Creating a uniform donor medical history questionnaire.

Blood Centers of California, Inc. (BCC) is a consortium of 19 independent blood centers that collectively draw approximately 800,000 units of whole blood each year. Over the past several years, a committee of BCC, composed primarily of medical and nursing directors at member institutions, developed a Uniform Donor Medical History Questionnaire (UDMHQ). The UDMHQ, consisting of 42 questions, satisfies the requirements of the United States Food and Drug Administration, the State of California, the American Association of Blood Banks, and the special concerns of the members of BCC. The primary benefit of standardizing the donor medical history was an improvement in its content. Other, unproved benefits include delivering a consistent message to donors and potentially providing some legal protection to participating blood centers.

Informed consent, risk, and blood transfusion.

Informed consent for blood transfusion has become a necessity in light of the known risks associated with this service. All transfusion services should institute written informed consent that clearly defines the patient's options, including the use of homologous blood, autologous blood, and directed donations. The risk of transfusion with an infectious blood product is dependent on the number of donors per recipient and the prevalence of undetected, contaminated blood in the tested blood supply. The chance that an adverse transfusion will occur can be calculated by use of these variables. Comparative risks can be explained to patients, thereby providing an understanding of the transfusion risk of human immunodeficiency virus, the human T-cell leukemia virus, and the agent of non-A, non-B hepatitis (hepatitis C).

Modifications of B, I, i, and Lewisb antigens in a patient with DiGuglielmo's erythroleukemia.

Loss of red blood cell antigens has been documented in patients with acute myelocytic leukemia and includes loss of A, B, and H antigens in the ABO system as well as antigens of the Rh, MNSsU, Lewis and Ii systems. The following case represents partial loss of the B, I and Lewisb antigens in a patient with erythroleukemia. Also, the loss of the I antigen was associated with a concomitant increase in i antigen, a known but rare finding. These changes within the ABO, Ii, and Lewis systems do not appear to be coincidental, as these blood group systems share a common biochemical backbone.

Multiple red cell antigen loss in acute granulocytic leukemia.

Loss of certain red blood cell antigens has been described in various disease states including acute granulocytic leukemia (AGL). This paper describes the loss of blood group A antigen in three patients, two with AGL and a third with a myeloproliferative disorder similar to AGL which developed following total body irradiation for malignant, well-differentiated lymphocytic lymphoma. In the latter case, the onset of the myeloproliferative disease correlated with the loss of A antigen. In addition to A antigen loss, all three patients' red cells showed the loss of Lewis antigen, a finding previously unreported. Finally, the two patients with AGL also exhibited the loss of I antigen from their red cells.

Hodgkin's disease and granulomatous angiitis of the central nervous system.

Granulomatous angiitis of the central nervous system, a pathologic entity associated previously with a fatal prognosis, is reported in a patient with Hodgkin's disease. Viral isolation, indirect fluorescent antibody, and electron microscopic studies performed on fresh cerebral tissue were negative. The granulomatous angiitis of the central nervous system in this patient remitted following therapy for Hodgkin's disease. The epidemiologic, clinical and pathologic data in all reported cases of granulomatous angiitis of the central nervous system suggest that it: 1) may have more than one etiology; 2) may not always be fatal; 3) is associated with varicella-zoster virus and Hodgkin's disease; 4) is one of two granulomatous reactions found in association with Hodgkin's disease; and when found with Hodgkin's disease, 5) may remit with adequate therapy for the lymphoma.

Diagnosis of radiosensitive hypothalamic tumors without craniotomy: endocrine and neuroradiologic studies of intracranial atypical teratomas.

Three patients with intracranial atypical teratomas presented with symptoms of endocrine dysfunction (diabetes insipidus, hyperprolactinemia, and anterior hypopituitarism) suggestive of a hypothalamic disorder. Computer-assisted tomography done in two of the three cases enabled us to document the presence of a mass and institute radiotherapy, without prior neurosurgical exploration. Computer-assisted tomography also provided a safe and effective method of assessing the effects of radiotherapy.

Serum enzyme levels in patients with myasthenia gravis afte aerobic and ischaemic exercise.

This study was designed to test the hypothesis that there is a myopathic component in myasthenia gravis. Serum enzyme analyses and lactate and pyruvate assays were undertaken before and after exercise in order to detect possible leakage from defective muscle membrane. A patient and a control group were exercised under (1) aerobic conditions, (2) ischaemic conditions, and (3) aerobic conditions under the influence of edrophonium chloride. The patient group showed a higher resting level of lactate in the aerobic state than did the controls. In addition, the average change in SGOT values in the patient group after one minute of aerobic exercise under the influence of edrophonium chloride exceeded that of the control group. Both these findings suggest possible leakage of enzyme and metabolite from the myasthenic muscle due to a membrane defect and support the hypothesis that there may be a myopathic component in myasthenia gravis. However, the two groups showed no significant differences in CPK values, which are often elevated in primary muscle diseases.