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Recombinant factor VIIa (rFVIIa) is used in patients with hemophilia who had developed inhibitors. A hemostatic effect has been demonstrated following the administration of rFVIIa in patients after trauma and bleeding. Currently, there is no widely accepted guideline for off-label rFVIIa usage in bleeding patients. We planned to review the rFVIIa utilization practice in our institution and develop policies and guidelines for future rFVIIa use. We acquired the medical records of 55 patients who received rFVIIa at our institution during 2003-2004. Patient charts were reviewed regarding their rFVIIa administration and indications, dose and frequency, cost, pre-rFVIIa blood component usage, utilization of hematology services and outcome were analyzed. Underlying liver disease with coagulopathy was the commonest (47%) indication for rFVIIa use. Recombinant FVIIa was successful (69%) in correcting laboratory parameters of coagulopathy, but did not alter outcome. Twenty-six of the 55 patients (47%) died during the same admission from their underlying diseases. Apart from two trauma patients, no one died from bleeding. We conclude that unregulated continuous administration of rFVIIa in bleeding/coagulopathic patients did not alter outcome. Closer monitoring of rFVIIa usage, including hematology consultation and enforcement of pre-rFVIIa blood component usage would optimize cost-effectiveness.

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The need for blood components for oncology patients is small compared with the need for patients with hematologic malignancies. The subject is important because use of these valuable components is dependent on a limited supply and availability. Agreement on when to use components is extremely important. In fact, at the time of this writing, the Transfusion Practices Committee of the American Association of Blood Banks is conducting an extensive survey on the use of platelets in oncology and hematology cancer patients (Questionnaire on Institutional Policy on Platelet Transfusion Practice for Hematology/Oncology Patients). The results will, we hope, provide a consensus on the proper times and counts that require prophylactic use of components for these patients. Because these patients use the vast majority of components (see Table 15), their proper use is imperative to maintaining an adequate platelet and frozen plasma supply. Transfusion support in cancer patients is vital for their survival. Platelets, in particular, are necessary to prevent serious bleeding. The risks from transfusion must always be considered. Fortunately, with increased monitoring of the blood supply, they have been reduced. As with any therapeutic regimen, these risks must be weighed against the benefit the patient may gain. Transfusion should always be used prudently.

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The need for blood components for oncology patients is small compared with the need for patients with hematologic malignancies. Appropriate use of blood components is necessary, not only medically, but also because of limited supply and availability. Agreement on when to use components is extremely important. In fact, at the time of this writing, the Transfusion Practices Committee of the AABB is conducting an extensive survey on the use of platelets in the oncology and hematology cancer patients (Questionnaire on Institutional Policy on Platelet Transfusion Practice for Hematology/Oncology Patients). The results will, it is hoped, provide a consensus on the proper times and counts that require prophylactic use of components for these patients. Since these patients use the vast majority of components (see Table 15), their proper use is imperative to maintaining an adequate platelet and frozen plasma supply. Transfusion support in cancer patients is vital for their survival. Platelets, in particular, are necessary to prevent serious bleeding. However, refractoriness to platelet transfusions can develop. It must be appreciated that refractoriness is not a general problem and need not require the expensiveness of a universal decision for handling all platelet transfusions in the same manner. Total refractoriness probably occurs in 15 to 20% of patients frequently transfused. In patients in whom frequent platelet transfusion is anticipated, that is, bone marrow transplantation, the development of platelet refractoriness may be reduced by using SDPC and administering them through leukocyte filters. Patients who become refractory to either random or SDPC can either be cross-matched for single-donor platelets that are compatible or can be given HLA-A,B matched platelets. Certainly, the success of platelet transfusion in leukemic patients cannot be denied, since only a small number of these patients now die because of bleeding due to platelet refractoriness. Most of the serious bleeding still seen is associated with sepsis. The risks from transfusion must always be considered. Fortunately, with increased monitoring of the blood supply, they have been reduced. As with any therapeutic regimen, these risks must be weighed against the benefit the patient may gain. Transfusion should always be used prudently.

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Healthcare bar code applications have developed more slowly than industrial or supermarket bar codes, but they are beginning to gain acceptance. Clinical laboratories that use bar code systems have already improved productivity and, more importantly, patient care through reduction of human clerical errors in identifying laboratory samples. Soon, integration of proven technology should expand the benefits of automatic ID to a broader range of healthcare applications.

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Deoxyribonucleic acid (DNA) fingerprints are Southern blots which have a pattern resembling bar codes. The pattern is created by DNA probes that bind to variable-length repeated sequences of human genomic DNA digested with restriction endonucleases. To improve DNA fingerprints obtained with biotin-labeled M13mp8 replicative form (RF) bacteriophage as the gene probe, the conditions for hybridization and the subsequent washing steps of the filter were refined. Experiments were conducted varying the electrophoresis time, blotting membranes, hybridization solution, and posthybridization washes. The simplicity, sensitivity, and reliability of this nonistopic technique make possible its application for identification of individuals within a species, for parentage testing, and for monitoring bone marrow transplantation.

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The breakpoint cluster region gene rearrangement associated with chronic myelogenous leukemia is becoming important in the diagnosis and management of the disease. At this time, the ability to demonstrate the gene rearrangement is limited to a few research laboratories. The problem results partially from unfamiliarity of medical laboratory personnel with DNA technology, but more because of the restricted use of radiolabeled phosphorus in hospital laboratories. With the introduction of biotinylated deoxynucleotides, nucleic acid hybridization procedures can now be performed without the use of radioisotopically labeled gene probes. This article describes the use of biotin-labeled gene probes to detect the gene rearrangement of the breakpoint cluster region of chromosome 22 in chronic myelogenous leukemia. The techniques are reproducible, sensitive, and safe. With the procedures described in this article, the assay can become more available to medical laboratories interested in offering this diagnostic and decision-making tool.

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A new generation in specimen handling has arrived with the introduction of bar code readers on medical laboratory equipment. The incorporation of this technology into laboratory information systems offers a streamlining of specimen workflow never before achievable in a laboratory environment. The use of evacuated collection tubes as the primary sampling container on a random-access chemistry analyzer interfaced to a laboratory information system creates a very simplified sampling/analysis system with tremendous advantages. There are significant labor savings, superior service to clinicians, and reduced chances for clerical error.

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High doses of corticosteroids have been found to have beneficial effects in various shock states. It has been well recognized that ischaemia is one of the important features in shock states. This prompted us to investigate the effect of high-dose methylprednisolone on tourniquet-induced ischaemia using mongrel dogs. After inflation of tourniquets to 600 mmHg on each thigh of the hind legs, one leg received an intravenous infusion of methyl-prednisolone, 3 mg.kg-1 dissolved in 20 ml of autologous blood. The other leg received the same amount of blood only, as a control. During two hours of tourniquet time and until 30 min after tourniquet deflation, venous blood was sampled five times from both hind legs for measurements of blood gas tensions (PvO2, PvCO2) and pH, lactic acid, creatinine kinase (CK), aspartate aminotransferase (AST) and lactate dehydrogenase (LDH). During tourniquet ischaemia, PvO2 and pH dropped and PvCO2, lactic acid, CK, AST and LDH rose steadily and significantly in both groups of legs, indicating respiratory and metabolic acidosis, and muscle cell damage. However, those changes were significantly smaller in the methylprednisolone-treated legs. The beneficial effect of methylprednisolone could be attributed to its vasodilatory effect, cellular membrane stabilization and direct metabolic effect on skeletal muscle cells. Although the tourniquet-induced ischaemia in our study is slightly different from the clinical paradigm, the results suggest that high-dose methylprednisolone may provide a beneficial effect during tourniquet ischaemia.

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Previous investigation have demonstrated the presence of the Rho(D) antigen in Rh negative erythrocytes. The intact Rh negative cell, however, does not bind anti-D IgG. Presently we have shown that an anti-D binding antigen resides on the cytoplasmic surface of Rh negative erythrocyte membranes. Unsealed Rh negative membranes, in which both the inner and outer surface are exposed, bind anti-D IgG. Dicyclohexylcarbodiimide specifically blocked the binding of anti-D IgG to these membranes. Sealed Rh negative membranes which expose only their external surface, failed to bind anti-D antiserum. These results were confirmed by proteolytic digestion of membrane preparations and subsequent Rho(D) antigen purification. Only when protease had access to the inner surface of Rh negative erythrocyte membranes did degradation of this 'D' antigen occur. Thus, intact Rh negative erythrocytes contain an antigen which binds anti-D antibody but is located on the inner surface of the membrane. In contrast, Rh positive erythrocytes expose Rho(D) antigen on the external surface of the membrane.

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Human erythrocyte membranes were solubilized in sodium dodecyl sulfate at 100 degree C and subjected to polyacrylamide gel electrophoresis. The gels were sliced into segments and each segment was incubated with anti-Rho(D) IgG, washed, and then incubated with goat anti-human IgG covalently linked to alkaline phosphatase. Para-nitrophenyl phosphate was added to each slice and the absorbance of the solution surrounding each slice was measured at 405 nm. This technique demonstrated that the Rho (D) antigen is a protein with a mol, wt between 13, 000 and 30,000. This method should be applicable to the investigation of other membrane-bound antigens.

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Steroid receptor assays play an important role in determining the efficiency of endocrine therapy for patients with breast cancer. Other tumors could also be hormonally dependent and patients with these tumours might also benefit from endocrine manipulation. Thus, patients with meningiomas were tested for the presence or absence of estrogen and progesterone receptors. The results showed that a majority of meningiomas lacked estrogen receptors but contained large amounts of progesterone receptor. Therefore, it should be possible to use antiprogestin therapy in cases where complete surgical resection of meningiomas is not possible.

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Estrogen receptors from rat uterus and human breast carcinoma were analyzed by diethylaminoethyl-cellulose chromatography. Cytosols which had been incubated for short periods of time demonstrated a single discrete elution peak, indicating a single ionic form, while cytosols incubated for longer periods of time generated a second ionic form of receptor. Addition of cations to cytosols also promoted the rapid appearance of this second ionic form of receptor. Either leupeptin, a protease inhibitor, or sodium molybdate prevented the appearance of this second ionic form of estrogen receptor. The estrogen receptor from rat uterine cytosol incubated without leupeptin or molybdate had a smaller apparent molecular weight than did estrogen receptor from cytosols incubated with leupeptin or molybdate. Altogether, these experiments suggested that a cation-dependent protease present in the cytosols from both tissues was degrading the estrogen receptor to a second smaller species during extended incubation times.

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Two cases of "nonocclusive" intestinal infarction are reported. No thrombosis or significant atherosclerosis was identified and proximal mesenteric arteries were widely patent. However, distal mesenteric arteries were thickened and had pinpoint lumens. Light microscopic findings suggested that this marked luminal narrowing was due to prominent intimal fibromuscular proliferation, medial hypertrophy and mild structural disarray, focal periarterial fibrosis, and transmural elastosis. Electron microscopic findings indicated that the endothelium was normal but the basal lamina was irregularly thickened. The predominant cellular component of the thickened intima consisted of smooth muscle cells, and smooth muscle cells of the media were seen to migrate through an extensively disrupted and degenerated internal elastic lamina. Deposits of young elastic fibers, collagen, and ground substance were also noted, particularly in the intima. The need for careful sectioning and microscopic examination of small distal mesenteric arteries in cases of so-called nonocclusive intestinal infarction is emphasized.

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