1
|
Klassen-Fischer MK, Nelson AM, Neafie RC, Neafie FA, Auerbach A, Baker TP, Burke AP, Datta AA, Franks TJ, Horkayne-Szakaly I, Lack EE, Lewin-Smith MR, Luiña Contreras A, Mattu RH, Rush WL, Shick PC, Zhang Y, Rentas FJ, Moncur JT. The Reemergence of Measles. Am J Clin Pathol 2023; 159:81-88. [PMID: 36315019 DOI: 10.1093/ajcp/aqac124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/07/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Present-day pathologists may be unfamiliar with the histopathologic features of measles, which is a reemerging disease. Awareness of these features may enable early diagnosis of measles in unsuspected cases, including those with an atypical presentation. Using archived tissue samples from historic patients, a unique source of histopathologic information about measles and other reemerging infectious diseases, we performed a comprehensive analysis of the histopathologic features of measles seen in commonly infected tissues during prodrome, active, and late phases of the disease. METHODS Subspecialty pathologists analyzed H&E-stained slides of specimens from 89 patients accessioned from 1919 to 1998 and correlated the histopathologic findings with clinical data. RESULTS Measles caused acute and chronic histopathologic changes, especially in the respiratory, lymphoid (including appendix and tonsils), and central nervous systems. Bacterial infections in lung and other organs contributed significantly to adverse outcomes, especially in immunocompromised patients. CONCLUSIONS Certain histopathologic features, especially Warthin-Finkeldey cells and multinucleated giant cells without inclusions, allow pathologists to diagnose or suggest the diagnosis of measles in unsuspected cases.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yang Zhang
- Joint Pathology Center, Silver Spring, MD, USA
| | | | | |
Collapse
|
2
|
Scott PT, Cohen RL, Brett-Major DM, Hakre S, Malia JA, Okulicz JF, Beckett CG, Blaylock JM, Forgione MA, Harrison SA, Murray CK, Rentas FJ, Fahie RL, Armstrong AW, Hayat AM, Pacha LA, Dawson P, Blackwell B, Eick-Cost AA, Maktabi HH, Michael NL, Jagodzinski LL, Cersovsky SB, Peel SA. Hepatitis B seroprevalence in the U.S. military and its impact on potential screening strategies. Mil Med 2021; 185:e1654-e1661. [PMID: 32648931 PMCID: PMC7526854 DOI: 10.1093/milmed/usaa131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 11/05/2019] [Accepted: 05/06/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Knowledge of the contemporary epidemiology of hepatitis B virus (HBV) infection among military personnel can inform potential Department of Defense (DoD) screening policy and infection and disease control strategies. MATERIALS AND METHODS HBV infection status at accession and following deployment was determined by evaluating reposed serum from 10,000 service members recently deployed to combat operations in Iraq and Afghanistan in the period from 2007 to 2010. A cost model was developed from the perspective of the Department of Defense for a program to integrate HBV infection screening of applicants for military service into the existing screening program of screening new accessions for vaccine-preventable infections. RESULTS The prevalence of chronic HBV infection at accession was 2.3/1,000 (95% CI: 1.4, 3.2); most cases (16/21, 76%) identified after deployment were present at accession. There were 110 military service-related HBV infections identified. Screening accessions who are identified as HBV susceptible with HBV surface antigen followed by HBV surface antigen neutralization for confirmation offered no cost advantage over not screening and resulted in a net annual increase in cost of $5.78 million. However, screening would exclude as many as 514 HBV cases each year from accession. CONCLUSIONS Screening for HBV infection at service entry would potentially reduce chronic HBV infection in the force, decrease the threat of transfusion-transmitted HBV infection in the battlefield blood supply, and lead to earlier diagnosis and linkage to care; however, applicant screening is not cost saving. Service-related incident infections indicate a durable threat, the need for improved laboratory-based surveillance tools, and mandate review of immunization policy and practice.
Collapse
Affiliation(s)
- Paul T Scott
- Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910
| | - Robert L Cohen
- U.S. Army Public Health Center, 5158 Black Hawk Road, Gunpowder, MD 21010.,United States Agency for International Development, Ronald Reagan Building, Washington, DC 20523-1000
| | - David M Brett-Major
- Department of Epidemiology University of Nebraska Medical Center College of Public Health 984395 Nebraska Medical Center Omaha NE 68198-4395
| | - Shilpa Hakre
- Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, 6720A Rockledge Drive, Bethesda, MD 20817
| | - Jennifer A Malia
- Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910
| | - Jason F Okulicz
- San Antonio Military Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234
| | - Charmagne G Beckett
- Navy Bloodborne Infection Management Center, 8901 Wisconsin Avenue, Bethesda, MD 20889
| | - Jason M Blaylock
- Infectious Disease Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889
| | - Michael A Forgione
- San Antonio Military Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234
| | - Stephen A Harrison
- San Antonio Military Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234
| | - Clinton K Murray
- San Antonio Military Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234
| | - Francisco J Rentas
- Armed Services Blood Program Office, 7700 Arlington Boulevard, Falls Church, VA 22042-5143
| | - Roland L Fahie
- Armed Services Blood Program Office, 7700 Arlington Boulevard, Falls Church, VA 22042-5143
| | - Adam W Armstrong
- Naval Medical Research Center, 8901 Wisconsin Ave, Bethesda, MD 20889
| | - Aatif M Hayat
- U.S. Army Public Health Center, 5158 Black Hawk Road, Gunpowder, MD 21010
| | - Laura A Pacha
- U.S. Army Public Health Center, 5158 Black Hawk Road, Gunpowder, MD 21010.,Regional Health Command, Central, 2899 Schofield Road, San Antonio, TX 78234
| | - Peter Dawson
- The Emmes Corporation, 401 N Washington, Rockville, MD 20850
| | - Beth Blackwell
- The Emmes Corporation, 401 N Washington, Rockville, MD 20850
| | - Angelia A Eick-Cost
- Defense Health Agency, Armed Forces Health Surveillance Branch, 11800 Tech Road, Silver Spring, MD 20904.,Cherokee Nation Technology Solutions, 10838 E Marshall Street, Tulsa, OK 74116
| | - Hala H Maktabi
- Defense Health Agency, Armed Forces Health Surveillance Branch, 11800 Tech Road, Silver Spring, MD 20904.,Office of Assistant Secretary for Policy & Planning, Washington, DC
| | - Nelson L Michael
- Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910
| | - Linda L Jagodzinski
- Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910
| | - Steven B Cersovsky
- U.S. Army Public Health Center, 5158 Black Hawk Road, Gunpowder, MD 21010
| | - Sheila A Peel
- Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910
| |
Collapse
|
3
|
Brett-Major DM, Frick KD, Malia JA, Hakre S, Okulicz JF, Beckett CG, Jagodinski LL, Forgione MA, Gould PL, Harrison SA, Murray CK, Rentas FJ, Armstrong AW, Hayat AM, Pacha LA, Dawson P, Eick-Cost AA, Maktabi HH, Michael NL, Cersovsky SB, Peel SA, Scott PT. Costs and consequences: Hepatitis C seroprevalence in the military and its impact on potential screening strategies. Hepatology 2016; 63:398-407. [PMID: 26481723 DOI: 10.1002/hep.28303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/16/2015] [Indexed: 01/18/2023]
Abstract
UNLABELLED Knowledge of the contemporary epidemiology of hepatitis C viral (HCV) infection among military personnel can inform potential Department of Defense screening policy. HCV infection status at the time of accession and following deployment was determined by evaluating reposed serum from 10,000 service members recently deployed to combat operations in Iraq and Afghanistan in the period 2007-2010. A cost model was developed from the perspective of the Department of Defense for a military applicant screening program. Return on investment was based on comparison between screening program costs and potential treatment costs avoided. The prevalence of HCV antibody-positive and chronic HCV infection at accession among younger recently deployed military personnel born after 1965 was 0.98/1000 (95% confidence interval 0.45-1.85) and 0.43/1000 (95% confidence interval 0.12-1.11), respectively. Among these, service-related incidence was low; 64% of infections were present at the time of accession. With no screening, the cost to the Department of Defense of treating the estimated 93 cases of chronic HCV cases from a single year's accession cohort was $9.3 million. Screening with the HCV antibody test followed by the nucleic acid test for confirmation yielded a net annual savings and a $3.1 million dollar advantage over not screening. CONCLUSIONS Applicant screening will reduce chronic HCV infection in the force, result in a small system costs savings, and decrease the threat of transfusion-transmitted HCV infection in the battlefield blood supply and may lead to earlier diagnosis and linkage to care; initiation of an applicant screening program will require ongoing evaluation that considers changes in the treatment cost and practice landscape, screening options, and the epidemiology of HCV in the applicant/accession and overall force populations.
Collapse
Affiliation(s)
- David M Brett-Major
- Infectious Diseases Directorate, Naval Medical Research Center, Silver Spring, MD.,Department of Preventive Medicine and Biometrics, Uniformed Services University, Bethesda, MD
| | - Kevin D Frick
- Carey Business School, Johns Hopkins University, Baltimore, MD
| | - Jennifer A Malia
- Walter Reed Army Institute of Research, US Military HIV Research Program, Silver Spring, MD
| | - Shilpa Hakre
- US Military HIV Research Program, Henry M. Jackson Foundation, Bethesda, MD
| | | | | | - Linda L Jagodinski
- Walter Reed Army Institute of Research, US Military HIV Research Program, Silver Spring, MD
| | | | | | | | | | - Francisco J Rentas
- Armed Services Blood Program Office and the US Army Blood Program, Falls Church, VA
| | | | - Aatif M Hayat
- US Army Public Health Center (Provisional), Aberdeen Proving Ground, MD
| | - Laura A Pacha
- US Army Public Health Center (Provisional), Aberdeen Proving Ground, MD
| | | | - Angelia A Eick-Cost
- Armed Forces Health Surveillance Center, Silver Spring, MD, and Henry M. Jackson Foundation, Bethesda, MD
| | - Hala H Maktabi
- Office of the Medical Inspector, Veterans Administration, Washington, DC
| | - Nelson L Michael
- Walter Reed Army Institute of Research, US Military HIV Research Program, Silver Spring, MD
| | | | - Sheila A Peel
- Walter Reed Army Institute of Research, US Military HIV Research Program, Silver Spring, MD
| | - Paul T Scott
- Walter Reed Army Institute of Research, US Military HIV Research Program, Silver Spring, MD
| |
Collapse
|
4
|
Heier HE, Badloe J, Bohonek M, Cap A, Doughty H, Korsak J, Medby C, Pfaff RM, Rentas FJ, Sailliol A, Schilha M, Söderström T. Use of Tranexamic Acid in Bleeding Combat Casualties. Mil Med 2015; 180:844-6. [DOI: 10.7205/milmed-d-14-00592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
5
|
Mansoor GF, Rahmani AM, Kakar MA, Hashimy P, Abrahimi P, Scott PT, Peel SA, Rentas FJ, Todd CS. Blood supply safety in Afghanistan: a national assessment of high-volume facilities. Transfusion 2013; 53:2061-8. [PMID: 23216410 DOI: 10.1111/trf.12005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 10/09/2012] [Accepted: 10/12/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little information is available regarding blood supply safety in Afghanistan. The purpose of this study was to assess blood safety through serologic and observational measures in Afghanistan. STUDY DESIGN AND METHODS This cross-sectional assessment included the 40 highest-volume facilities collecting and transfusing blood nationally identified in a previous survey. At each facility, study representatives completed a standardized instrument assessing staff performance of transfusion-related activities and performed rapid testing for human immunodeficiency virus, syphilis, and hepatitis B and C with rapid diagnostic tests on clinically discarded specimens. Reactive samples received confirmatory testing. Descriptive statistics were generated, with differences analyzed using chi-square or Fisher's exact tests. RESULTS Between November 2010 and May 2011, a total of 332 blood donor collection procedures were observed. Only 52.4% of observed encounters correctly screened and deferred donors by international criteria. Public and private facilities demonstrated glove use, proper sharps disposal, and patient counseling and relayed screening test results in less than 75% of observed events, significantly less likely than military facilities (p < 0.01). Of 1612 specimens assessed, confirmed cases of hepatitis B (n = 6), hepatitis C (n = 1), and syphilis (n = 3) were detected among units already prescreened and accepted for transfusion. CONCLUSION Lapses in proper donor screening contributed to the presence of confirmed-positive units available for transfusion, as detected in this study. Steps must be taken to ensure standardization of testing kits requirements, documentation, and mandatory training and continuing education for blood bank staff with regard to counseling, drawing, processing, and transfusion of blood products.
Collapse
Affiliation(s)
- G Farooq Mansoor
- Health Protection and Research Organisation, Afghan National Blood Safety and Transfusions Services, Ministry of Public Health, Islamic Republic of Afghanistan; School of Medicine, Yale University, New Haven, Connecticut; United States Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland; Armed Services Blood Program Office, United States Department of Defense, Washington, DC; Department of Obstetrics & Gynecology, Columbia University, New York, New York
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Gerhardt RT, Strandenes G, Cap AP, Rentas FJ, Glassberg E, Mott J, Dubick MA, Spinella PC. Remote damage control resuscitation and the Solstrand Conference: defining the need, the language, and a way forward. Transfusion 2013; 53 Suppl 1:9S-16S. [PMID: 23301981 DOI: 10.1111/trf.12030] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Damage control resuscitation (DCR) is emerging as a standard practice in civilian and military trauma care. Primary objectives include resolution of immediate life threats followed by optimization of physiological status in the perioperative period. To accomplish this, DCR employs a unique hypotensive-hemostatic resuscitation strategy that avoids traditional crystalloid intravenous fluids in favor of early blood component use in ratios mimicking whole blood. The presence of uncontrolled major hemorrhage (UMH) coupled with a delay in access to hemostatic surgical intervention remains a primary contributor to preventable death in both combat and in many domestic settings, including rural areas and disaster sites. As a result, civilian and military emergency care leaders throughout the world have sought a means to project DCR principles forward of the traditional trauma resuscitation bay, into such remote environments as disaster scenes, rural health facilities, and the contemporary battlefield. After reflecting on experiences from past conflicts, defining current capability gaps, and examining available and potential solutions, a strategy for "remote damage control resuscitation" (RDCR) has been proposed. In order for RDCR to progress from concept to clinical strategy, it will be necessary to define existing gaps in knowledge and clinical capability; develop a lexicon so that investigators and operators may understand each other; establish coherent research and development agendas; and execute comprehensive investigations designed to predict, diagnose, and mitigate the consequences of hemorrhagic shock and acute traumatic coagulopathy before they become irreversible. This article seeks to introduce the concept of RDCR; to reinforce the importance of identifying and optimally managing UMH and the resulting shock state as part of a comprehensive approach to out-of-hospital stabilization and en route care; and to propose investigational strategies to enable the development and broad implementation of RDCR principles.
Collapse
Affiliation(s)
- Robert T Gerhardt
- US Army Institute of Surgical Research, Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas 78234, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Hakre S, Manak MM, Murray CK, Davis KW, Bose M, Harding AJ, Maas PR, Jagodzinski LL, Kim JH, Michael NL, Rentas FJ, Peel SA, Scott PT, Tovanabutra S. Transfusion-transmitted human T-lymphotropic virus Type I infection in a United States military emergency whole blood transfusion recipient in Afghanistan, 2010. Transfusion 2013; 53:2176-82. [PMID: 23362944 DOI: 10.1111/trf.12101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 11/19/2012] [Accepted: 11/26/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The United States introduced human T-lymphotropic virus Type I (HTLV-I) screening of blood donors in 1988. The US military uses freshly collected blood products for life-threatening injuries when available stored blood components in theater have been exhausted or when these components are unsuccessful for resuscitation. These donors are screened after donation by the Department of Defense (DoD) retrospective testing program. All recipients of blood collected in combat are tested according to policy soon after and at 3, 6, and 12 months after transfusion. CASE REPORT A 31-year-old US Army soldier tested positive for HTLV-I 44 days after receipt of emergency blood transfusions for severe improvised explosive device blast injuries. One donor's unit tested HTLV-I positive on the DoD-mandated retrospective testing. Both the donor and the recipient tested reactive with enzyme immunoassay and supplemental confirmation by HTLV-I Western blot. The donor and recipient reported no major risk factors for HTLV-I. Phylogenetic analysis of HTLV-I sequences indicated Cosmopolitan subtype, Subgroup B infections. Comparison of long terminal repeat and env sequences revealed molecular genetic linkage of the viruses from the donor and recipient. CONCLUSION This case is the first report of transfusion transmission of HTLV-I in the US military during combat operations. The emergency fresh whole blood policy enabled both the donor and the recipient to be notified of their HTLV-I infection. While difficult in combat, predonation screening of potential emergency blood donors with Food and Drug Administration-mandated infectious disease testing as stated by the DoD Health Affairs policy should be the goal of every facility engaged with emergency blood collection in theater.
Collapse
Affiliation(s)
- Shilpa Hakre
- Armed Services Blood Program Office, Falls Church, Virginia; San Antonio Military Medical Center, San Antonio, Texas; United States Military HIV Research Program, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland; United States Military HIV Research Program, Walter Reed Army Institute of Research, Rockville, Maryland
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
O'Connell RJ, Gates RG, Bautista CT, Imbach M, Eggleston JC, Beardsley SG, Manak MM, Gonzales R, Rentas FJ, Macdonald VW, Cardo LJ, Reiber DT, Stramer SL, Michael NL, Peel SA. Laboratory evaluation of rapid test kits to detect hepatitis C antibody for use in predonation screening in emergency settings. Transfusion 2012; 53:505-17. [DOI: 10.1111/j.1537-2995.2012.03770.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
9
|
Hakre S, Peel SA, O'Connell RJ, Sanders-Buell EE, Jagodzinski LL, Eggleston JC, Myles O, Waterman PE, McBride RH, Eader SA, Davis KW, Rentas FJ, Sateren WB, Naito NA, Tobler SK, Tovanabutra S, Petruccelli BP, McCutchan FE, Michael NL, Cersovsky SB, Scott PT. Transfusion-transmissible viral infections among US military recipients of whole blood and platelets during Operation Enduring Freedom and Operation Iraqi Freedom. Transfusion 2010; 51:473-85. [PMID: 20946199 DOI: 10.1111/j.1537-2995.2010.02906.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Current US military clinical practice guidelines permit emergency transfusions of non-Food and Drug Administration (FDA)-compliant freshly collected blood products in theaters of war. This investigation aimed to characterize the risks of transfusion-transmitted infections (TTIs) associated with battlefield transfusions of non-FDA-compliant blood products. STUDY DESIGN AND METHODS US Service members who received emergency transfusion products in Iraq and Afghanistan (March 1, 2002-September 30, 2007) were tested for hepatitis C virus (HCV), human immunodeficiency virus (HIV), and hepatitis B virus (HBV) infections using reposed pre- and posttransfusion sera. Selected regions of viral genomes from epidemiologically linked infected recipients and their donors were sequenced and compared. RESULTS Of 761 US Service members who received emergency transfusion products, 475 were tested for HCV, 472 for HIV, and 469 for HBV. One transfusion-transmitted HCV infection (incidence rate of 2.1/1000 persons) was identified. The pretransfusion numbers (prevalence per 1000 persons) were HCV-four (8/1000), HIV-zero (0/1000), chronic HBV-two (4 /1000), and naturally immune (antibody to HBV core antigen)-nine (19/1000). CONCLUSION One HCV TTI was determined to be associated with emergency blood product use. The pretransfusion HCV and HBV prevalence in transfusion recipients, themselves members of the potential donor population, indicates better characterization of the deployed force's actual donor population, and further investigations of the TTI prevalence in these donors are needed. These data will inform countermeasure development and clinical decision making.
Collapse
Affiliation(s)
- Shilpa Hakre
- Armed Services Blood Program Office and the United States Army Blood Program, Falls Church, Virginia, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Perkins JG, Cap AP, Spinella PC, Shorr AF, Beekley AC, Grathwohl KW, Rentas FJ, Wade CE, Holcomb JB. Comparison of platelet transfusion as fresh whole blood versus apheresis platelets for massively transfused combat trauma patients (CME). Transfusion 2010; 51:242-52. [PMID: 20796254 DOI: 10.1111/j.1537-2995.2010.02818.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND At major combat hospitals, the military is able to provide blood products to include apheresis platelets (aPLT), but also has extensive experience using fresh whole blood (FWB). In massively transfused trauma patients, we compared outcomes of patients receiving FWB to those receiving aPLT. STUDY DESIGN AND METHODS This study was a retrospective review of casualties at the military hospital in Baghdad, Iraq, between January 2004 and December 2006. Patients requiring massive transfusion (≥10 units in 24 hr) were divided into two groups: those receiving FWB (n = 85) or aPLT (n = 284) during their resuscitation. Admission characteristics, resuscitation, and survival were compared between groups. Multivariate regression analyses were performed comparing survival of patients at 24 hours and at 30 days. Secondary outcomes including adverse events and causes of death were analyzed. RESULTS Unadjusted survival between groups receiving aPLT and FWB was similar at 24 hours (84% vs. 81%, respectively; p = 0.52) and at 30 days (60% versus 57%, respectively; p = 0.72). Multivariate regression failed to identify differences in survival between patients receiving PLT transfusions either as FWB or as aPLT at 24 hours or at 30 days. CONCLUSIONS Survival for massively transfused trauma patients receiving FWB appears to be similar to patients resuscitated with aPLT. Prospective trials will be necessary before consideration of FWB in the routine management of civilian trauma. However, in austere environments where standard blood products are unavailable, FWB is a feasible alternative.
Collapse
|
11
|
Rentas FJ, Lincoln DA, Jenkins CR, O'Connell RJ, Gates RG. Walking blood banks: screening blood in the battlefield. MLO Med Lab Obs 2010; 42:13-19. [PMID: 20383997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|
12
|
Abstract
Most tailed bacteriophages and herpes viruses replicate genome as a concatemer which is cut by a 'headful' nuclease upon completion of genome packaging. Here, the catalytic centre of phage T4 headful nuclease, present in the C-terminal domain of 'large terminase' gp17, has been defined by mutational, biochemical and structural analyses. The crystal structure shows that this nuclease has an RNase-H fold, suggesting that it cuts DNA by a two-metal ion mechanism. The active centre has a Mg ion co-ordinated by three acidic residues, D401, E458 and D542. Mutations at any of these residues resulted in loss of nuclease activity, but the mutants can package linear DNA. The gp17's nuclease activity is modulated by the 'small terminase', gp16, by the N-terminal ATPase domain of gp17, and by the assembled packaging motor. These results lead to hypotheses concerning how phage headful nucleases cut the viral genomes before and after, but not during, DNA packaging.
Collapse
Affiliation(s)
- Tanfis I Alam
- Department of Biology, The Catholic University of America, Washington, DC 20064, USA
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Grose HL, Byrne KM, Salata JM, Rentas FJ, Stroncek DF. In vitro variables of red blood cell components collected by apheresis and frozen 6 and 14 days after collection. Transfusion 2006; 46:1178-83. [PMID: 16836565 DOI: 10.1111/j.1537-2995.2006.00868.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND An automated cell processing system (ACP 215, Haemonetics Corp.) can be used for the glycerolization and deglycerolization of RBC components, but the components must be 6 or fewer days old. Depending on the anticoagulant (CP2D)/additive solution (AS) used, deglycerolized RBCs can be stored at 1 to 6 degrees C for up to 14 days. This study evaluated in vitro variables of apheresis RBC stored for 6 and 14 days at 1 to 6 degrees C before glycerolization and 14 days after deglycerolization. STUDY DESIGN AND METHODS Two units of CP2D/AS-3 leukoreduced RBCs were collected by apheresis from seven donors. One unit was glycerolized and frozen 6 days and the other 14 days after collection. All units were deglycerolized with the ACP 215 and stored at 1 to 6 degrees C for 14 days in AS-3. Several in vitro variables were evaluated during postdeglycerolization storage. RESULTS All components had postdeglycerolization RBC recoveries greater than 81 percent and osmolalities of less than 400 mOsm per kg. No significant differences were noted in potassium and supernatant hemoglobin after 14 days of postdeglycerolization storage between RBCs frozen at 6 and 14 days after collection. After 14 days of postdeglycerolization storage, however, the pH, lactate, and ATP levels were slightly lower in RBCs frozen after 14 days. CONCLUSION The ACP 215 can be used to glycerolize and deglycerolize apheresis RBC components that are up to 14 days of age. It is likely that apheresis components glycerolized at 14 days of age or less can be stored up to 14 days in AS-3 after deglycerolization, but this should be confirmed with in vivo survival studies.
Collapse
Affiliation(s)
- Heather L Grose
- Department of Transfusion Medicine, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland 20892-1184, USA
| | | | | | | | | |
Collapse
|
14
|
Cardo LJ, Rentas FJ, Ketchum L, Salata J, Harman R, Melvin W, Weina PJ, Mendez J, Reddy H, Goodrich R. Pathogen inactivation of Leishmania donovani infantum in plasma and platelet concentrates using riboflavin and ultraviolet light. Vox Sang 2006; 90:85-91. [PMID: 16430665 DOI: 10.1111/j.1423-0410.2005.00736.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Leishmania is transmitted by the bite of the phlebotomine sandfly or by transfusion of infected blood products. Leishmaniasis currently poses a significant problem in several parts of the world, and is an emerging problem in others. The Mirasol PRT technology is based on the use of riboflavin and ultraviolet light to generate chemical reactions in the nucleic acids of pathogens, which prevents replication and leads to inactivation. The intent of this study was to examine the ability of the Mirasol PRT System to kill the Leishmania parasite in human plasma and platelet concentrates. MATERIALS AND METHODS In visceral Leishmaniasis, amastigotes are present in the blood and in the reticuloendothelial system within monocytes. For each unit of plasma or platelets treated, isolated mononuclear cells obtained from 100 ml of normal donor whole blood were incubated with 1.0 x 10(8) Leishmania donovani infantum promastigotes to produce amastigote-laden macrophages. The infected macrophages were added to 250 ml of human plasma or to 250 ml of platelet concentrates. Infected units were cultured pretreatment in 10-fold serial dilutions to determine the limits of detection. Thirty millilitres of 500 microM riboflavin was added to each unit, which was then illuminated with 5.9 J/cm2 of ultraviolet light (6.24 J/ml). After treatment and after 2 months of frozen storage, plasma units were cultured in 10-fold serial dilutions. Platelets were cultured on the day of treatment and on day 5 of storage post-illumination. RESULTS A 5 log reduction of Leishmania was demonstrated in five of six units of plasma, and a 7 log reduction of Leishmania was demonstrated in one plasma unit. A 5 log reduction of Leishmania was demonstrated in five of six units of platelets, and a 6 log reduction of Leishmania was demonstrated in one unit. CONCLUSIONS There is no donor screen for Leishmania and other pathogens constantly emerging in our blood supply. The Mirasol PRT System for Platelets and Plasma is an effective means of killing Leishmania and other emerging pathogens in these blood products.
Collapse
Affiliation(s)
- L J Cardo
- Walter Reed Army Institute of Research, Department of Blood Research, Transfusion Medicine Branch, Silver Spring, MD 20910-7500, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Rentas FJ, Macdonald VW, Rothwell SW, McFaul SJ, Asher LV, Kennedy AM, Hmel PJ, Meledandri CJ, Salata JM, Harman RW, Reid TJ. White particulate matter found in blood collection bags consist of platelets and leukocytes. Transfusion 2004; 44:959-66. [PMID: 15225233 DOI: 10.1111/j.1537-2995.2004.03398.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In late January 2003, some blood centers and hospitals throughout the US voluntarily sus-pended the use of some RBC and plasma units for trans-fusion due to the presence of unknown white particulate matter (WPM) in these units. To better understand the WPM phenomena, a number of technologies were used to establish the nature of the particulates observed in Terumo Collection sets. STUDY DESIGN AND METHODS All AS-5 nonleuko-reduced RBCs and plasma units were visually inspected for WPM by placing the bags on a flat counter, undisturbed, for approximately 10 minutes and then perform-ing a visual examination for particles. Particles were isolated and placed on microscope slides or in plastic tubes for further analysis. Electron microscopy, bright field microscopy, differential interference contrast microscopy, infrared spectroscopy, and flow cytometry procedures were performed to establish the nature of the particulate matter. In addition, leukoreduction filters and blood transfusion sets were used on RBCs units with WPM. RESULTS The particles were mostly composed of PLTs and WBCs, and fragments of these cells. All macroscopic WPM was removed from RBCs with leukoeduction and transfusion filters. CONCLUSIONS WPM originated from PLTs and WBCs. Foreign matter (e.g., plastic) was not observed in any of the units. Leukoreduction and transfusion filters can be used to remove macroscopic WPM.
Collapse
Affiliation(s)
- F J Rentas
- Department of Blood Research, Department of Pathology, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Rentas FJ, Macdonald VW, Houchens DM, Hmel PJ, Reid TJ. New insulation technology provides next-generation containers for “iceless” and lightweight transport of RBCs at 1 to 10°C in extreme temperatures for over 78 hours. Transfusion 2004; 44:210-6. [PMID: 14962312 DOI: 10.1111/j.1537-2995.2004.00642.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a universal need, in both civilian and military settings, for a lightweight container capable of maintaining RBCs at 1 to 10 degrees C in remote areas, during extended transit times, and under austere environments. The use of ice in insulated containers or small commercial coolers for these purposes often results in loss of RBCs due to failure to maintain temperatures within the requisite range. A lightweight and thermally efficient container capable of carrying 4 to 6 units of RBCs at 1 to 10 degrees C for over 72 hours under extreme conditions would help resolve current problems in RBC transportation. STUDY DESIGN AND METHODS Six different prototype containers incorporating phase-change materials (PCMs) in their designs were evaluated for their ability to maintain RBCs between 1 and 10 degrees C while exposed to external temperatures of -24 degrees C and 40 degrees C. In separate experiments, a container was opened and a RBC unit removed. RESULTS One container weighing 10 pounds with four units of RBCs was capable of maintaining the temperature of the units between 1 and 10 degrees C for over 78 hours, 96 hours, and 120 hours at 40 degrees C, -24 degrees C, and 23 degrees C, respectively. Opening the container decreased these times by 2 to 3 hours. CONCLUSIONS An energy-efficient and lightweight container that maintains RBCs at 1 to 10 degrees C under austere environments for over 78 hours is now available. This container, known as the Golden Hour container (GHC), will facilitate transport of RBCs. The GHC will have additional applications (transport and/or storage of vaccines, other biologics, organs, reagents, etc).
Collapse
Affiliation(s)
- Francisco J Rentas
- Department of Blood Research, Walter Reed Army Institute of Research, Silver Spring, Maryland 20910-7500, USA.
| | | | | | | | | |
Collapse
|
17
|
Rentas FJ, Rao VB. Defining the bacteriophage T4 DNA packaging machine: evidence for a C-terminal DNA cleavage domain in the large terminase/packaging protein gp17. J Mol Biol 2003; 334:37-52. [PMID: 14596798 DOI: 10.1016/j.jmb.2003.09.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Double-stranded DNA packaging in bacteriophage T4 and other viruses occurs by translocation of DNA into an empty prohead by a packaging machine assembled at the portal vertex. Coordinated with this complex process is the cutting of concatemeric DNA to initiate and terminate DNA packaging and encapsidate one genome-length viral DNA. The catalytic site responsible for cutting, and the mechanisms by which cutting is precisely coordinated with DNA translocation remained as interesting open questions. Phage T4, unlike the phages with defined ends (e.g. lambda, T3, T7), packages DNA in a strictly headful manner, and exhibits no strict sequence specificity to initiate or terminate DNA packaging. Previous evidence suggests that the large terminase protein gp17, a key component of the T4 packaging machine, possesses a non-specific DNA cutting activity. A histidine-rich metal-binding motif, H382-X(2)-H385-X(16)-C402-X(8)-H411-X(2)-H414-X(15)-H430-X(5)-H436, in the C-terminal half of gp17 is thought to be involved in the terminase cleavage. Here, exhaustive site-directed mutagenesis revealed that none of the cysteine and histidine residues other than the H436 residue is critical for function. On the other hand, a cluster of conserved residues within this region, D401, E404, G405, and D409, are found to be critical for function. Biochemical analyses showed that the D401 mutants exhibited a novel phenotype, showing a loss of in vivo DNA cutting activity but not the DNA packaging activity. The functional nature of the critical residues and their disposition in the conserved loop region between two predicted beta-strands suggest that these residues are part of a metal-coordinated catalytic site that cleaves the phosphodiester bond of DNA substrate. The data suggest that the T4 terminase consists of at least two functional domains, an N-terminal DNA-translocating ATPase domain and a C-terminal DNA-cutting domain. Although the DNA recognition mechanisms may be distinct, it appears that T4 and other phage terminases employ a common catalytic paradigm for phosphodiester bond cleavage that is used by numerous nucleases.
Collapse
Affiliation(s)
- Francisco J Rentas
- Department of Biology, The Catholic University of America, 103 McCort Ward Hall, 620 Michigan Ave., N.E. Washington, DC 20064, USA
| | | |
Collapse
|
18
|
Leiby DA, Rentas FJ, Nelson KE, Stambolis VA, Ness PM, Parnis C, McAllister HA, Yawn DH, Stumpf RJ, Kirchhoff LV. Evidence of Trypanosoma cruzi infection (Chagas' disease) among patients undergoing cardiac surgery. Circulation 2000; 102:2978-82. [PMID: 11113049 DOI: 10.1161/01.cir.102.24.2978] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Trypanosoma cruzi, the agent of Chagas' heart disease, is transmitted by triatomine insects and by blood transfusion. The emigration of several million people from T cruzi-endemic countries to the United States has raised concerns regarding a possible increase in cases of Chagas' heart disease here, as well as an increased risk of transfusion-transmitted T cruzi. To investigate these 2 possible outcomes, we tested a repository of blood specimens from multiply transfused cardiac surgery patients for antibodies to T cruzi. METHODS AND RESULTS Postoperative blood specimens from 11 430 cardiac surgery patients were tested by enzyme immunoassay, and if repeat-reactive, were confirmed by radioimmunoprecipitation. Six postoperative specimens (0.05%) were confirmed positive. Corresponding preoperative specimens, available for 4 of these patients, were also positive. The other 2 patients had undergone heart transplantations. Tissue samples from their excised hearts were tested for T cruzi by polymerase chain reaction and were positive. Despite the fact that several of these 6 patients had histories and clinical findings suggestive of Chagas' disease, none of them were diagnosed with or tested for it. Patient demographics showed that 5 of 6 positive patients were Hispanic, and overall, 2. 7% of Hispanic patients in the repository were positive. CONCLUSIONS No evidence for transfusion-transmitted T cruzi was found. All 6 seropositive patients apparently were infected with T cruzi before surgery; however, a diagnosis of Chagas' disease was not known or even considered in any of these patients. Indeed, Chagas' disease may be an underdiagnosed cause of cardiac disease in the United States, particularly among patients born in countries in which T cruzi is endemic.
Collapse
Affiliation(s)
- D A Leiby
- American Red Cross, Rockville, MD 20855, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Rentas FJ, Clark PA. Blood type discrepancies on military identification cards and tags: a readiness concern in the U.S. Army. Mil Med 1999; 164:785-7. [PMID: 10578589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Current policy allows the use of identification cards and tags for transfusion purposes during contingency operations. The purpose of this study was to determine the percentage of soldiers having the wrong blood type on their identification card or dog tag and the effects that these findings could have during wartime. Thirty-four of 923 soldiers (3.7%) demonstrated at least one discrepancy during testing. Of these 34 discrepancies, 22 (2.3%) involved ABO group errors, 10 (1.1%) involved Rh type errors, and 2 (0.2%) involved both ABO group and Rh type errors. These errors could lead to transfusion of the wrong blood type during wartime. The interface of computer systems in the near future may decrease the blood type error rate on identification cards and dog tags. Quality improvement programs to increase the accuracy of the blood type on identification cards and dog tags are suggested.
Collapse
Affiliation(s)
- F J Rentas
- Blood Bank Center, Fort Hood, TX 76544, USA
| | | |
Collapse
|
20
|
|