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Background: Umbilical cord blood (UCB) transplantation is becoming more widely used, yet ethical and policy issues regarding consent and health history persist. Whereas most UCB banks do not require paternal consent or paternal health history (PHH), both are obtained at this institution whenever possible. This study assessed the value of PHH in making UCB safer.Study Design and Methods: A retrospective review was performed of all cord blood units (CBUs) collected by this bank between November 1999 and October 2000. All discarded CBUs were studied to identify those deferred based exclusively on PHH provided by the father in the PHH questionnaire.Results: PHH was obtained for 301 of 655 (46%) CBUs collected. Of the 339 CBUs banked, 269 (79%) had PHH available. Three of the 301 CBUs in which PHH was available were discarded based solely on PHH, since maternal medical history and infectious disease testing were negative. Paternal high-risk factors in those three cases were: gave money or drugs for sex; traveled to an HIV high-risk area; and did not answer high-risk questions.Conclusion: Considerable time and effort is expended in the process and follow-up of obtaining PHH with an overall indistinct and unconvincing role in minimizing infectious disease transmission risk in UCB banking. [ABSTRACT FROM AUTHOR]

Background: Chemical pleurodesis is frequently used to treat chronic pneumothorax (PTX) with pulmonary air leak in patients that are high-risk for surgery. More recently, commercial fibrin sealants, typically virus-inactivated human fibrinogen and thrombin, have been successfully used in these patients. Several fibrin sealant preparations have been available in Europe for more than 20 years and in the United States since May 1998. Topical fibrin glue, a less expensive alternative to commercially available fibrin sealants, is prepared by mixing cryoprecipitate, bovine thrombin and calcium. The use of cryoprecipitate glue for pleurodesis has rarely been reported. We describe two cases in which persistent pneumothoraces were successfully treated by intrapleural instillation of cryoprecipitate glue via chest tube. Case report - 1: A 78-year-old male with severe emphysema developed a posttraumatic right apical PTX. Three weeks later, his dyspnea worsened with oxygen saturation of 94% on 3 liters of oxygen via nasal cannula. The PTX persisted despite one week of chest tube drainage at 20 cm of water suction and an attempt at pleurodesis with intrapleural Doxycycline. Intrapleural instillation of cryoprecipitate glue via a chest tube was performed using 4 units of cryoprecipitate closely followed by 1000 units of bovine thrombin and 0.1 mi of 10% CaCl. Saline was injected into the chest tube after both cryoprecipitate and thrombin to prevent fibrin occlusion of the chest tube. The patient's bed was kept in the Trendelenberg position for 5 minutes. The air leak resolved immediately after the cryoprecipitate glue instillation and a subsequent chest X-ray revealed resolution of the PTX. The patient's exercise capacity improved and there was no evidence of recurrence of PTX at a two-week follow up. Case report - 2: A 73-year-old man with severe ankylosing spondylitis, ischemic heart disease and restrictive lung disease underwent right lower lobe decortication for a chronic pleural effusion. The procedure was complicated by formation of a brenchopleural fistula with right basilar PTX. A chest tube in place for three months did not resolve the PTX and he developed respiratory distress with oxygen saturation of 92% on 2 liters of oxygen via nasal cannula. He then underwent cryoprecipitate glue-pieurodesis similar to case-1, using 6 units of cryoprecipitate. Chest X-rays obtained the following day and at two weeks showed absence of recurrence. Conclusion: Intrapleural instillation of cryoprecipitate glue may be an effective and less expensive alternative to commercial fibrin sealant in the treatment of high-risk patients with persistent PTX. [ABSTRACT FROM AUTHOR]

Background: Umbilical cord blood (UCB) transplantation is becoming more widely used, yet ethical and policy issues in obtaining informed consent and health history (HH) information persist. Most UCB banks do not require father's consent or HH. Our UCB bank, established in October 1999, obtains both written paternal consent and HH whenever possible. We performed this study in order to assess the value of paternal health history (PHH) in making cord blood safer for transplantation by excluding units at higher risk of infectious or other disease transmission. Methods: A retrospective review was performed of all CBUs collected over a one-year period, between November 1999 and October 2000. The cases in which PHH was obtained were evaluated to identify those discarded based solely on information provided by the father in the PHH questionnaire. Results: A total of 655 CBUs were collected over the study period and PHH was obtained in 299 of them (46%). Seventy-nine percent of CBUs banked during that period had PHH available (see table). Three CBUs (3 of 299; 1% of all CBUs collected with PHH) were discarded based purely on PHH; written information provided by the father was the only reason for discarding those units since maternal HH and infectious disease testing was negative. The identified high-risk factors in those three cases were: the father gave money or drugs for sex, traveled to an HIV high-risk area, or did not answer the high-risk questions in the PHH questionnaire. Conclusion: Considerable time and effort is expended in the process and follow-up of obtaining PHH. Although it has the potential to broaden the safety profile of CBUs banked for clinical use, our study suggests that it has little overall impact in minimizing infectious disease transmission risk in UCB banking. [ABSTRACT FROM AUTHOR]

Background: The corrected count increment (CCI) can standardize assessment of platelet transfusions by correcting for patient's body surface area (BSA) and platelet dose (PD). By using a fixed CCI and a desired post-transfusion platelet count, CCI formula can be used to calculate PD based on patient's BSA. Our transfusion service has used the following formula since May 1990, to determine the PD for non-bleeding patients: PD = (Desired post minus pro-transfusion platelet count/mL) × (BSA in m²)/(7000/mL × 1.7), where PD is expressed in number of platelet concentrates, 7000 is the expected platelet count increment per unit transfused, and 1.7 is BSA in m² in a 70-kilogram adult. This study evaluated the clinical value of this approach. Methods: A retrospective review was performed of all 2202 platelet transfusions at our hospital between 1/1/98 and 12/31/00. In 89 cases a calculated PD was determined prior to transfusion and these were evaluated for platelet increments at 1, 1-18, or 18-24 hours post-transfusion. The transfusions that used the calculated PD were compared with those that did not. Results: 83 transfusions in 69 patients were reviewed (see table). The background clinical conditions were: miscellaneous uncomplicated cases 49%, sepsis 25%, hematological malignancy 16%, coagulopathy secondary to alcoholic hepatitis 6%, and solid tumor 4%. No difference in mean platelet count increments was noted between the two groups (p=0.46). Conclusion: While calculated platelet dose can reduce the number of donor exposures and also identify cases that need more than the conventional dose based on BSA, its overall impact on platelet transfusion response appears less significant. [ABSTRACT FROM AUTHOR]

Background: Optimizing product quality is a current focus in cord blood banking. This study evaluates the role of selected donor- and collection-related variables., Study Design and Methods: Retrospective review was performed of cord blood units (CBUs) collected ex utero between February 1, 2000, and February 28, 2002. Preprocessing volume and total nucleated cell (TNC) counts and postprocessing CD34 cell counts were used as product quality indicators., Results: Of 2084 CBUs, volume determinations and TNC counts were performed on 1628 and CD34+ counts on 1124 CBUs. Mean volume and TNC and CD34+ counts were 85.2 mL, 118.9 x 10(7), and 5.2 x 10(6), respectively. In univariate analysis, placental weight of greater than 500 g and meconium in amniotic fluid correlated with better volume and TNC and CD34+ counts. Greater than 40 weeks' gestation predicted enhanced volume and TNC count. Cesarean section, two- versus one-person collection, and not greater than 5 minutes between placental delivery and collection produced superior volume. Increased TNC count was also seen in Caucasian women, primigravidae, female newborns, and collection duration of more than 5 minutes. A time between delivery of newborn and placenta of not greater than 10 minutes predicted better volume and CD34+ count. By regression analysis, collection within not greater than 5 minutes of placental delivery produced superior volume and TNC count., Conclusion: Donor selection and collection technique modifications may improve product quality. TNC count appears to be more affected by different variables than CD34+ count.