Background: A case definition of Gulf War illness with 3 primary variants, previously developed by factor analysis of symptoms in a US Navy construction battalion and validated in clinic veterans, identified ill veterans with objective abnormalities of brain function. This study tests prestated hypotheses of its external validity. Methods: A stratified probability sample (n = 8,020), selected from a sampling frame of the 3.5 million Gulf War era US military veterans, completed a computer-assisted telephone interview survey. Application of the prior factor weights to the subjects’ responses generated the case definition. Results: The structural equation model of the case definition fit both random halves of the population sample well (root mean-square error of approximation = 0.015). The overall case definition was 3.87 times (95% confidence interval, 2.61–5.74) more prevalent in the deployed than the deployable nondeployed veterans: 3.33 (1.10–10.10) for syndrome variant 1; 5.11 (2.43–10.75) for variant 2, and 4.25 (2.33–7.74) for variant 3. Functional status on SF-12 was greatly reduced (effect sizes, 1.0–2.0) in veterans meeting the overall and variant case definitions. Conclusions: The factor case definition applies to the full Gulf War veteran population and has good characteristics for research.

BACKGROUND High school students 16 to 18 years‐old contribute 10% of the US blood supply. Mitigating iron depletion in these donors is important because they continue to undergo physical and neurocognitive development. STUDY DESIGN AND METHODS Study objectives were to determine the prevalence of iron depletion in 16‐ to 18‐year‐old donors and whether their risk for iron depletion was greater than adult donors. Successful, age‐eligible donors were enrolled from high school blood drives at two large US blood centers. Plasma ferritin testing was performed with ferritin less than 12 ng/mL as our primary measure of iron depletion and ferritin less than 26 ng/mL a secondary measure. Multivariable repeated‐measures logistic regression models evaluated the role of age and other demographic/donation factors. RESULTS Ferritin was measured from 4265 enrollment donations September to November 2015 and 1954 follow‐up donations through May 2016. At enrollment, prevalence of ferritin less than 12 ng/mL in teenagers was 1% in males and 18% in females making their first blood donation, and 8% in males and 33% in females with prior donations. Adjusted odds for ferritin less than 12 ng/mL were 2.1 to 2.8 times greater in 16‐ to 18‐year‐olds than in 19‐ to 49‐year‐olds, and for ferritin less than 26 ng/mL were 3.3‐ to 4.7‐fold higher in 16‐ to 18‐year‐olds. Progression to hemoglobin deferral was twice as likely in 16‐ to 18‐year‐old versus 19‐ to 49‐year‐old females. CONCLUSION Age 16 to 18 years‐old is an independent risk factor for iron deficiency in blood donors at any donation frequency. Blood centers should implement alternate eligibility criteria or additional safety measures to protect teenage donors from iron depletion.

Major risk factors of peripartum transfusion in South Africa, namely, prenatal anemia and access to prenatal care, may be amenable to intervention. HIV infection and moderately low PLT count are novel risk factors that merit further investigation.

Background Globally, as in South Africa, obstetric hemorrhage (OH) remains a leading cause of maternal mortality and morbidity. Although blood transfusion is critical to OH management, the incidence and predictors of transfusion as well as their relation to HIV infection are poorly described. Study Design and Methods A cross-sectional study was conducted of all peripartum patients at four major hospitals in South Africa (April to July 2012). Comprehensive clinical data were collected on patients who sustained OH and/or were transfused. Logistic regression was used to model risk factors for OH and transfusion. Results A total of 15,725 peripartum women were evaluated, of whom 3,969 (25.2%) were HIV positive. Overall, 387 (2.5%) women sustained OH and 438 (2.8%) were transfused, including 213 (1.4%) women with both OH and transfusion. There was no significant difference in OH incidence between HIV positive (2.8%) and HIV negative (2.3%) patients (adjusted OR = 0.95, 95% CI 0.72–1.25). In contrast, the incidence of blood transfusion was significantly higher in HIV positive (3.7%) than in HIV negative (2.4%) patients (adjusted OR = 1.52, 95% CI 1.14–2.03). Other risk factors for transfusion included OH, low prenatal hemoglobin, the treating hospital, lack of prenatal care and gestational age ≤34 weeks. Conclusion In the South African obstetric setting, the incidence of peripartum blood transfusion is ten-fold higher than in the U.S. and other high-income countries while OH incidence is similar. While OH and prenatal anemia are major predictors of transfusion, HIV infection is a common and independent contributing factor.

No abstract