The classification of coronary artery bypass graft patients on the basis of attributes known preoperatively and by conduits used yields subsets of patients with distinctly different transfusion requirements and in-hospital outcomes.

After a hiatus of several decades, the concept of cold whole blood (WB) is being reintroduced into acute clinical trauma care in the United States. Initial implementation experience and data grew from military medical applications, followed by more recent development and data acquisition in civilian institutions. Anesthesiologists, especially those who work in acute trauma facilities, are likely to be presented with patients either receiving WB from the emergency department or may have WB as a therapeutic option in massive transfusion situations. In this focused review, we briefly discuss the historical concept of WB and describe the characteristics of WB, including storage, blood group compatibility, and theoretical hemolytic risks. We summarize relevant recent retrospective military and preliminary civilian efficacy as well as safety data related to WB transfusion, and describe our experience with the initial implementation of WB transfusion at our level 1 trauma hospital. Suggestions and collective published experience from other centers as well as ours may be useful to those investigating such a program. The role of WB as a significant therapeutic option in civilian trauma awaits further prospective validation.

Ehrlichiosis is a tick-borne disease that ranges in severity from asymptomatic infection to fatal sepsis. Ehrlichiosis acquired from transfusion of blood products has not been documented in the literature to date. A case of Ehrlichia ewingii infection likely transmitted by transfusion of leukoreduced platelets is described, and public health implications are discussed.

The cytologic features of a multifocal adult rhabdomyoma of the head and neck, as observed in a fine-needle aspiration specimen, are described. Cross-striations and characteristic cytoplasmic "crystals" were conspicuous in the cytologic preparations and also during ultrastructural examination. The cytologic features of adult rhabdomyoma are distinctive, allowing a rapid specific diagnosis.

BACKGROUND: Red cell use in patients undergoing Diagnosis Related Group (DRG) 209 procedures (major joint and limb reconstruction procedures of the lower extremities) has been shown to have large, unexplained interhospital variations. STUDY DESIGN AND METHODS: Abstracted records of 2590 consecutive DRG 209 patients at five university hospitals from January 1992 to December 1993 were stratified by procedure and preoperative blood deposit status. Patient characteristics and transfusion and inhospital outcomes were compared across hospitals. RESULTS: Blood use among patients who did not preoperatively deposit blood was similar across hospitals. Significant differences were found across hospitals for total hip replacement patients in the percentage of patients preoperatively depositing blood (59-80%), percentage of patients receiving transfusion(s) (51 to >99%), the mean number of units collected per patient (1.6-2.9), and the mean number of unused autologous units per 100 patients (1-185). No significant differences were found in the percentage of those who deposited blood and then required allogeneic units. There was little variability in length of hospital stay or in last hematocrits. Findings were similar for total knee replacement patients. CONCLUSIONS: lnterhospital variations in red cell use for primary total hip and knee reconstruction are primarily due to hospital-specific differences in autologous blood collection and transfusion.ABBREVIATIONS: CHTS = Collaborative Hospital(s) Transfusion Study; DRG = diagnosis-related group; Hct(s) = Hematocrit(s); LOS =length of (hospital) stay; PABD = preoperative autologous blood deposit; RBC(s) = red cell(s); THR = primary total hip replacement; TKR = primary total knee replacement.

For prospective comparison of product yield and volume, collection efficiency, white cell (WBC) and red cell (RBC) contamination, donor acceptability, and staff acceptance, each of 31 donors underwent plateletpheresis on two different cell separators (the Fenwal CS-3000 and the COBE Spectra). The same operator performed the paired procedures and collected all study data. The instruments provided equivalent high-yield platelet products (CS-3000: 5.3 x 10(11); Spectra: 5.7 x 10(11]. Platelet collection efficiency was greater with the Spectra (81%) than with the CS-3000 (57%) (p less than 0.0005). All products contained less than 1 mL of RBCs, but the Spectra products were more likely to contain less than 10(6) WBCs (14/31) than those of the CS-3000 (1/31) (p less than 0.001). In the remaining products, the mean WBC contamination was 1.0 x 10(8) for the CS-3000 and 0.03 x 10(8) for the Spectra (p less than 0.001). More ACD-A anticoagulant was infused with Spectra (463 mL) than with CS-3000 procedures (400 mL) (p = 0.002). Although postdonation ionized calcium (Ca2+) levels and the percentage of decrease in Ca2+ were not significantly different between groups, more Spectra donors experienced symptoms of hypocalcemia (20/31 vs 9/31; p = 0.015). CS-3000 products had lower mean volumes (217 mL) than Spectra collections (300 mL) (p less than 0.0005). Both instruments were accepted well by volunteer donors and the technical staff.

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