Isohemagglutinin titration in pooled and apheresis platelets.

BACKGROUND: Platelet inventory constraints necessitate ABO-incompatible platelet transfusion. Many minimize the hemolytic impact by confirming low titre (LT) donor isohemagglutinins. This process is costly. Pathogen-reduced platelets (PRP) in platelet additive solutions (PAS) will dilute plasma and decrease high-titre isohemagglutinins (HT). We determined the proportion of HT platelets and incompatible transfusions for units suspended in plasma to reassess the need for titres following introduction of PRP/PAS. STUDY DESIGN AND METHODS: Our titre method is manual tube (1:50) dilution of platelet supernatant from apheresis or whole blood derived buffy coat pools suspended in plasma, tested with A1/B red cells. Testing included 49,058 pooled and 11,738 apheresis platelets over 4 years. The HT proportion, rate of out-of-group transfusions, and hemolytic reactions were determined. The impact of PAS dilution was estimated. RESULTS: Totally 60,796 platelet units were tested. Group O pooled and group B apheresis platelets had HT in 6.6% and 5.7%, respectively. Group A pooled and apheresis platelets included 2% with HT. Approximately 25% of platelets transfused were ABO-incompatible and no hemolytic reactions were reported. Based on the proportions of PAS-E and plasma for PRP platelets, plasma from each donor comprises 11 mL (6% of total volume) vs 20-257 mL in untreated pools. PAS-E will replace and dilute residual plasma by at least 50%. DISCUSSION: Rare platelet pools may demonstrate HT. PRP platelets with PAS will reduce titres and may abrogate the need for titration. A strategy of group specific transfusion or transfusion of group A PRP platelet transfusions may be a safe alternative.

PCBs and OCPs in male harbour, grey, harp and hooded seals from the Estuary and Gulf of St Lawrence, Canada.

Blubber samples from adult male harbour seals (Phoca vitulina) from the St Lawrence Estuary, and from grey (Halichoerus grypus), harp (Phoca groenlandica) and hooded (Cystophora cristata) seals from the Gulf of St Lawrence, were analysed for polychlorinated biphenyls (PCB) and organochlorinated pesticides (OCP). All seals were between 5 and 19 years of age, and mean ages were not statistically different among the seal species. Mean concentrations of sigmaPCB and mirex were significantly higher in harbour seals, while sigmaDDT concentrations were significantly higher in hooded seals than in the other species examined. Harbour and hooded seals had similar concentrations of sigmaCHLOR, which were higher than in grey and harp seals. SigmaHCH concentrations were significantly higher in harp seals than in harbour and hooded seals and they were significantly higher in harbour and grey seals than in hooded seals. Harp and grey seals had similar levels of HCB, which were significantly higher than in either hooded or harbour seals. Patterns of PCB congeners and individual OCPs varied considerably between the four species. In PCA plots harbour, harp and hooded seals were well separated from each other, while grey seals were separated from the other species by a smaller degree. Between species variations may be explained by their dissimilar migratory patterns, habitat use and proximity to sources of industrial and agricultural pollution, their dietary regime (trophic level and individual prey items) as well as possible variations in the seals' abilities to eliminate these compounds.

PCBs and organochlorine pesticides in blubber biopsies from free-ranging St. Lawrence River Estuary beluga whales (Delphinapterus leucas), 1994-1998.

For the first time, organochlorine (OC) contaminants were measured in blubber biopsies from free-ranging St. Lawrence River Estuary beluga whales (Delphinapterus leucas), to compare contaminant levels to those previously measured in dead stranded belugas. PCBs, DDTs, toxaphene and chlordane-related compounds were the major OC contaminants detected in 44 belugas biopsied in 1994-1998. SigmaPCB (the sum of 104 congeners) ranged from 2080 to 128,000 ng/g lipid in males (n=34; minimum estimated ages 8-22 years), and from 148 to 44,100 ng/g lipid in females (n=10; minimum estimated ages 7-22 years). The concentrations of PCBs and OC pesticides in the blubber of these whales overlapped those observed in stranded belugas from an earlier study, and demonstrated comparable age and sex-related trends. However, lower proportions of mirex, HCB, DDTs, and many of the highly chlorinated PCBs occurred in the biopsy samples compared to results for blubber from stranded carcasses. Most major OC compounds were present at lower concentrations in the biopsies, but this does not appear to be solely related to age differences between the two groups, or to emaciation in the stranded whales. Nor does it appear to be associated with the use of superficial biopsies, and the possible stratification of lipids and OCs in the blubber layer. Nevertheless, given these possible confounding factors, and the uncertainty in age estimates for the biopsied whales, the results point to the need for careful interpretation of biopsy results when comparing with data taken from the full depth of the blubber mantle in stranded whales. Taken together, results from both biopsied whales and previously studied stranded belugas indicate that PCB and OC pesticide contamination of St. Lawrence beluga whales may occur across a broader range of levels than previously thought, at least for males which formed the largest group in this study, possibly due to different degrees of dietary exposure. It also appears that measuring contaminant concentrations only in stranded whales, may overestimate OC levels in the population as a whole, especially for highly chlorinated OCs.

Developing an orientation toolkit for new public health nurse hires for Ontario's changing landscape of public health practice.

In 2008/2009, the Orientation: Transition to Public Health Nursing Toolkit was developed to enhance the integration of new hires into public health nursing practice in Ontario and to increase retention of these hires. The changing landscape of public health in Canada, such as the introduction of new standards and competencies, presents challenges to leaders orienting staff to public health nursing. The toolkit was designed to provide a standardized general orientation, involving a broad range of public health knowledge and issues. Through the use of technology, a virtual network of public health nurses, educators, managers, senior nurse leaders and nursing professors from various areas of Ontario designed, implemented and evaluated the toolkit. Three modules were developed: foundations of practice (e.g., core competencies, national and provincial standards, public health legislation), the role of the public health nurse, and developing partnerships and relationships. Evaluations demonstrated that the toolkit was useful to new hires adjusting to public health nursing. It has had significant uptake within Canada and is well accepted by public health nursing leaders for use in Ontario's health units.