Maintaining adequate donations and a sustainable blood supply: Lessons learned

Background

The availability of a safe blood supply is a key component of transfusion medicine. A decade of decreased blood use, decreased payment for products, and a dwindling donor base have placed the sustainability of the US blood supply at risk.

Study Design and Methods

A literature review was performed for blood center (BC) and hospital disaster management, chronically transfusion‐dependent diseases, and appropriate use of group O‐negative red blood cells (RBCs), and the Choosing Wisely campaign. The aim was to identify current practice and to make recommendations for BC and hospital actions.

Results

While BCs are better prepared to handle disasters than after the 9/11 attacks, messaging to the public remains difficult, as donors often do not realize that blood transfused during a disaster was likely collected before the event. BCs and transfusion services should participate in drafting disaster response plans. Hospitals should maintain inventories adequate for patients in the event supply is disrupted. Providing specialty products for transfusion‐dependent patients can strain collections, lead to increased use of group O RBCs, and create logistical inventory challenges for hospitals. The AABB Choosing Wisely initiative addresses overuse of blood components to optimally use this precious resource. Group O‐negative RBCs should be transfused only to patients who truly need them.

Conclusions

Collecting and maintaining a blood supply robust enough to handle disasters and transfusion‐dependent patients in need of specialty products is challenging. Collaboration of all parties should help to optimize resources, ensure appropriate collections, improve patient care, and ultimately result in a robust, sustainable blood supply.

Abstract P1-08-12: Trends in incidence of bilateral breast cancer: A Population-based comparative study of the United States and Japan

Background: Previous studies demonstrated that the incidence rate of invasive contralateral breast cancer (CBC) was 5% within the first 10 years after the primary breast cancer (BC). However improving long-term breast cancer survivorship and advancements in diagnostic imaging have resulted in an increased detection of bilateral breast cancer (BBC), and trends of bilateral invasive and in situ breast cancer are not well established. The aim of this study was to assess national trends of BBC incidence of the United States (US) and Japan.

Methods: The Surveillance, Epidemiology, and End Results (SEER) database (1973-2014) and the clinical database of Breast Oncology Center of Cancer Institute Hospital in Tokyo, Japan (Ganken) database (1946-2015) were used to identify nSEER=11,771 and nGanken=1,499 women diagnosed with BBC, respectively. BBC was defined as invasive BC and/or ductal or lobular carcinoma in situ diagnosed in both breasts simultaneously or after primary breast cancer diagnosis. BBC was grouped into synchronous or metachronous BBC by the interval between first BC and contralateral BC; synchronous cases were defined as CBC diagnosed at the same time or within an interval of 1 year from primary BC diagnosis whereas metachronous cases were defined as a diagnosis occuring 1 year following the primary BC. We assessed trends of BBC incidence and characteristics of BBC cases between the two countries. To determine temporal trends in the incidence of BBC and proportion of the characteristics, we compared them using the Cochrane-Armitage test for trend.

Results: The rates of BBC have significantly increased in both countries (Table 1, 2) [1975: 2.6%; 2014: 7.5% in SEER (p<0.001), 1946-1980: 3.3%; 2011-2015: 10.7% in Ganken (p<0.001)]. The increase was identified in both synchronous and metachronous BBC. In SEER, 40% of synchronous BBC were found as in situ BC and about 15% of BBC presented as invasive lobular carcinoma. More recently, CBC was more likely to be diagnosed at early stages (in situ and local disease) than in previous years [1975: 65%; 2014: 85% in SEER (p<0.001)]. The interval between first BC and contralateral BC have shortened, and CBC were more likely to be operated simultaneously in both countries [1985: 40%; 2014: 51% in SEER, 1946-1980: 24%; 2011-2015: 74% in Ganken].

[Table 1]Crude rates of BBC in all breast cancer in SEER 19751985199520052014All breast cancer941813618258766016471505BBC and rates (%)249 (2.6%)790(5.8%)1421(5.5%)3336(5.6%)5381(7.5%)Rates of synchronous BC2.1%2.8%2.3%2.6%3.5%Rates of metachronous BC0.5%3.0%3.2%3.0%4.0%BBC: Bilateral breast cancer

[Table 2]Crude rates of BBC in all breast cancer in Ganken 1946-19801981-19851991-19952001-20052011-2015All breast cancer47772162280637915241BBC and rates (%)157(3.3%)110(5.1%)188(6.7%)298(7.9%)559(10.7%)Rates of synchronous BC1.0%1.9%2.0%2.7%4.9%Rates of metachronous BC2.3%3.2%4.7%5.2%5.8%

Conclusion: In the modern era, the number of BBC cases have increased and are more likely to be found at an early stage. Further studies are needed to demonstrate the usefulness of early detection of CBC and to define the best means to tailor therapy for patients with bilateral disease.

Citation Format: Sakai T, Ozkurt E, Desantis S, Wong S, Rosenbaum L, Zheng H, Ohno S, Golshan M. Trends in incidence of bilateral breast cancer: A Population-based comparative study of the United States and Japan [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-12.

Epstein-Barr virus-associated inflammatory pseudotumor of the spleen: report of two cases and review of the literature

We report two rare examples of Epstein–Barr virus (EBV)-associated inflammatory pseudotumor of the spleen. One patient presented with night sweats, abdominal pain, and weight loss and was found to have a splenic mass on CT scan suspected of lymphoma. The splenic mass in second patient was found incidentally at the time of work up for kidney stones. The pathologic examination of these splenectomy specimens showed similar histologic features. However, the spindle cells were composed of EBV-infected follicular dendritic cells in one case whereas the second case lacked significant follicular dendritic cell proliferation and showed only focal EBV-infected cells suggesting that these proliferations are heterogenous in nature.

Biochemical quantification of triamcinolone in subconjunctival depots

OBJECTIVE

To biochemically quantify the amount of active triamcinolone acetonide remaining after subconjunctival administration and to assess the effectiveness of surgical management for glaucoma induced by triamcinolone.

DESIGN

Case series.

PARTICIPANTS

Seven eyes of seven patients whose ages ranged from 47 to 84 years underwent excision of depot triamcinolone. Six of seven eyes required surgical intervention for medically unresponsive intraocular pressure (IOP) elevation.

RESULTS

Pharmacologically active triamcinolone was identified up to 13 months following injection (range, 3 to 13 months). The mean amount in the excised sample was 5.4 mg (range, 2.0 to 8.8 mg), and the mean percentage of the original sample remaining was 20% (range, 4.2% to 44%). Glaucoma was diagnosed a mean of 3 months after injection (range, 1 to 6 months). Mean IOP was 37 mm Hg before excision and 16 mm Hg after removal. Surgical excision of visible triamcinolone normalized IOP in six of seven patients without need for glaucoma medications.

CONCLUSIONS

Periocular injection of triamcinolone necessitates careful monitoring of IOP. Medically unresponsive IOP elevation may occur as late as 6 months following periocular triamcinolone injection. Surgical excision of remaining triamcinolone depot is an effective therapy for IOP elevation. Guidelines for safely using triamcinolone are discussed.

A victimization assessment tool: instrument development and clinical implications

Although most health care providers now recognize the importance of crisis intervention, support, and/or treatment for survivors of violence and abuse, such care is compromised unless early detection becomes a routine part of intake and assessment protocols in nursing and other facets of health care. This paper describes the development of a tool to assist nurses and other primary care providers with routine assessment for victimization in diverse health and mental health settings. It includes outcomes of preliminary validity and reliability studies, and concludes with suggestions for use in clinical work with victims/survivors of abuse in an era of increasing international concern regarding the health implications of violence.

Intravascular immunoglobulin crystalloids in monoclonal cryoglubulinemia-associated dermatitis: ultrastructural findings

A 46-year-old woman developed polyarthritis, purpuric skin rashes, nasal septal perforation and marginal furrowing of corneas in 1980. Monoclonal IgG, kappa cryoglobulinemia was found in the patient's serum. No underlying lymphoproliferative disorder has been found in ten years since her original diagnosis. In 1991, she developed palpable purpura on both lower extremities with subsequent necrosis and ulceration. A skin biopsy revealed fibrin thrombi within capillaries in the papillary dermis, and immunofluorescence studies showed IgG and light chain kappa within the fibrin thrombi. An electron microscopy study showed intravascular immunoglobulin crystalloid structures with a mean diameter of 80.3A degrees (8.03 nm), mixed with fibrin and red blood cells. The exclusive vascular location of these crystalloids may have implication in the pathogenesis of skin lesions.

Biofeedback-assisted stress management for insulin-treated diabetes mellitus

Six insulin-treated diabetic patients (four with type I and two with type II) who completed a biofeedback-assisted stress management program based on family systems theory improved their response to life stressors, and none had negative side effects. Four decreased their insulin requirement, including one who remained stable even during two pregnancies; the sixth became stable and discontinued drug abuse. All started biofeedback for reasons other than diabetes. Follow-ups of some individuals extend over 4 years.

Effect of agents which block steroid receptor-DNA interaction on anti-DNA antibody titers in sera of patients with systemic lupus erythematosus

We studied whether agents capable of blocking the interaction between steroid receptors and DNA could inhibit the serologic reactivity of anti-nuclear, and other, autoantibodies found in sera of humans with autoimmune disease. Conventional immunofluorescence procedures were used for both detection and titration of these autoantibodies. Parallel studies were conducted with sera diluted in buffers containing the inhibitory agents; KCl, Na2MoO4 or 1,10-phenanthroline, at optimal or suboptimal levels for blocking the steroid receptor-DNA interaction. In most cases these agents had no significant effect on the titer of autoantibodies present in human sera. However, there was one notable exception, that of autoantibodies to native DNA found in sera of patients' with systemic lupus erythematosus and detected by indirect immunofluorescence using Crithidia luciliae kinetoplast DNA as substrate. Here these agents caused either total inhibition of serologic reactivity at optimal blocking concentrations, or a significant reduction in titer, in all twelve specimens studied. These results give rise to at least two possible interpretations: (1) antibodies to native DNA are unusual with respect to the ease with which their binding to antigen may be inhibited by these three chemically unrelated compounds, and (2) steroid receptors are somehow involved in the binding of these antibodies to native DNA.

Ongoing assessment: experience of a university biofeedback clinic

The purpose of this paper is to assess the Georgetown University Family Center Biofeedback Clinic in its first 2 years of operation. The clinic used Budzynski's and Stoyva's training routines as well as family systems theory. Details of the treatment methods and the patients seen are described, along with an ongoing procedure developed to assess results. Preliminary results on 93 patients show that 80% report symptom improvement. Self-report of improvement is associated with decreases in frontal EMG levels and with changes in life-style.

Upper airway obstruction as a complication of oral anticoagulation therapy. Report of three cases

While taking orally administered anticoagulants, three patients had hemorrhages into their retropharyngeal and submandibular spaces, suffering eventual acute airway obstruction. One of the patients died. Despite the life-threatening nature of this complication of anticoagulant therapy, the diagnosis was obscure and initially veiled in complaints of sore throat or hoarseness, suggesting infection. Thorough investigation of such complaints is necessary in patients receiving anticoagulation therapy. If a hematoma is discovered, the patient should be admitted to the hospital for close observation and prompt reversal of anticoagulation with plasma. Intubation or tracheostomy also may be required.

Semantic Differential Factor Structure Stability Across Subject, Concept, and Time Differences

Semantic differential ratings by 90 students at the University of Maryland toward 6 political concepts were obtained before and after the 1964 Presidential Election. When the repsonses of Johnson and Goldwater supporters ere combined in a single factor analysis, 2 factors were extracted. These are described as the evaluative factor and a dynamism factor.