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Reducing O Negative Blood Product Usage In A Tertiary Care Academic Medical Center, Wendy Weiler, Tracy Cook, MMC Blood Bank, Mark Parker, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks 2018 Maine Medical Center

Reducing O Negative Blood Product Usage In A Tertiary Care Academic Medical Center, Wendy Weiler, Tracy Cook, Mmc Blood Bank, Mark Parker, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Excellence

MANAGEMENT OF O NEGATIVE BLOOD USE

O registered blood cells are the universal donor but it comprises only 7% of the blood supply. As a result, inappropriate use can result in shortages.

At an academic tertiary care medical center, a performance improvement goal was established that O negative blood cells would make up less than 12% of all blood type transfused by the end of their fiscal year.

A root cause analysis established reasons for the use of O negative blood cells. A number of countermeasures were initiated using the plan, do, study, act (PDSA) problem solving model. Using newly ...


Primary Cardiac Lymphoma: Importance Of Tissue Diagnosis, Lauren Mendelson, Emily Hsu, Hojune Chung, Andrew Hsu 2018 University of Massachusetts Medical School

Primary Cardiac Lymphoma: Importance Of Tissue Diagnosis, Lauren Mendelson, Emily Hsu, Hojune Chung, Andrew Hsu

Open Access Articles

Primary cardiac lymphoma (PCL) is a rare disease entity that can present with severe cardiac and cardioembolic symptoms. We present a 79-year-old male with history of polymalgia rheumatica on chronic prednisone who presented with a two-week history of progressively worsening dyspnea, cough, and a 10 pound weight loss. Transthoracic echocardiogram (TTE) and computed tomography (CT) of the chest showed a large mediastinal mass with invasion of the pericardium. A biopsy of an abdominal soft-tissue mass confirmed the diagnosis of PCL. The patient was treated with two cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) which was complicated by ...


Lenalidomide Consolidation Benefits Patients With Cll Receiving Chemoimmunotherapy: Results For Calgb 10404 (Alliance)., John C Byrd, Amy S Ruppert, Nyla A Heerema, Alese E Halvorson, Eva Hoke, Mitchell R Smith, John E Godwin, Stephen Couban, Todd A Fehniger, Michael J Thirman, Martin S Tallman, Frederick R Appelbaum, Richard M Stone, Sue Robinson, Julie E Chang, Sumithra J Mandrekar, Richard A Larson 2018 Providence Cancer Center, Portland, OR.

Lenalidomide Consolidation Benefits Patients With Cll Receiving Chemoimmunotherapy: Results For Calgb 10404 (Alliance)., John C Byrd, Amy S Ruppert, Nyla A Heerema, Alese E Halvorson, Eva Hoke, Mitchell R Smith, John E Godwin, Stephen Couban, Todd A Fehniger, Michael J Thirman, Martin S Tallman, Frederick R Appelbaum, Richard M Stone, Sue Robinson, Julie E Chang, Sumithra J Mandrekar, Richard A Larson

Journal Articles and Abstracts

Prior to novel targeted agents for chronic lymphocytic leukemia (CLL), the best chemoimmunotherapy regimen in patients with non-del(11q) disease was unclear. The role of lenalidomide was also not defined. This phase 2 study randomized 342 untreated patients with non-del(11q) CLL requiring therapy to fludarabine plus rituximab (FR; n = 123), FR plus lenalidomide consolidation (FR+L; n = 109), or FR plus cyclophosphamide (FCR; n = 110) and compared 2-year progression-free survival (PFS) rates of each to the historical control rate with FC (60%). Patients with del(11q) in at least 20% of pretreatment cells continued with FCR (n = 27) or ...


Distribution Of Chromosomal Abnormalities Commonly Observed In Adult Acute Myeloid Leukemia In Pakistan As Predictors Of Prognosis, Muhammad Shariq Shaikh, Zeeshan Ansar Ahmed, Mohammad Usman Shaikh, Salman Naseem Adil, Mohammad Khurshid, Tariq Moatter, Anila Rashid, Farheen Karim, Ahmed Raheem, Natasha Ali 2018 Aga Khan University

Distribution Of Chromosomal Abnormalities Commonly Observed In Adult Acute Myeloid Leukemia In Pakistan As Predictors Of Prognosis, Muhammad Shariq Shaikh, Zeeshan Ansar Ahmed, Mohammad Usman Shaikh, Salman Naseem Adil, Mohammad Khurshid, Tariq Moatter, Anila Rashid, Farheen Karim, Ahmed Raheem, Natasha Ali

Department of Pathology and Laboratory Medicine

Objectives: The heterogenous response to treatment in acute myeloid leukemia (AML) can be attributed largely to the difference in cytogenetic features identified in between cases. Cytogenetic analysis in acute leukemia is now routinely used to assist patient management, particularly in terms of diagnosis, disease monitoring, prognosis and risk stratification. Knowing about cytogenetic profile at the time of diagnosis is important in order to take critical decisions in management of these patients. The study was conducted to determine the distribution of cytogenetic abnormalities in Pakistani adult patients with AML in order to have insights regarding behavior of the disease.
Methods:
A ...


Platelet Function In Normal Pregnancy, Naomi Burke 2018 Royal College of Surgeons in Ireland

Platelet Function In Normal Pregnancy, Naomi Burke

MD theses

The concept for this thesis arose after a collaboration between the Platelet Biology Laboratory and the Department of Obstetrics and Gyanecology in the Royal College of Surgeons in Ireland. They discovered a significant difference in platelet aggregation in women with a history of recurrent pregnancy loss using a novel platelet assay. This posed the question as to whether or not this platelet assay would eludicate different platelet reactivity at different time points in a normal, heathy pregnancy. The objective was to critically evaluate platelet reactivity in normal pregnancy using this assay which assessed platelet aggregation to several agonists at multiple ...


Pre-Diagnosis Plasma Immune Markers And Risk Of Non-Hodgkin Lymphoma In Two Prospective Cohort Studies, Mara M. Epstein, Bernard Rosner, Elizabeth C. Breen, Julie L. Batista, Edward L. Giovannucci, Larry Magpantay, Jon C. Aster, Scott J. Rodig, Kimberly A. Bertrand, Francine Laden, Otoniel Martinez-Maza, Brenda M. Birmann 2018 University of Massachusetts

Pre-Diagnosis Plasma Immune Markers And Risk Of Non-Hodgkin Lymphoma In Two Prospective Cohort Studies, Mara M. Epstein, Bernard Rosner, Elizabeth C. Breen, Julie L. Batista, Edward L. Giovannucci, Larry Magpantay, Jon C. Aster, Scott J. Rodig, Kimberly A. Bertrand, Francine Laden, Otoniel Martinez-Maza, Brenda M. Birmann

Open Access Articles

Inflammation and B-cell hyperactivation have been associated with non-Hodgkin lymphoma development. This prospective analysis aimed to further elucidate pre-diagnosis plasma immune marker profiles associated with non-Hodgkin lymphoma risk. We identified 598 incident lymphoma cases and 601 matched controls in Nurses' Health Study and Health Professionals Follow-up Study participants with archived pre-diagnosis plasma samples and measured 13 immune marker levels with multiplexed immunoassays. Using multivariable logistic regression we calculated odds ratios and 95% confidence intervals per standard deviation unit increase in biomarker concentration for risk of non-Hodgkin lymphoma and major histologic subtype, stratifying additional models by years ( < 5, 5 to < 10, > /=10) after blood draw ...


Inherited Bleeding Disorders-Experience Of A Not-For-Profit Organization In Pakistan, Shabneez Hussain, Shahida Baloch, Azra Parvin, Akbar Najmuddin, Farhana Musheer, Mubashra Junaid, Rab Nawaz Memon, Fareeda Bhanbhro, Hayat Ullah, Bushra Moiz 2018 Fatimid Foundation, Karachi, Pakistan

Inherited Bleeding Disorders-Experience Of A Not-For-Profit Organization In Pakistan, Shabneez Hussain, Shahida Baloch, Azra Parvin, Akbar Najmuddin, Farhana Musheer, Mubashra Junaid, Rab Nawaz Memon, Fareeda Bhanbhro, Hayat Ullah, Bushra Moiz

Department of Pathology and Laboratory Medicine

Patient registry is a powerful tool for planning health care and setting groundwork for research. This survey reports a detailed registry of inherited bleeding disorders (IBD) and their management at a not-for-profit organization in a developing country to form the basis for planning development and research. We reviewed medical records of patients with IBD from 8 hemophilia treatment centers of Fatimid Foundation located in various cities. Information collected included sociodemographic data, diagnostic tests, severity of hemophilia A and B, number of bleeding episodes per year, site and frequency of hemarthrosis, and seropositivity for viral diseases. We analyzed 1497 patients from ...


Immunohistochemical Expression And Prognostic Value Of Pd-L1 In Extrapulmonary Small Cell Carcinoma: A Single Institution Experience, Mohammed Salhab, Yazan Migdady, Melanie Donahue, Yiqin Xiong, Karen A. Dresser, William Walsh, Benjamin J. Chen, James Liebmann 2018 University of Massachusetts Medical School

Immunohistochemical Expression And Prognostic Value Of Pd-L1 In Extrapulmonary Small Cell Carcinoma: A Single Institution Experience, Mohammed Salhab, Yazan Migdady, Melanie Donahue, Yiqin Xiong, Karen A. Dresser, William Walsh, Benjamin J. Chen, James Liebmann

Open Access Articles

BACKGROUND: Extrapulmonary small cell carcinomas (ESCC) are rare but aggressive tumors. Relapses are common despite treatment with chemotherapy and/or radiotherapy. Prospective data for treatment of ESCC are lacking; treatment of these cancers usually incorporates lung small cell carcinoma treatment recommendations. Cancer staging remains the most important prognostic factor. Cancer immunotherapy targeting the PD-1/PD-L1 pathway has shown efficacy in multiple tumor types, and could be an appealing treatment strategy for these rare tumors.

METHODS: We investigated PD-L1 expression by immunochemistry (IHC) in ESCCs diagnosed at University of Massachusetts Medical Center, from 1999 to 2016. 34 cases with sufficient material ...


Poorly Cytotoxic Terminally Differentiated Cd56(Neg)Cd16(Pos) Nk Cells Accumulate In Kenyan Children With Burkitt Lymphomas, Catherine Forconi, Cormac P. Cosgrove, Pryia Saikumar-Lakshmi, Christina E. Nixon, Joslyn Foley, John Michael Ong'echa, Juliana A. Otieno, Galit Alter, Christian Munz, Ann M. Moormann 2018 University of Massachusetts Medical School

Poorly Cytotoxic Terminally Differentiated Cd56(Neg)Cd16(Pos) Nk Cells Accumulate In Kenyan Children With Burkitt Lymphomas, Catherine Forconi, Cormac P. Cosgrove, Pryia Saikumar-Lakshmi, Christina E. Nixon, Joslyn Foley, John Michael Ong'echa, Juliana A. Otieno, Galit Alter, Christian Munz, Ann M. Moormann

Open Access Articles

Natural killer (NK) cells are critical for restricting viral infections and mediating tumor immunosurveillance. Epstein-Barr virus (EBV) and Plasmodium falciparum malaria are known risk factors for endemic Burkitt lymphoma (eBL), the most common childhood cancer in equatorial Africa. To date, the composition and function of NK cells have not been evaluated in eBL etiology or pathogenesis. Therefore, using multiparameter flow cytometry and in vitro killing assays, we compared NK cells from healthy children and children diagnosed with eBL in Kenya. We defined 5 subsets based on CD56 and CD16 expression, including CD56(neg)CD16(pos) We found that licensed and ...


Hematological Changes In Response To A Drastic Increase In Training Volume In Recreational Cyclists, Jessie Axsom 2018 James Madison University

Hematological Changes In Response To A Drastic Increase In Training Volume In Recreational Cyclists, Jessie Axsom

James Madison Undergraduate Research Journal (JMURJ)

Changes in blood volume contribute to improvement in oxygen utilization (VO2max) with chronic endurance exercise training. Although hematological changes resulting from long-term endurance training have been well documented, it has not been well established whether an increased volume of endurance training preferentially affects plasma volume or red blood cell volume. To answer this question, I studied seven female and four male recreational cyclists before and after exposure to drastic increases (632%) in training volume. Following the 10-week training period, the mean hematocrit (Hct) of the 11 subjects who completed the study significantly (p0.05) correlated with the change in self-reported ...


Structure Determination Of A Bioengineered Human/Porcine Factor Viii For Hemophilia A Treatment, And Improvements To The Human Factor Viii Model, Ian Smith 2018 Western Washington University

Structure Determination Of A Bioengineered Human/Porcine Factor Viii For Hemophilia A Treatment, And Improvements To The Human Factor Viii Model, Ian Smith

Graduate Student Symposium

Blood coagulation factor VIII (FVIII), is a non-enzymatic cofactor which plays a crucial role in the formation of a stable blood clot. Absence or deficiency of FVIII results in the blood disorder hemophilia A; with symptoms including internal hemorrhaging and the inability to stop bleeding from open wounds. Treatment of hemophilia A relies on infusions of blood, plasma, or protein concentrates to replace FVIII. Unfortunately, approximately 30% of patients receiving replacement FVIII generate pathologic anti-FVIII inhibitory antibodies, which both reduce the effectiveness of the FVIII therapeutic and increase the severity of hemophilia A symptoms. We have determined the molecular structure ...


Metastatic Breast Cancer Presenting As Painless Jaundice, Daniel S. Wilen DO, Donald J. McMahon DO, Brian J. Blair DO, Joanne Kaiser-Smith DO, Darshan B. Roy MD 2018 Rowan University SOM

Metastatic Breast Cancer Presenting As Painless Jaundice, Daniel S. Wilen Do, Donald J. Mcmahon Do, Brian J. Blair Do, Joanne Kaiser-Smith Do, Darshan B. Roy Md

Stratford Campus Research Day

Breast cancer is the most commonly diagnosed cancer in women in the United States. Treatment options are wide-­‐ ranging based on a multitude of factors, including extent of disease and receptor positivity. Following treatment, a relapse-­‐free interval ≥ 2 years carries a more favorable prognosis.

We present a case involving a female with history of breast cancer and relapse-­free interval of 15 years who unfortunately presented with metastatic disease involving the liver, bone, and lymph nodes.


Development Of Novel Dual Inhibitor Of Chemokine Receptor 4 And Mcl-1 Against Multiple Myeloma, Kuntal Bhowmick, Kristy K. Patel, Suman Pathi, Subash Jonnalagadda, Tulin Budak-Alpdogan, Manoj K. Pandey 2018 Rowan University

Development Of Novel Dual Inhibitor Of Chemokine Receptor 4 And Mcl-1 Against Multiple Myeloma, Kuntal Bhowmick, Kristy K. Patel, Suman Pathi, Subash Jonnalagadda, Tulin Budak-Alpdogan, Manoj K. Pandey

Stratford Campus Research Day

Multiple myeloma (MM) is a neoplastic plasma-cell disorder. This is characterized by clonal proliferation of malignant plasma cells in the bone-marrow (BM) microenvironment, monoclonal protein in blood or urine, and associated organ dysfunction. The treatment options approved by FDA are immune-modulatory agents, proteasome inhibitors, and autologous stem cell transplantation (ASCT). Unfortunately, MM remains uniformly fatal owing to intrinsic or acquired drug resistance and the median survival time is 3 to 5 years. Thus, there is a great need for novel strategies to combat MM.

The intimate relationship of myeloma cells to BM microenvironment is “hallmark of myeloma”. The homing of ...


Different Methodologies To Characterize And Diagnose Sickle Cell Disease In Both Developed And Developing Nations, Mohammed AlHarbi 2018 Dominican University of California

Different Methodologies To Characterize And Diagnose Sickle Cell Disease In Both Developed And Developing Nations, Mohammed Alharbi

Master's Theses and Capstone Projects

Sickle cell disease (SCD) is a genetic blood disorder that causes the RBC to become sickle shaped due to a mutation in the β-globin gene encoding the protein hemoglobin. This disease causes reduced oxygen carrying capacity of RBC resulting in painful crisis, hemolytic anemia, and infection susceptibility. SCD affects around 100,000 individuals in USA alone and 14 million people globally. SCD affected individuals have high mortality rates. Early detection and constant monitoring of this disease is essential. The following review focuses on various methodologies that have emerged in the diagnosis of SCD. Also, low cost methods that can be ...


No Risk Reduction For Plasmodium Vivax Malaria In Sickle Cell Disease, Bushra Moiz, Ayesha Majeed Memon 2018 Aga Khan University

No Risk Reduction For Plasmodium Vivax Malaria In Sickle Cell Disease, Bushra Moiz, Ayesha Majeed Memon

Department of Pathology and Laboratory Medicine

Hemoglobin S is known to protect against uncomplicated Plasmodium falciparum malaria. However, there is paucity of the literature regarding interaction of HbS and other malaria species. Usually, P. vivax malaria is a relapsing condition, and without radical cure with primaquine, recurrence may be observed even with hemoglobin S.


Bexarotene-Induced Hypertriglyceridemia: A Case Report, Chris Maminakis, Arin C. Whitman, Nahida Islam 2018 Western New England University

Bexarotene-Induced Hypertriglyceridemia: A Case Report, Chris Maminakis, Arin C. Whitman, Nahida Islam

Open Access Articles

We present a case of a patient with cutaneous T-cell lymphoma started on bexarotene 300 mg/m(2) due to progressing disease. The patient experienced good clinical response, but unfortunately, she developed rapid and profound hypertriglyceridemia. Although hypertriglyceridemia occurs in high incidence with bexarotene therapy, management recommendations are scarce. Due to the rise in triglycerides, atorvastatin 10 mg daily was initiated in combination with fenofibrate 120 mg daily. Triglycerides continued to increase, so the patient was instructed to take atorvastatin 40 mg, fenofibrate 120 mg, and to hold bexarotene for 2 weeks. After the 2-week break, bexarotene was restarted at ...


Adequacy Of Platelet Counting By Automated Haematology Analyzers: An Insight On Current Methodologies, Muhammad Shariq Shaikh, Noor Rahman Khan, Zeeshan Ansar Ahmed 2018 Aga Khan University

Adequacy Of Platelet Counting By Automated Haematology Analyzers: An Insight On Current Methodologies, Muhammad Shariq Shaikh, Noor Rahman Khan, Zeeshan Ansar Ahmed

Department of Pathology and Laboratory Medicine

No abstract provided.


Comorbidities In Aging Patients With Sickle Cell Disease., Samir K. Ballas 2018 Thomas Jefferson University

Comorbidities In Aging Patients With Sickle Cell Disease., Samir K. Ballas

Cardeza Foundation for Hematologic Research

Sickle cell disease (SCD) in general and sickle cell anemia in particular is a highly complex disorder both at the molecular and clinical levels. Although the molecular lesion is a single-point mutation, the sickle gene is pleiotropic in nature causing multiple phenotypic expressions that constitute the various complications of the disease. Moreover, despite the fact that SCD is a chronic malady, its manifestations are both acute and chronic. The former include, among other things, the recurrent vaso-occlusive crises (its hallmark) and acute chest syndrome. The chronic complications include most commonly avascular necrosis and leg ulcers. Currently, survival of patients with ...


Sickle Cell Disease: Classification Of Clinical Complications And Approaches To Preventive And Therapeutic Management., Samir K. Ballas 2018 Thomas Jefferson University

Sickle Cell Disease: Classification Of Clinical Complications And Approaches To Preventive And Therapeutic Management., Samir K. Ballas

Department of Medicine Faculty Papers

Sickle cell disease (SCD) is an inherited disorder of hemoglobin structure that has no established cure in adult patients. Cure has been achieved in selected children with sickle cell anemia (SCA) using allogeneic bone marrow transplantation or cord blood transplantation. SCD is essentially a triumvirate of (1) pain syndromes, (2) anemia and its sequelae and (3) organ failure, including infection. Pain, however, is the hallmark of SCD and dominates its clinical picture throughout the life of the patients. The prevalence of these complications varies with age from infancy through adult life. However, pain, infections and anemia requiring blood transfusion occur ...


Blood Rheological Abnormalities In Sickle Cell Anemia., Philippe Connes, Céline Renoux, Marc Romana, Manouk Abkarian, Philippe Joly, Cyril Martin, Marie-Dominique Hardy-Dessources, Samir K. Ballas 2018 University of Lyon; PRES Sorbonne Paris Cité

Blood Rheological Abnormalities In Sickle Cell Anemia., Philippe Connes, Céline Renoux, Marc Romana, Manouk Abkarian, Philippe Joly, Cyril Martin, Marie-Dominique Hardy-Dessources, Samir K. Ballas

Department of Medicine Faculty Papers

This review focuses on the contribution of abnormal blood rheology in the pathophysiology of sickle cell anemia (SCA). SCA is characterized by a reduction of red blood cell (RBC) deformability but this reduction is very heterogeneous among patients. Recent works have shown that patients with the lowest RBC deformability (measured by ektacytometry) have enhanced hemolysis and would be more prone to develop several complications such as priapism, leg ulcers and glomerulopathy. In contrast, patients with the highest deformability, and not under hydroxyurea therapy, seem to develop more frequently vaso-occlusive like events. Although less studied, RBC aggregation properties are very different ...


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