American journal of clinical pathology
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The operating theater blood transaction system (OTBTS) is a virtual blood banking system that allows computer crossmatch-compatible blood ordering and delivery in the operating theater remote from the hospital blood bank. It was developed and implemented in our hospital in 1997 and was expanded in 2002 to include an unmatched blood module that allows ordering and issuing unmatched RBCs for intraoperative transfusion. ⋯ The OTBTS has proven to be efficient (with a turnaround time for blood ordering and issuing < 30 seconds), effective (with a reduced crossmatch/transfusion ratio and blood wastage), and error free (no delay or error in transfusion or postponement of operation). Furthermore, our experience with the unmatched blood module has attested to the safety and efficacy of computer-controlled, online ordering and real-time, on-site delivery of unmatched RBCs for emergency transfusion.
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Child abuse is a problem that is frequently underdiagnosed. Recognition that underdiagnosis of abuse exists has produced a high zeal for identifying cases of child abuse, which has inevitably produced cases of overdiagnosis. Overdiagnosis of child abuse is as catastrophic as underdiagnosis. ⋯ Many children and adults have coagulation or vascular disorders that predispose them to bruise or bleed excessively with minor trauma. It is very easy for a health care worker to presume that bruising and bleeding is associated with trauma, because the coagulopathies that may explain the findings are often poorly understood. The clinical cases reviewed in this article show the need for an extremely thorough analysis for an underlying bleeding disorder in the bruised or bleeding child being evaluated as a possible victim of child abuse.
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Am. J. Clin. Pathol. · Jun 2005
ReviewCurrent concepts in the classification of interstitial lung disease.
The diagnosis and classification of idiopathic interstitial pneumonias continue to be problematic areas for pathologists. The recently proposed American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias defines specific clinical, radiologic, and pathologic criteria for each of the pulmonary disorders that encompass the idiopathic interstitial pneumonias. In this review, the highlights of this classification are presented, along with recommended guidelines for handling lung biopsy specimens and diagnosing interstitial lung diseases.
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Am. J. Clin. Pathol. · Feb 2005
Comparative StudyClinical impact of point-of-care vs laboratory measurement of anticoagulation.
Patients using anticoagulation point-of-care (POC) monitors are advised to periodically test these systems against laboratory methods to monitor performance. The international normalized ratio (INR), however, can vary between test systems owing to different instrument-reagent combinations. In a randomized study evaluating warfarin self-management, we compared INR measured by patients on a POC monitor (ProTime, International Technidyne Corporation, Edison, NJ) with those obtained at a hospital laboratory within 1 hour Ninety-one paired INR determinations from 55 patients met inclusion criteria. ⋯ Six pairs differed by 1 or more INR units, 3 at study initiation resulting in POC monitor replacement. The accuracy of INR self-testing with ProTime was acceptable. The small failure rate of INR agreement might be clinically important, suggesting the need for external quality control systems.
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Am. J. Clin. Pathol. · Jan 2005
Case ReportsZinc-induced copper deficiency: a report of three cases initially recognized on bone marrow examination.
Copper deficiency is a rare cause of sideroblastic anemia and neutropenia that often is not suspected clinically. The morphologic findings in bone marrow, while not pathognomonic, are sufficiently characteristic to suggest the diagnosis, leading to further testing to establish the correct diagnosis. Excess zinc ingestion is among the causes of copper deficiency. ⋯ The third patient was a 42-year-old man with anemia, severe neutropenia, and a peripheral neuropathy that had progressed during 8 months. The bone marrow findings in all cases suggested copper deficiency, which was confirmed by further laboratory testing and determined to be due to zinc excess. The morphologic features, clinical manifestations, differential diagnosis, and pathogenetic mechanisms are discussed.