and without leukocyte depletion for gastrointestinal surgery.

BACKGROUND: Allogeneic transfusion is associated with postoperative infections that significantly prolong hospital stays and increase costs. Recent studies suggest that filtering leukocytes from blood prior to transfusion reduces the risk of postoperative infection associated with blood transfusion. We compared the incidence of postoperative infections, hospital stays, and hospital charges of gastrointestinal surgery patients transfused with packed red cells or leukocyte-depleted cells. METHODS: Consecutive patients admitted for elective gastrointestinal surgery without previous blood transfusion were randomized to receive routine packed red cells or packed red cells filtered to remove leukocytes if transfusion was required. Multivariate analysis was used to assess the significance of the relationship between leukocyte-depleted blood and postoperative infectious complications, postoperative stay, and hospital charges. RESULTS: Fifty-nine (27%) of the 221 patients were transfused. The most significant variable related to transfusion was intraoperative blood loss (P <0.0001), followed by admission hematocrit (P <0.0001) and age (P = 0.0022). Infections were noted in 16% of the patients: 11% of untransfused patients, 16% of leukocyte-depleted blood recipients, and 44% of patients transfused with packed red cells. Both operative site and nosocomial infections were significantly (P <0.001) more frequent in patients transfused with packed red cells compared with patients transfused with leukocyte-depleted red cells. Postoperative stays averaged 9 days for untransfused patients, 12 days for leukocyte-depleted recipients, and 18 days for recipients of packed red cells. Hospital charges were $19,132, $33,954, and $41,002, respectively. Both transfusion and infection were significantly (P <0.001) related to postoperative stay in multivariate analysis. Hospital charges were significantly related to postoperative stay (P <0.001), blood loss (P <0.001), age (P <0.001), infection (P = 0.007), and randomization to packed red cells (P = 0.032). CONCLUSIONS: Filtering blood of leukocytes prior to transfusion for elective gastrointestinal surgery is associated with lower risk of postoperative infection, shorter postoperative stays, and lower hospital charges.

Cost-Benefit Analysis↗
PubMed1994

Increased incidence of HLA antigen B35 in patients with chronic lymphocytic leukemia.

We and others have reported an increased incidence of chronic lymphocytic leukemia (CLL) among Ashkenazi (ASH) Jews of European origin. We performed HLA Class I typing on all 50 CLL patients seen by us and compared them with 3886 controls consisting of healthy blood donors from the New York Blood Center. Thirty of our CLL patients were ASH Jews, 17 of whom (57%) expressed the B35 antigen compared with 462 ASH controls (26%). Seven (39%) of the CLL Caucasian patients expressed the B35 antigen compared with 305 (14.5%) of the Caucasian controls. Combining the information from the ASH Jews and the Caucasians the difference is highly significant, (p = 0.0001). The summary odds ratio was 3.7. These results indicate an increased incidence of the antigen B35 amongst ASH and Caucasian patients with CLL.

Adult↗
PubMed1986

Porphyria cutanea tarda in a patient with acute leukemia.

A 20-year-old woman with acute nonlymphocytic leukemia in remission was treated postremission with intermittent courses of intensive chemotherapy. She required blood and platelet transfusions following therapy, and oral contraceptives were used to suppress her menses while she was thrombocytopenic. One and one-half years after treatment began, she developed blisters on her hands, hypertrichosis, and dark urine. The diagnosis of porphyria cutanea tarda was made. This report discusses the possible precipitating cause(s) and the subsequent treatment of both her porphyria and her leukemia.

Adult↗
PubMed1979

An in vivo evaluation of microaggregate blood filtration during total hip replacement.

In order to evaluate the effect of microaggregate blood filtration on pulmonary status, hemostatic status, and incidence of infection, a prospective study was performed on patients undergoing elective total hip replacement for osteoarthritis. Forty patients were randomized to either a 260 micron standard filter group or a 20 micron microaggregate filter group. Patients were monitored pre- and postoperatively for changes in arterial blood gases and in vitro test of hemostasis. Postoperative measurements were also made of the total volume of blood collected from the operative wound drain and of the number of infections incurred by patients in the two filter groups. Average transfusion was 4.0 units for the standard filter group and 4.6 units for the microaggregate filter group. Results showed that postoperatively, either immediately or after 48 hours, there were no statistically significant differences (p greater than 0.05) between either filter group for any of the tests of pulmonary or hemostatic function evaluated. For infection no trends were found to suggest that microaggregate filters conveyed any protective effect. These data suggest that routine microaggregate blood filtration of up to 5 units of blood is not required.

Adult↗
PubMed1975

Folic acid deficiency in the United States: folate assays in a prenatal clinic.

Tissue deficiency of folic acid, as measured by a red cell folate level below 150 ng. per milliliter, was present in 16 per cent of 110 sequential pregnant women at the time of their first prenatal visit to a municipal clinic. A further 14 per cent of subjects had red cell folate levels in the range "suggestive but not conclusive for tissue folate depletion" (150 to 199 ng. per milliliter). All of the subjects were from low-income families in New York City and most were black or of Puerto Rican origin. Serum folate levels showed good general correlation with red cell folate but were of less value as a diagnostic test, since they were below the lower limit of normal in 64 per cent of subjects, including many subjects who did not yet have low tissue folate. In contrast to their value in other folate deficiency states, neutrophil lobe counts showed no correlation with serum or red cell folate levels in pregnancy and thus appeared of little diagnostic value in pregnancy. It is suggested that surveys of folate deficiency in other pregnant population groups in the United States be carried out. These results support the recommendations of the Committee on Maternal Nutrition and the Committee on Dietary Allowances of the Food and Nutrition Board, National Research Council (U.S.A.) that folic acid supplements (200 to 400 mug per day) should be taken throughout pregnancy.

Black or African American↗
PubMed1975

Intravascular hemolysis: a complication of midtrimester abortion: a report of two cases.

Intravascular hemolysis occurred twice in a series of 1582 consecutive intraamniotic midtrimester saline abortions. The hemolysis was associated with consumption coagulopathy and acute renal failure. Both patients made a complete recovery after a prolonged hospital stay; one required peritoneal dialysis. The pathogenesis of this serious complication of saline abortion is discussed but no satisfactory explanation has been reached.

Abortion, Induced↗