Preweaned heifer management on US dairy operations: Part II. Factors associated with colostrum quality and passive transfer status of dairy heifer calves.

Passive transfer of immunity is essential for the short- and long-term health of dairy calves. The objective of this study was to evaluate factors associated with colostrum quality and passive transfer status of US heifer calves. This study included 104 operations in 13 states that participated in the calf component of the National Animal Health Monitoring System's Dairy 2014 study. This 18-mo longitudinal study included 1,972 Holstein heifer calves from birth to weaning. Multivariable mixed linear regression models were selected using backward elimination model selection after univariate screening to determine which factors were associated with colostrum IgG and serum IgG concentrations. The mean colostrum IgG concentration was 74.4 g/L with 77.4% of colostrum samples having IgG concentrations >50 g/L. The final model for colostrum IgG included colostrum source and a categorized temperature-humidity index value (cTHI) for the month before calving. Mean colostrum IgG concentrations were highest for dams in third and higher lactations (84.7 g/L) and lowest for commercial colostrum replacers (40.3 g/L). Colostrum IgG concentrations were highest for cTHI ≥70 (72.6 g/L) and lowest for cTHI <40 (64.2 g/L). The mean serum IgG concentration was 21.6 g/L, with 73.3% of calves having serum IgG concentrations >15 g/L. The final model for serum IgG concentration included region, heat treatment of colostrum, colostrum source, timing to first feeding, volume of colostrum fed in the first 24 h, age of the calf at blood sampling, and colostrum IgG concentration. Mean serum IgG concentrations were highest for calves that received colostrum from first-lactation dams (25.7 g/L) and lowest for calves fed commercial colostrum replacer (16.6 g/L). Serum IgG concentrations were higher for calves fed heat-treated colostrum (24.4 g/L) than for calves fed untreated colostrum (20.5 g/L). Serum IgG concentration was positively associated with the volume of colostrum fed in the first 24 h and colostrum IgG concentration, and negatively associated with the number of hours from birth to colostrum feeding and age (days) at blood collection. Dairy producers should be encouraged to measure the quality of colostrum before administering it to calves and to measure serum IgG or a proxy such as serum total protein or Brix to evaluate passive immunity and colostrum management programs.

Preweaned heifer management on US dairy operations: Part I. Descriptive characteristics of preweaned heifer raising practices.

The objective of this study was to describe preweaned dairy heifer calf management practices on dairy operations across the United States that were used to analyze factors associated with colostrum quality and passive transfer, Cryptosporidium and Giardia, morbidity and mortality, and average daily gain. This study included 104 dairy operations in 13 states that participated in the National Animal Health Monitoring System's Dairy 2014 calf component study. This 18-mo longitudinal study focused on dairy heifer calves from birth to weaning, and data were collected on 2,545 heifer calves. Descriptive statistics were generated regarding colostrum feeding, preweaning housing, milk feeding and consumption, growth, morbidity and mortality, and weaning practices. The majority of calves enrolled were Holsteins (89.4%). Over half the calves (63.2%) enrolled in the study received the majority of their colostrum via bottle; however, 22.1% of calves from 51.0% of operations received colostrum via suckling from their dams. For all calves, the mean time to the first colostrum feeding was 2.8 h, and the average amount of colostrum at the first feeding was 2.9 L, with 4.5 L provided in the first 24 h. The mean serum IgG of all calves was 21.7 g/L; however, 76.0% of operations had at least 1 calf with failure of passive transfer of immunity with a serum IgG below 10 g/L. The majority of calves in the study were housed individually (86.6%). Nonetheless, 20.2% of operations housed some calves in groups, representing 13.4% of all calves. Approximately one-half of the calves in the study (52.3%) were dehorned or disbudded during the preweaning period, with only 27.8% of these calves receiving analgesics or anesthetics during the procedure. Whole or waste milk was the liquid diet type fed to 40.1% of calves, and milk replacer was fed to 34.8% of calves. A combination of milk and milk replacer was fed to 25.1% of calves. Calves, on average, were fed 2.6 L per feeding and fed 2.6 times/d, resulting in a total of 5.6 L of liquid diet fed per day. The mean average daily gain for all calves enrolled in the study was 0.7 kg/d. Fecal samples were collected and almost all operations had at least 1 calf positive for Cryptosporidium (94.2%) or Giardia (99.0%), and 84.6% of operations had calves that tested positive for both Cryptosporidium and Giardia. Over one-third of calves (38.1%) had at least one morbidity event during the preweaning period and the mortality rate was 5.0%. The mean age at weaning was 65.7 d. This study provides an update on dairy heifer raising practices in the United States.

Preweaned heifer management on US dairy operations: Part V. Factors associated with morbidity and mortality in preweaned dairy heifer calves.

The objective of this study was to evaluate morbidity and mortality in preweaned dairy heifer calves based on different health, feeding, and management practices, as well as environmental factors. This study was conducted as part of the calf component of the National Animal Health Monitoring System's Dairy 2014 study, which included 104 dairy operations in 13 states. The calf component was an 18-mo longitudinal study focused on dairy heifer calves from birth to weaning; data were collected on 2,545 calves. The percentage morbidity for all calves enrolled in the study was 33.9%. Backward elimination model selection was used after univariate screening to determine which management practices and environmental factors significantly affected morbidity and mortality. The final morbidity model included birth weight, serum IgG concentration, ventilation type, and average temperature-humidity index (THI) during the preweaning period. After controlling for other independent variables in the model, calves born at a higher birth weight had a lower predicted risk of morbidity than calves with a lower birth weight. An increase in serum IgG concentration was associated with decreased morbidity. Calves housed in positive- or cross-ventilated systems had a 2.2 times higher odds of developing disease compared with calves housed in natural ventilation systems. Average THI during the preweaning period was inversely correlated with morbidity; as THI increased, the predicted morbidity risk decreased. The percent mortality for all calves enrolled in the study was 5.0%. The final mortality model included birth weight, serum IgG concentration, amount of fat/day in the liquid diet, and morbidity. After controlling for other independent variables in the model, calves born at a higher birth weight had a lower risk of mortality. An increase in serum IgG concentration decreased the risk of mortality. The odds of mortality were 3.1 times higher in calves fed ≤0.15 kg of fat/d in the liquid diet compared with calves fed ≥0.22 kg of fat/d. The odds of mortality were 4.7 times higher in calves that experienced any disease throughout the preweaning period than in calves with no disease. In summary, morbidity and mortality were both associated with birth weight and serum IgG concentration. Additionally, morbidity was associated with ventilation type and average monthly THI, and mortality was associated with amount of fat per day in the liquid diet and morbidity.

Preweaned heifer management on US dairy operations: Part VI. Factors associated with average daily gain in preweaned dairy heifer calves.

The study objective was to evaluate average daily gain (ADG) in dairy heifer calves based on health, feeding, management practices, and environmental factors. This study included 102 operations in 13 states that participated in the calf component of the National Animal Health Monitoring System's Dairy 2014 study. This 18-mo longitudinal study included 1,410 Holstein heifer calves monitored from birth to weaning. The mean ADG from birth to final weight was 0.74 kg/d. Backward elimination model selection in Proc Mixed after univariate screening determined factors that significantly affected ADG. The final model included dam lactation number, singleton versus twin birth, bedding type, Giardia and Cryptosporidium fecal shedding, disease events, a categorized average temperature-humidity index for the preweaning period (pTHI), amount of protein in the liquid diet (kg/d), milk pasteurization, direct-fed microbials, and the interaction between milk pasteurization and direct-fed microbials. After controlling for other independent variables in the model, calves born to first-lactation dams gained less (0.60 kg/d) than calves from second- (0.65 kg/d) or third- or greater-lactation (0.64 kg/d) dams. Singleton calves gained 0.07 kg/d more than twins. Calves bedded with sand or no bedding gained less (0.49 kg/d) than calves on all other bedding types. Calves negative for Cryptosporidium or Giardia at the time of sampling gained 0.03 or 0.02 kg/d more, respectively, than calves that were positive for Cryptosporidium or Giardia. Calves with no disease events gained 0.07 kg/d more than calves with one or more disease events. Calves experiencing an average pTHI <50 gained more (0.67 kg/d) than calves experiencing an average pTHI from 50 to 69 (0.62 kg/d), or ≥70 (0.59 kg/d). Within the range of observed kilograms of protein fed per day in the liquid diet, every additional 0.1 kg of protein fed per day equated to 0.02 kg/d of gain. Calves fed milk replacer with a direct-fed microbial gained less (0.44 kg/d) than calves fed milk replacer without a direct-fed microbial (0.60 kg/d) and calves fed pasteurized or unpasteurized milk regardless of direct-fed microbial use. These results highlight the importance of feeding a quantity and quality of a liquid diet to achieve optimal growth, keeping calves free of disease, the type or status of bedding, and mitigating the effects of temperature and humidity on preweaning ADG.

Hyperspectral data processing improves PpIX contrast during fluorescence guided surgery of human brain tumors.

Fluorescence guided surgery (FGS) using aminolevulinic-acid (ALA) induced protoporphyrin IX (PpIX) provides intraoperative visual contrast between normal and malignant tissue during resection of high grade gliomas. However, maps of the PpIX biodistribution within the surgical field based on either visual perception or the raw fluorescence emissions can be masked by background signals or distorted by variations in tissue optical properties. This study evaluates the impact of algorithmic processing of hyperspectral imaging acquisitions on the sensitivity and contrast of PpIX maps. Measurements in tissue-simulating phantoms showed that (I) spectral fitting enhanced PpIX sensitivity compared with visible or integrated fluorescence, (II) confidence-filtering automatically determined the lower limit of detection based on the strength of the PpIX spectral signature in the collected emission spectrum (0.014-0.041 µg/ml in phantoms), and (III) optical-property corrected PpIX estimates were more highly correlated with independent probe measurements (r = 0.98) than with spectral fitting alone (r = 0.91) or integrated fluorescence (r = 0.82). Application to in vivo case examples from clinical neurosurgeries revealed changes to the localization and contrast of PpIX maps, making concentrations accessible that were not visually apparent. Adoption of these methods has the potential to maintain sensitive and accurate visualization of PpIX contrast over the course of surgery.

Identification and Characterization of Isolates of Pythium and Phytophthora spp. from Snap Beans with Cottony Leak.

Cottony leak is an important disease of snap bean in Oklahoma and nearby states. Oomycete pathogens isolated from diseased pods collected from commercial fields and research plots consisted of both Pythium spp. (n = 131) and Phytophthora spp. (n = 46). Isolates were identified to species by morphological characteristics and by sequencing a portion of the internal transcribed spacer region of representative isolates. The most common Pythium spp. were Pythium ultimum var. ultimum; Pythium 'group HS', a self-sterile form of P. ultimum that produces hyphal swellings in lieu of sporangia (n = 74); and P. aphanidermatum (n = 50). Phytophthora spp. included Phytophthora drechsleri (n = 41) and P. nicotianae (n = 5). Nearly all of the isolates (95%) and all species were pathogenic on detached pods but Pythium ultimum var. ultimum and Pythium 'group HS' were most aggressive. Phytophthora drechsleri was most aggressive on seedlings, causing preemergence damping off and seed rot. Pythium ultimum var. ultimum, Pythium 'group HS', and P. aphanidermatum were intermediate in virulence to seedlings, causing root rot, stunting, and limited postemergence damping off. Phytophthora nicotianae and Pythium diclinum (n = 4) were not pathogenic on seedlings. Most (87%) isolates were sensitive to metalaxyl-M (concentration that caused a 50% reduction in mycelial growth [EC50] < 1 µg/ml) and the rest were intermediate in sensitivity (EC50 > 1 to < 100 µg/ml). Phytophthora drechsleri was the most sensitive species (EC50 = 0.06 µg/ml) compared with Pythium aphanidermatum, which was least sensitive (EC50 = 1.3 µg/ml). Cottony leak is a disease complex caused by several oomycete species that should include Phytophthora drechsleri, a newly reported pathogen of snap bean in the United States.

Reproductive risk factors for culling and productive life in large dairy herds in the eastern United States between 2001 and 2006.

Knowledge of reproductive risk factors for culling is useful in making insemination and culling decisions and helps motivate efforts to reduce or eliminate risk factors. The objective of this study was to describe survival and reproductive risk factors for culling in Holstein dairy herds with at least 200 cows. Results were calculated from 2,345,015 DHI lactation records from 727 herds with at least 200 cows from 2001 to 2006. Herds were located in 36 states primarily located east of the Mississippi River. Kaplan-Meier survival curves were obtained and daily hazards of culling were calculated with the actuarial method. Cox regression was performed with the GLIMMIX procedure in SAS (SAS Institute Inc., Cary, NC). The hazard of culling increased with parity number. Cows in their sixth parity had 3 times greater hazards than cows in their first parity. Medium remaining productive life for cows calving in parity 1 to 6 were 907, 697, 553, 469, 423, and 399 d, respectively. Daily hazards of culling first peaked approximately 30 d after calving and then again later in lactation, after 280 d, for older cows. Hazards for first-parity cows peaked earlier, around d 10 after calving, and the first-parity cows had lower risks of culling later in lactation than older cows. Pregnant cows had 3 to 7 times lower hazards of culling than open cows. Hazards of culling increased for cows that had greater calving difficulty, gave birth to males or twins, were in herds with shorter days to first insemination, or had longer days to conception. The possible to likely use of a synchronized breeding program increased from 21.9% in 2001 to 41.4% in 2006. Cows in herds that did not use a synchronized breeding program had slightly lower risks of culling than those in herds that at least possibly used a synchronized breeding program.

In situ site-specific specimen preparation for atom probe tomography.

Techniques for the rapid preparation of atom-probe samples extracted directly from a Si wafer are presented and discussed. A systematic mounting process to a standardized microtip array allows approximately 12 samples to be extracted from a near-surface region and mounted for subsequent focused-ion-beam sharpening in a short period of time, about 2h. In addition, site-specific annular mill extraction techniques are demonstrated that allow specific devices or structures to be removed from a Si wafer and analyzed in the atom-probe. The challenges presented by Ga-induced implantation and damage, particularly at a standard ion-beam accelerating voltage of 30 keV, are shown and discussed. A significant reduction in the extent of the damaged regions through the application of a low-energy "clean-up" ion beam is confirmed by atom-probe analysis of the damaged regions. The Ga+ penetration depth into {100} Si at 30 keV is approximately 40 nm. Clean-up with either a 5 or 2 keV beam reduces the depth of damaged Si to approximately 5 nm and <1 nm, respectively. Finally, a NiSi sample was extracted from a Si wafer, mounted to a microtip array, sharpened, cleaned up with a 5 keV beam and analyzed in the atom probe. The current results demonstrate that specific regions of interest can be accessed and preserved throughout the sample-preparation process and that this preparation method leads to high-quality atom probe analysis of such nano-structures.

Dietary-induced metabolic acidosis decreases bone mineral density in mature ovariectomized ewes.

Dietary-induced metabolic acidosis (DIMA) may be a significant confounder in the development of osteoporosis. Diets that are acidifying are typically rich in proteins and grains and relatively poor in fruits and vegetables. Previous studies have not examined whether an interaction between estrogen depletion and DIMA have a compounded affect on bone mineral density loss. Sheep have been used successfully in previous studies to examine the interaction of bone turnover and ovariectomy. Therefore, the goal of this pilot study was to determine if bone mineral density (BMD) loss could be induced using DIMA in skeletally mature ovariectomized (OVX) ewes.

A phase II trial of temozolomide for patients with recurrent or progressive brain metastases.

BACKGROUND: Treatment options for patients with recurrent brain metastases are extremely limited. This study was designed to determine the safety and efficacy of temozolomide in the treatment of recurrent or progressive brain metastases. PATIENTS AND METHODS: Forty-one patients (11 men, 30 women) with a median KPS of 80 were treated with temozolomide 150 mg/m2/day (200 mg/m3/day if no prior chemotherapy) for 5 days; treatment cycles were repeated every 28 days. Primary tumor types included 22 non-small cell lung, 10 breast, three melanoma, two small cell lung, two rectal, one ovarian and one endometrial cancer. RESULTS: There were five episodes of grade 3 thrombocytopenia and one grade 4 leukopenia. Significant non-hematologic toxicity possibly related to temozolomide included pneumonitis [21, constipation [1], and elevated liver enzymes [21. Thirty-four patients were assessed for radiographic response; two had a partial response, 15 stable disease and 17 progressed. Both objective responses were seen in patients with non-small cell lung cancer. Overall median survival was 6.6 months. CONCLUSIONS: Single agent temozolomide achieved disease control (PR or SD) in 41% of patients with recurrent brain metastases from a variety of primary malignancies with minimal toxicity. Therefore, temozolomide may be a reasonable treatment option for some patients with recurrent brain metastases.

Inhibition of human platelet function by sulfatides.

Sulfatides are glycolipid constituents of human platelet cell membranes and have been shown to interact with platelet-binding proteins involved in hemostasis. Because little is known about the physiological role of sulfatides in platelet function, the effect of sulfatide on platelet adhesion, aggregation, release, and ristocetin-induced platelet agglutination (RIPA) was studied. These processes are inhibited when exogenous sulfatide is present in vitro. Inhibition of aggregation induced by collagen, thrombin, and ristocetin by sulfatide was dose dependent. Adenosine diphosphate-mediated adhesion and aggregation were not significantly affected by sulfatide, nor was serotonin- and epinephrine-mediated aggregation. Collagen mediate release of serotonin was reduced sulfatide. RIPA demonstrated dose-dependent inhibition in response to sulfatide. These results suggest that sulfatide may play a role in modulating platelet activation.

Coexisting dysfibrinogenemia (gammaR275C) and factor V Leiden deficiency associated with thromboembolic disease (fibrinogen Cedar Rapids).

Fibrinogen Cedar Rapids is a heterozygous dysfibrinogenemia (gammaR275C) that was associated with thromboembolism during and following pregnancy in three second-generation family members who also were heterozygotic for factor V Leiden (V R506Q). Like other dysfibrinogenemias with substitutions at position 275 of the gamma-chain, fibrinogen Cedar Rapids is characterized by defective end-to-end intermolecular fibrinogen and fibrin 'D : D' associations, a fibrin network structure that is composed of thicker and more highly branched fibers, normal fibrin 'D: E' associations, and normal factor XIII-mediated crosslinking of fibrinogen and fibrin. In addition, Cedar Rapids fibrinogen and fibrin displayed delayed plasmin lysis rates. Compared with normal fibrinogen, platelet aggregation or platelet fibrinogen receptor clustering was defective in the presence of fibrinogen Cedar Rapids. Most subjects with gammaR275 mutations do not experience clinical thrombotic disorders, suggesting that the combination of a factor V Leiden defect and a gammaR275C dysfibrinogenemia predisposes to thromboembolic disease.

Long-term outcome of low-grade oligodendroglioma and mixed glioma.

BACKGROUND: Low-grade oligodendrogliomas and mixed gliomas can be indolent and remain unchanged for years. Optimal timing and effectiveness of initial treatment is uncertain and therapy can be associated with toxicity. METHODS: Retrospective review of patients diagnosed between 1979 and 1997 with low-grade oligodendroglioma or mixed glioma. Time to progression, survival, prognostic factors, and treatment toxicities were evaluated. RESULTS: A total of 106 patients (77 oligodendroglioma, 29 mixed glioma) were identified; median age was 36.7 years. Initial presenting symptoms were seizures in 76 (72%) and headache in 11 (10%); tumor was diagnosed as an incidental finding in five patients. Tumor progression was diagnosed in 72 patients (68%). Overall median time to progression (MTTP) was 5.0 years (range 0.5 to 14.2). Median overall survival (OS) was 16.7 years. No prognostic factors reached statistical significance. MTTP and OS were not significantly affected by treatment. Of 62 patients who received radiation therapy, 9 (15%) developed radiation necrosis and 13 developed radiation therapy-related cognitive changes, requiring ventriculoperitoneal shunting in six. Significant myelosuppression was seen in 35 of 76 (46%) patients treated with chemotherapy. CONCLUSIONS: Low-grade oligodendroglioma and mixed glioma have a long median overall survival. There were no apparent differences in either immediate versus deferred treatment or choice of initial therapy on disease-free or overall survival. Chemotherapy was associated with significant acute toxicity in almost one half of patients; radiation therapy produced late neurotoxicity in one third, justifying deferred treatment until clinically necessary.

A method for proficiency testing of small peer groups in the College of American Pathologists Coagulation Surveys.

OBJECTIVE: To develop a grading scheme for the proficiency testing of small peer groups of fewer than 10 members for the prothrombin time (PT) and activated partial thromboplastin time (APTT). METHODS: A modified target value for small peer groups was derived based on the assumption that measurement variability in the PT and APTT is more greatly influenced by variations in reagents than in instruments. Criteria for grading were established by statistical simulation to achieve misclassification errors of less than 5% for both incorrectly passing and failing participants. College of American Pathologists Coagulation Survey data were analyzed to determine the number of additional laboratories graded using the proposed scheme, as well as the failure rates among participants in the small peer groups. RESULTS: The modified target value for small peer groups is a weighted average between the mean of the peer group and the mean of all participants using the same reagent (reagent group). Peer groups with as few as 4 members can be graded provided that specific criteria are satisfied: there must be at least 5 peer groups for the same reagent, at least 3 of these 5 peer groups must have more than 3 members, and the coefficient of variation for the reagent group must be less than 10%. This proposed grading scheme decreased the number of ungraded laboratories by 44% to 46% for the PT and 42% to 55% for the APTT. The percentage of failing grades among participants in the small peer groups ranged from 1.3% to 4.1% for the PT and 1.4% to 7.2% for the APTT. These failure rates were 2.8- to 13.0-fold higher than the failure rates in large peer groups (P < or = .05). CONCLUSIONS: The proposed small peer group grading scheme can improve the effectiveness of College of American Pathologists proficiency testing for the PT and APTT and may also be generally applicable to other test methods and analytes.

Fetal hemorrhage and platelet dysfunction in SLP-76-deficient mice.

The adapter protein SLP-76 is expressed in T lymphocytes and hematopoietic cells of the myeloid lineage, and is known to be a substrate of the protein tyrosine kinases that are activated after ligation of the T-cell antigen receptor. Transient overexpression of SLP-76 in a T-cell line potentiates transcriptional activation after T-cell receptor ligation, while loss of SLP-76 expression abrogates several T-cell receptor-dependent signaling pathways. Mutant mice that lack SLP-76 manifest a severe block at an early stage of thymocyte development, implicating SLP-76 in signaling events that promote thymocyte maturation. While it is clear that SLP-76 plays a key role in development and activation of T lymphocytes, relatively little is understood regarding its role in transducing signals initiated after receptor ligation in other hematopoietic cell types. In this report, we describe fetal hemorrhage and perinatal mortality in SLP-76-deficient mice. Although megakaryocyte and platelet development proceeds normally in the absence of SLP-76, collagen-induced platelet aggregation and granule release is markedly impaired. Furthermore, treatment of SLP-76-deficient platelets with collagen fails to elicit tyrosine phosphorylation of phospholipase C-gamma2 (PLC-gamma2), suggesting that SLP-76 functions upstream of PLC-gamma2 activation. These data provide one potential mechanism for the fetal hemorrhage observed in SLP-76-deficient mice and reveal that SLP-76 expression is required for optimal receptor-mediated signal transduction in platelets as well as T lymphocytes.

College of American Pathologists Conference XXXI on laboratory monitoring of anticoagulant therapy: laboratory monitoring of unfractionated heparin therapy.

OBJECTIVE: To review the state of the art as reflected in the medical literature and the consensus opinion of recognized experts in the field regarding the laboratory monitoring of unfractionated heparin therapy. DATA SOURCES, EXTRACTION AND SYNTHESIS: The authors made an extensive review of the literature. The draft manuscript was circulated to every participant in the consensus conference prior to the convening of the conference. Extensive discussion concerning all of the issues addressed in the manuscript as well as the resulting recommendations occurred. This information was then used to revise the manuscript into its final form. CONCLUSIONS: The resulting manuscript has 23 specific recommendations regarding preanalytic, analytic, and postanalytic phases of monitoring and testing for complications related to unfractionated heparin therapy. This report contains detailed discussion of these recommendations and includes literature citations that support them. A number of issues for which consensus could not be reached are also discussed. A method is provided to assist laboratories, particularly small laboratories, in providing clinicians with an appropriate therapeutic range for the activated partial thromboplastin time, the most commonly used test in monitoring heparin therapy.

The Collaborative Hospital Transfusion Study: variations in use of autologous blood account for hospital differences in red cell use during primary hip and knee surgery.

BACKGROUND: Red cell use in patients undergoing Diagnosis Related Group (DRG) 209 procedures (major joint and limb reconstruction procedures of the lower extremities) has been shown to have large, unexplained interhospital variations. STUDY DESIGN AND METHODS: Abstracted records of 2590 consecutive DRG 209 patients at five university hospitals from January 1992 to December 1993 were stratified by procedure and preoperative blood deposit status. Patient characteristics and transfusion and in-hospital outcomes were compared across hospitals. RESULTS: Blood use among patients who did not preoperatively deposit blood was similar across hospitals. Significant differences were found across hospitals for total hip replacement patients in the percentage of patients preoperatively depositing blood (59-80%), percentage of patients receiving transfusion(s) (51 to > 99%), the mean number of units collected per patient (1.6-2.9), and the mean number of unused autologous units per 100 patients (1-185). No significant differences were found in the percentage of those who deposited blood and then required allogeneic units. There was little variability in length of hospital stay or in last hematocrits. Findings were similar for total knee replacement patients. CONCLUSIONS: Interhospital variations in red cell use for primary total hip and knee reconstruction are primarily due to hospital-specific differences in autologous blood collection and transfusion.

Outcome of transfusion of K:11 erythrocytes in a patient with anti-K11 antibody.

BACKGROUND AND OBJECTIVES: The clinical significance of anti-K11 in red cell transfusion therapy is unknown. We report the outcome of transfusion of K:11 erythrocytes into a patient with a known anti-K11 antibody. MATERIALS AND METHODS: The patient was monitored clinically following transfusion of 11 units of K:11 erythrocytes. A red cell survival study with K:11 erythrocytes and a monocyte monolayer assay (MMA) were performed. RESULTS: No adverse clinical outcome was detected. The red cell survival study showed normal survival of K:11 erythrocytes, and the MMA showed no increase in reactive monocytes. CONCLUSION: These findings suggest that K:11 red cells can safely be transfused to individuals with anti-K11 antibody.