ABSTRACT
The maintenance of an adequate and safe blood supply begins with choosing the right donor at the right time. The evolution of donor screening has been shaped by experience, donor satisfaction, and the ever-challenging emergence of relevant infectious diseases. Screening donors has been standardized over the past 6 decades to protect donor and recipient safety. In this review, we outline, define, and simplify the requirements to assess and defer donors with a focus on recent and ongoing changes to provide up to date information on donor qualification and current challenges in maintaining the blood supply.
Subject(s)
Blood Donors , Donor Selection , HumansABSTRACT
Post transfusion purpura (PTP) is an uncommonly reported post transfusion adverse event that can present with severe thrombocytopenia; sometimes resulting in significant bleeding and hemorrhage. Its diagnosis can be elusive given its substantial symptomatic overlap with other thrombocytopenic syndromes. Underdiagnosis and underreporting make the true incidence of disease difficult to define. While clinical suspicion is key, laboratory evidence of platelet-targeted antibodies and identification of the antigen(s) they recognize are necessary to confirm the diagnosis. A curious aspect of PTP is paradoxical destruction of both transfused and autologous platelets. Although the first case was reported over 50 years ago, this aspect of PTP pathogenesis is still not fully understood and is widely debated. Several theories exist, but conclusive evidence to support most is lacking. Despite limited understanding of disease incidence and etiology, treatment with IVIG (Intravenous Immunoglobulin) has become standard practice and can be highly effective. Although recurrence is rare, precautions should be taken if patients with a history of PTP require transfusions in the future.
ABSTRACT
Infective endocarditis is rarely caused by Corynebacterium species. We report a unique case of Corynebacterium propinquum endocarditis in an otherwise healthy individual, and it is the first example of this organism causing culture-negative endocarditis. Conflicting clinical and microbiological data led to the use of sequencing to confirm the causative organism. This case illustrates C. propinquum as a cause of infective endocarditis, and it demonstrates the utility of ancillary molecular diagnostic techniques to identify etiologic agents in difficult cases of infective endocarditis.
Subject(s)
Aortic Valve/microbiology , Corynebacterium Infections/microbiology , Corynebacterium/classification , Endocarditis, Bacterial/microbiology , Ribotyping , Anti-Bacterial Agents/therapeutic use , Aortic Valve/drug effects , Aortic Valve/pathology , Ceftriaxone/therapeutic use , Corynebacterium/drug effects , Corynebacterium/genetics , Corynebacterium/isolation & purification , Corynebacterium Infections/diagnosis , Corynebacterium Infections/drug therapy , Corynebacterium Infections/pathology , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/pathology , Humans , Male , Middle Aged , Predictive Value of Tests , Treatment OutcomeABSTRACT
Energy restriction decreases bone mineral density (BMD), and epidemiological studies suggest that the risk of weight loss-induced bone loss is greater in lean than in heavier individuals. Our goal in this study was to determine how bone density and geometry respond to energy restriction in mature obese rats compared with lean rats. At 6 mo of age, 36 diet-induced obese and lean female Sprague-Dawley rats were allocated to control (CTL; ad libitum; n = 18) and energy-restricted (EnR; 40% restriction; n = 18) diets. After 10 wk of dietary intervention, obese EnR rats lost more weight (-91 +/- 34 g) than lean EnR rats(-61 +/- 14 g) (P < 0.02), [corrected] whereas body weight did not change significantly in the 2 CTL groups (14 +/- 23 g). Only the lean EnR (and not obese EnR) rats showed lower BMD compared with CTL rats at the tibia, distal, and proximal femur and femoral neck, and trabecular bone volume (P < 0.05). Serum estradiol declined in lean EnR rats compared with baseline (P < 0.05) but not in the obese EnR rats. In addition, the final serum 25-hydroxyvitamin D (25OHD) concentration was higher (P < 0.05) in obese than in lean EnR rats. Serum parathyroid hormone decreased (P < 0.05) from baseline to final in lean and obese CTL, but not EnR rats. These data support the hypothesis that energy restriction in lean rats compared with obese rats is more detrimental to bone, and it is possible that the greater decline in estrogen and lower levels of 25OHD contribute to this effect.
