Characteristics of thawed pooled cryoprecipitate stored at refrigerated temperature for 24 hours.

BACKGROUND: The need for thawed cryoprecipitate is growing. However, according to current guidelines, the shelf-life of pooled thawed cryoprecipitate at room temperature is limited because of possible bacterial contamination and loss of clotting factor activity. Here we assessed microbial growth and retention of clotting activity in cryoprecipitate stored at 4 °C after thawing to see whether its shelf life could be safely extended. MATERIALS AND METHODS: Pooled thawed cryoprecipitate units (n=10) were maintained at room temperature for 6 hours and then placed at 1-6 °C for 18 hours after thawing. We examined the cryoprecipitate pools for fibrinogen, factor VIII, and von Willebrand factor activity at the following time points: 0 hours (immediately after thawing), after 6 hours at room temperature, and after 24 hours at 1-6 °C. A 5-mL aliquot from each pool was collected for aerobic and anaerobic bacterial cultures at the 24-hour time point. RESULTS: Mean fibrinogen concentration and von Willebrand factor activity were similar at each time point, but factor VIII activity decreased significantly over the storage period. Bacterial growth was not detected in any cultured pooled sample. DISCUSSION: Extended storing of thawed cryoprecipitate at 1-6 °C does not appear to increase the risk of bacterial contamination or affect coagulation factor activity.

Secondary Bone Marrow Fibrosis in Children And Young Adults: An Institutional Experience.

Secondary bone marrow fibrosis (BMF) is associated with many disease conditions in children, but its prevalence and characteristics have not been well elucidated. We present our experience with pediatric secondary BMF, in an attempt to characterize it in terms of underlying diagnoses, severity, and outcome. A retrospective chart review of patients diagnosed with secondary BMF by bone marrow aspirate and biopsy between January 1984 and April 2011 showed a total of 214 patients, the majority (67.1%) of whom had an underlying oncologic disease. At diagnosis, 87 patients (39.7%) had mild, 51 (23.3%) had moderate, and 33 (15.1%) had marked BMF; it was not quantified in 48 (21.9%) patients. An underlying oncologic disease was more frequently associated with marked fibrosis compared with hematologic and miscellaneous diagnoses. Follow-up posttreatment bone marrow aspirate assessments were available for 117 patients. The outcome ranges from worsening of fibrosis to complete resolution. A majority of these children (N=70/117, 60%) showed complete resolution of fibrosis. Of note, 27 patients had marked fibrosis at initial diagnosis and 16 (60%) of them showed complete resolution. These findings underscore the importance of appropriate treatment of the underlying disorder in reversing secondary BMF. Ours is the largest series of pediatric secondary BMF reported.

Validation of the procalcitonin (PCT) assay: Experience in a pediatric hospital.

OBJECTIVES: Procalcitonin (PCT) is a potential early biomarker used to differentiate sepsis from systemic inflammation. Serial PCT measurement is useful in reducing the duration of antibiotic exposure without increasing treatment failure. Our aim was to establish and evaluate an automated quantitative PCT assay at Texas Children's Hospital. METHODS: We validated the analytical and clinical performance of the automated miniVIDAS B.R.A.H.M.S PCT® assay (BioMerieux®, France) at Texas Children's Hospital. Analytical performance parameters included precision, linearity, accuracy, correlation, and effect of different common interferents (free Hb, bilirubin, triglyceride and rheumatoid factor). Also, the interference of high calcitonin (CT) on PCT assay was tested. We performed clinical correlation of PCT to blood culture, WBC counts and CRP in sepsis patients. RESULTS: The PCT assay showed good precision with %CV of <5% for intra-assay and %CV of 6.5% for inter-assay precision. The assay was linear across the measurement range (0.05µg/L-200µg/L). Correlation studies showed a good correlation (r>0.9). No significant effects on PCT levels were seen with common interferents however, calcitonin concentrations of 1000ng/L or more showed cross-reactivity with PCT values. Fourteen (78%) out of the total eighteen patients with positive blood culture, showed median PCT concentrations greater than the cut-off values of 0.15µg/L. CONCLUSION: The miniVIDAS PCT assay can be used for diagnostic purposes in clinical laboratories. We envision that serial PCT monitoring along with clinical correlation will be beneficial in critically ill patients.

Evaluation of the International Society on Thrombosis and Haemostasis and institutional diagnostic criteria of disseminated intravascular coagulation in pediatric patients.

Globally, adult intensive care units routinely use the International Society on Thrombosis and Haemostasis (ISTH) scoring system for identifying overt disseminated intravascular coagulation (DIC). However, in our pediatric intensive care unit, a modified diagnostic criterion (Texas Children's Hospital [TCH] criteria) that requires serial monitoring of the coagulation variables is employed. A retrospective analysis of 2,136 DIC panels from 130 patients who had at least 4 DIC panels during 1 admission to a pediatric intensive care unit was done to compare the diagnostic utility of the TCH criteria with the ISTH scoring method in children. Both scoring systems were evaluated against the gold standard diagnostic method of autopsy confirmation of DIC in the subset of children who died. Receiver operating characteristic analysis indicates that TCH diagnostic criteria are comparable to the ISTH scoring method (area under the curve of 0.878 for TCH and 0.950 for ISTH). On the contrary, TCH diagnostic criteria perform better, with a sensitivity significantly higher than the ISTH scoring method when tested against the gold standard (P < .05). Fibrinogen is not a significant predictor of overt DIC in both models. Sequential testing of coagulation parameters is recommended for improved sensitivity when applying ISTH criteria to pediatric populations.

Can phase angle determined by bioelectrical impedance analysis assess nutritional risk? A comparison between healthy and hospitalized subjects.

BACKGROUND & AIMS: Low phase angle (PhA) by bioelectrical impedance analysis (BIA), is associated with increased morbidity and nutritional risk. This study determined the cut-off values for PhA compared to Nutritional Risk Screening (NRS-2002) and Subjective Global Assessment (SGA) in patients at hospital admission, and evaluated the association between PhA and serum albumin. METHODS: PhA was determined in patients (Men (M)/Women (W)=382/267), and healthy age-, sex- and height-matched controls. Sensitivity and specificity were calculated for PhA compared to NRS-2002, SGA and serum albumin. The cut-off values were assessed by receiver operator characteristics area under the curve (ROC-AUC). RESULTS: The best PhA cut-offs were 5.0° and 4.6° in M/W. The sensitivity for NRS-2002 was 70.0/58.1% (M/W); SGA: 73.3/64.5%; albumin: 58.8/23.5%; specificity for NRS-2002: 85.1/81.7% (M/W); SGA: 76.6/76.1% and albumin: 93.2/96.6%. The PhA showed a ROC-AUC for NRS-2002 of 0.85/0.80 (M/W); SGA: 0.83/0.80 and albumin: 0.85/0.91. Patients with albumin levels <35 g/L had a relative risk of 7.5 to have low PhA compared to patients with ≥35 g/L CONCLUSIONS: The consistent sensitivity and specificity between PhA and three screening tools strengthens the validity of our study. PhA appears to be a useful screening tool to assess nutritional risk without having to measure weight or height.