No abstract
BACKGROUND: Transfusion of red blood cells (RBCs) is frequently required for care of individuals with sickle cell disease (SCD). Alloimmunization rates are high and may be reduced by matching for RBC antigens that can cause alloimmunization. STUDY DESIGN AND METHODS: During the PROACTIVE Feasibility Study, patients with SCD age 2 years or older admitted for pain without acute chest syndrome were enrolled for possible randomization to preventive blood transfusion or standard care. Transfusion and antibody histories were obtained at each site, and antibody screening was done, to assess transfusion burden and alloimmunization prevalence. Participating sites were surveyed regarding antigen matching practice. RESULTS: A total of 237 patients (169 SS, 42 SC, 15 Sβ0‐thalassemia, 11 Sβ+‐thalassemia), 118 males and 119 females, were enrolled. Mean age was 19.3 years (range, 2.0‐68.0); there were 122 children and 115 adults. A total of 75.8% had received at least a single transfusion of RBCs before the study. Thirty‐four patients (14.4%) had a history of at least one alloantibody and 17 of these had more than one. When surveyed, 19 sites (83% of responders) reported antigen matching to at least include C, E, and K for transfusion of all patients with SCD. CONCLUSION: Though antigen typing before transfusion of people with SCD and providing antigen‐negative units is now widely employed by sickle cell centers, the alloimmunization rate remains quite high in contemporary sickle cell populations and may be due in large part to transfusions received at institutions not providing extended matching.
Increased peripheral blood leukocyte count and decreased level of pulmonary function have both been implicated as causes of increased total mortality in population-based studies. The extent to which these factors are independent of cigarette smoking is controversial. The authors explored the relation of leukocyte count and the level of forced expiratory volume in 1 second to total mortality in the Normative Aging Study population in the Boston, Massachusetts, area. Other covariates examined included forced vital capacity, height, body mass index, systolic and diastolic blood pressure, and total cholesterol. The sample for the current analysis consisted of 1,956 men who underwent the baseline Normative Aging Study examination during 1961-1969. Subjects ranged in age from 21 to 80 years of age at the time of entry. A total of 170 deaths occurred over the 30 years of follow-up. Statistical analysis was conducted utilizing Cox proportional hazards modeling and regression trees for censored survival data. The Cox proportional hazards model suggested that age, forced expiratory volume in 1 second, and peripheral blood leukocyte count were the three most important predictors of increased mortality in this cohort. A regression tree analysis in general confirmed these results. Both methods of analysis suggest that forced expiratory volume in 1 second and peripheral blood leukocyte count were predictors of mortality, independent of cigarette smoking.
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