Objectives: To investigate the utilization of CBC and CBC with differential (CBC w/diff) tests at University of Alabama at Birmingham Hospital, and to determine if a reduction in CBC w/diff tests could be achieved without negatively impacting patient care. Methods: The quantity of testing and distribution of repeated tests before, during, and after an educational intervention were compared. Results: CBC w/diff tests were ordered 10-fold more frequently than CBC tests. The trauma burn intensive care unit ordered the most CBC w/diff tests, with repeat tests done every 4 or 12 hours. The educational intervention reduced the number of CBC w/diff tests ordered and tests repeated every 12 hours. Conclusions: The educational intervention changed the ordering practices of CBC w/diff and CBC tests. This was sustained after the intervention and no negative effects on patient care were noted. Similar interventions may lead to optimization of ordering practices of other laboratory tests.
Germline or acquired mutations involving the GATA‐binding protein gene (GATA2) have been linked to a variety of clinical conditions. In addition, patients harboring GATA2 mutations have a striking predisposition to develop myeloid malignancies, such as myelodysplastic syndrome or acute myeloid leukemia, but not acute lymphoblastic leukemia (ALL). We report here a unique occurrence of early T‐cell precursor ALL in a young child with GATA2 haploinsufficiency.
HB-Line Phase II process requires the addition of sodium permanganate followed by a sodium nitrite addition to prevent the precipitation of plutonium solids in a non-geometrically safe vessel. Previous experimental work has shown this method effective. Current concerns are related to the gas generated by the reaction. Potential difficulties include tank over-pressurization and tank overflow due to foaming or eructation. It is also necessary to verify that the quantity of permanganate specified by the facility is sufficient to reach the desired endpoint in a single addition.Several experiments were performed in which sodium permanganate and sodium nitrite were added to simulated, non-radioactive filtrate solutions at constant feed rates. The volume of gas generated by the reaction was monitored. Experiments were also performed using a "reverse addition" method. In this method the permanganate was added to the reaction vessel first, then the simulated filtrate solution was added to the vessel at a constant rate.It was found that the gas generation rate is not a linear function of the permanganate feed rate. The gas generation rate peaked early during the permanganate addition for all of the standard addition experimental runs. The peak gas generation rate was found to be strongly dependent on the permanganate feed rate. No significant foaming or bubbling occurred at the feed rates tested.Many technical issues make the "reverse addition" method an undesirable option. Problems associated with this method include excessive solids generation, increased NO x generation, and excessive gas generation.Experimental results indicate the amounts of permanganate supplied as input by the facility are not sufficient to reach the desired endpoint.
CD5 antigen expression in B-cell acute lymphoblastic leukemia (B-ALL) is exceptionally rare. There are six detailed case reports in the literature, with only 16 cases described. Case series analyzing the frequency of aberrant B-ALL immunophenotypes suggest that this variant may occur in as little as 2-4.5% of all B-ALL cases, with one series having no CD5 + positive cases. Herein we report a case of CD5 + B-ALL in a 15-year-old female, and review the previously reported cases. As limited information is available, more data from prospective clinical trials are required to determine whether CD5 positivity portends a poorer prognosis. K E Y W O R D S acute lymphoblastic leukemia, B-cell ALL, CD5 + , immunophenotypic aberrancies in ALL, variant B-ALL
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