Nucleated red blood cells in normal bone marrow for transplantation.

AIM: Nucleated red blood cells (nRBCs) are indistinguishable from white cells, and therefore are counted by standard electronic cell counters as white cells. We sought to find a correlation between the number of nRBCs and the age of the bone marrow donor, and determine when to correct the total nucleated cell count (TNCC), when reporting graft data. MATERIAL AND METHODS: Presence of nucleated red blood cells was evaluated in 117 samples of normal bone marrow from the donors aged 3 months to 52 years. The nRBCs were counted manually on the smear of bone marrow as the numbers of nucleated RBCper 100 of white cells. The TNCC was obtained from the automated hematological counter Sysmex 9500. RESULTS: The number of nRBCs was substantial in the bone marrow of older donors (up to 44 per 100 of white cells). There was significantly higher number of nRBCs in the bone marrow of older donors. There was no statistically significant difference in the number of nRBCs between female and male bone marrow. The presence ofnRBC in Hematopoietic Progenitor Cell, Marrow (HPC, Marrow) products gives a falsely high cell dose as well as a falsely high dose of total and CD34+ cells per kg, when the flow cytometric dual platform count based on International Society ol Hematotherapy and Graft Eunineering guidelines is utilized (ISHAGE). CONCLUSIONS: The outcome of the bone marrow transplantation depends on the total nucleated cells dose, and the dose of CD344 cells/kg. It is therefore important to evaluate correctly the quality of the graft. We propose, that the rule of correction for nRBCs in bone marrow for transplantation should be applied if the number of nucleated red blood cells is > or = 5 per 100 of white blood cells.

Human leukocyte antigen-DR expression on peripheral blood monocytes and the risk of pneumonia in pediatric lung transplant recipients.

BACKGROUND: Pneumonia is the leading cause of morbidity and mortality after living lobar lung transplantation (LT). Low levels of human leukocyte antigen-DR (HLA-DR) expression on peripheral blood monocytes, have been demonstrated to correlate with risk of infection in surgical, trauma, and adult transplant patients. In addition, interleukin (IL)-10 has been shown to be a negative regulator of HLA-DR expression. This study investigates whether HLA-DR expression and serum IL-10 levels correlate with the development of pneumonia after pediatric LT. METHODS: Thirteen LT recipients were prospectively monitored with blood samples obtained pre-LT (baseline) and post-LT weeks 1-4. Mean fluorescence intensity (MFI) of HLA-DR on CD14+ monocytes was measured by flow cytometry. IL-10 levels were determined by ELISA from frozen serum collected at the same time points as monocyte HLA-DR expression. Correlates of pneumonia were abstracted from the medical record. RESULTS: Monocyte HLA-DR expression declined in 11 of 13 patients in the first week post-LT. Two patients without an initial decline and four others whose HLA-DR expression recovered by week 2 post-LT, did not develop pneumonia or other infection or rejection. Pneumonia was observed in seven patients, six of whom failed to recover their monocyte HLA-DR expression by 2 weeks post-LT. Six of seven patients with pneumonia recovered, and one patient died of aspergillosis. During weeks 1-4, a statistically significant difference was seen in the profile of mean monocyte HLA-DR expression levels, analyzed as percent of baseline, between the patients with and without pneumonia (P=0.002). The greatest difference between groups over time was seen from post-LT weeks 1-2 (P=0.003). In addition, when comparing the values at each week, a significant difference was seen between the two groups at post-LT week 2 (P=0.006) and week 4 (P=0.05). Analysis of IL-10 concentrations revealed that the overall difference between the groups (patients with and without pneumonia) was statistically significant (P=0.014), with a paradoxical positive correlation between HLA-DR expression at post-LT week 4 and IL-10 concentrations. CONCLUSIONS: Persistent low monocyte HLA-DR expression was associated with the risk of post-LT pneumonia in these patients. This measurement may be useful for monitoring risk of infection and stratifying patients into higher and lower risk groups. Increased IL-10 levels may be protective for infection in this group of patients. At present it is unknown whether the predictive power of HLA-DR expression is indicative of a global defect in monocytic function or a specific abnormality.

Recommended default methodology for analysis of airborne exposures to mixtures of chemicals in emergencies.

Emergency planning and hazard assessment of Department of Energy (DOE) facilities require consideration of potential exposures to mixtures of chemicals released to the atmosphere. Exposure to chemical mixtures may lead to additive, synergistic, or antagonistic health effects. In the past, the consequences of exposures to each chemical have been analyzed separately. This approach may not adequately protect the health of persons exposed to mixtures. This article presents default recommendations for use in emergency management and safety analysis within the DOE complex where potential exists for releases of mixtures of chemicals. These recommendations were developed by the DOE Subcommittee on Consequence Assessment and Protective Actions (SCAPA). It is recommended that hazard indices (e.g., HIi = Ci/Limiti, where Ci is the concentration of chemical "i") be calculated for each chemical, and unless sufficient toxicological knowledge is available to indicate otherwise, that they be summed, that is, sigma i(n) = 1HIi = HI1 + HI2 + ... + HIn. A sum of 1.0 or less means the limits have not been exceeded. To facilitate application of these recommendations for analysis of exposures to specific mixtures, chemicals are classified according to their toxic consequences. This is done using health code numbers describing toxic effects by target organ for each chemical. This methodology has been applied to several potential releases of chemicals to compare the resulting hazard indices of a chemical mixture with those obtained when each chemical is treated independently. The methodology used and results obtained from analysis of one mixture are presented in this article. This article also demonstrates how health code numbers can be used to sum hazard indices only for those chemicals that have the same toxic consequence.

Comparison of the safety of early enteral vs parenteral nutrition in mild acute pancreatitis.

BACKGROUND: This prospective study was designed to compare the safety, efficacy, cost, and impact on patient outcome of early total enteral nutrition (TEN) vs total parenteral nutrition (TPN) in acute pancreatitis. METHODS: Patients admitted with acute pancreatitis or an acute flare of chronic pancreatitis, characterized by abdominal pain and elevated serum amylase and lipase, were randomized to receive either isocaloric and isonitrogenous TEN (via a nasojejunal feeding tube placed endoscopically) or TPN (via a central or peripheral line) started within 48 hours of admission. RESULTS: Thirty patients were studied over 32 admissions (TEN given on 16 and TPN on 16) for acute pancreatitis. There were no differences on admission in mean age, Ranson criteria, multiple organ failure score (MOF), or APACHE III score between TEN and TPN groups. Although slower to approach goal feeding over the first 72 hours of admission, TEN patients received 71.3% goal calories by day 4 vs 85.2% for TPN patients (not significant). There were no deaths and no differences between groups in serial pain scores, days to normalization of amylase, days to diet by mouth, serum albumin levels, or percent nosocomial infection. However, the mean cost of TPN per patient was over four times greater than that for TEN ($3294 vs $761, respectively, p < .001). Mean serial Ranson criteria, APACHE III, and MOF scores recorded every 2 to 3 days decreased in the TEN group, whereas those in the TPN group increased. Only the difference in the third Ranson criteria (mean 6.3 days after admission) for the TEN and TPN groups (0.5 vs 2.8, respectively) reached statistical significance (p = .002). Stress-induced hyperglycemia was worse in the TPN group, as serum glucose levels increased significantly over the first 5 days of hospitalization (p < .02), whereas those in the TEN group showed no significant change. An exacerbation of pancreatitis, occurring in one TEN patient when the nasojejunal tube was dislodged into the stomach, resolved after placement back in the jejunum. Three patients who became asymptomatic and normalized amylase on TEN flared upon advancing to diet by mouth. CONCLUSIONS: TEN for acute pancreatitis is as safe and effective, but is significantly less costly than TPN. Compared with TPN, TEN may promote more rapid resolution of the toxicity and stress response to pancreatitis. TEN via jejunal feeding should be used preferentially in this disease setting.