Adelbert B. James

Pathophysiology of Early Trauma Induced Coagulopathy: Emerging Evidence for Hemodilution and Coagulation Factor Depletion

BACKGROUND Trauma patients present with a coagulopathy, termed early trauma-induced coagulopathy (ETIC), that is associated with increased mortality. This study investigated hemostatic changes responsible for ETIC. METHODS Case-control study of trauma patients with and without ETIC, defined as prolonged prothrombin time (PT), was performed from prospective cohort of consecutive trauma patients who presented to Level I trauma center. Univariate and multivariate analyses were performed. RESULTS The case-control study group (n = 91) was 80% male, with mean age of 37 years, 17% penetrating trauma and 7% mortality rate. Patients with ETIC demonstrated decreased common and extrinsic pathway factor activities (factors V and VII) and decreased inhibition of the coagulation cascade (antithrombin and protein C activities) when compared with the matched control patients without ETIC. Both cohorts had evidence of increased thrombin and fibrin generation (prothrombin fragment 1.2 levels, thrombin-antithrombin complexes, and soluble fibrin monomer), increased fibrinolysis (d-dimer levels), and increased inhibition of fibrinolysis (plasminogen activator inhibitor-1 activity) above normal reference values. Patients with versus without ETIC had increased mortality and received increased amount of blood products. CONCLUSION ETIC following injury is associated with decreased factor activities without significant differences in thrombin and fibrin generation, suggesting that despite these perturbations in the coagulation cascade, patients displayed a balanced hemostatic response to injury. The lower factor activities are likely secondary to increased hemodilution and coagulation factor depletion. Thus, decreasing the amount of crystalloid infused in the early phases following trauma and administration of coagulation factors may prevent the development.

Demographic variations in blood donor deferrals in a major metropolitan area.

BACKGROUND: Presenting blood donors are screened to ensure both their safety and that of the recipients of blood products. Donors with identified risks are deferred from donating blood either temporarily or permanently. Minorities are underrepresented as donors in the United States and this may in part be a result of increased donor deferral rates in minorities compared to white individuals.

Demographic Patterns of Blood Donors and Donations in a Large Metropolitan Area

BACKGROUND Nationally, minorities are underrepresented in community blood donation programs. The reason for this disparity is poorly understood. To better understand why minorities do not donate, first, accurate blood donor and donation data are needed. METHODS Donor and donation demographic data were collected for 2004-2007 from a single blood collection agency in the Atlanta, Georgia, metropolitan area. Population data from the same area were acquired from the US Census. Donor and donation rates per 1000 population were calculated by race/ethnicity, gender, and age. RESULTS Of the 389 340 blood donations reported by donors aged 16 to 69 years (98.7% of all donations), the collections were from white (77.7%), African American (16.3%), Hispanic (2.3%), Asian (2.2%), and other (1.6%) donors. Forty- to 49-year-olds (26.8%) donated the highest percentage of units. The blood donor rates were 11 per 1000 population for whites, 6 per 1000 for African Americans and 3 per 1000 population for Hispanics. The blood donation rates were 77 donations per 1000 population for whites, 22 per 1000 population for African Americans and 10 per 1000 population for Hispanics. CONCLUSION Minorities are underrepresented in the blood donor pool. New recruitment strategies are needed to increase minority blood donor and donation rates.

Chlamydia Prevalence Among College Students : Reproductive and Public Health Implications

Background: Routine chlamydia screening is not readily available at all college campuses. Objectives: To assess the prevalence of Chlamydia trachomatis among asymptomatic college students and to compare chlamydia positivity by selected demographic variables. Methods: Analysis of demographical data collected on 789 students who volunteered for a urine screening of C. trachomatis and Neisseria gonorrheae infections at 10 colleges in Alabama, Georgia, and Mississippi. Results: The median age was 20 years. The chlamydia prevalence among all students was 9.7%. Students under the age of 20 years were 66% more likely to be infected than were older students (95% CI 1.01–2.73). Younger female students were 92% more likely to be infected than were older female students (95% CI 1.03–3.59). Conclusions: The chlamydia prevalence was higher in younger college students; more screening efforts and increased awareness are needed to reduce the prevalence of chlamydial infections among students.

Demographic differences in estimated blood donor eligibility prevalence in the United States

BACKGROUND: The prevalence of blood donor eligibility factors has a major impact on the availability of blood donors and thus the blood supply in the United States. The prevalence of these factors may differ between demographic groups and thus help explain the differences in blood donation rates.

The African American church as a donation site: motivations and barriers

BACKGROUND: In the United States, African Americans donate at approximately half the rate of whites and therefore are underrepresented in the volunteer blood donor pool. The goal of this study was to identify motivators and barriers to African Americans donating blood.

Contribution of attitudinal factors to blood donation in African American church attendees

BACKGROUND: Historically, African Americans have a general mistrust for the health care system that has contributed to significant health disparities. The goal of this study was to evaluate whether this distrust among African Americans affects attitudes toward blood donation.

Chlamydial and gonococcal infections in women seeking pregnancy testing at family-planning clinics

OBJECTIVE The objective of the study was to assess genital chlamydia and gonorrhea prevalence and associated predictors in women seeking pregnancy testing. STUDY DESIGN The study included analysis of demographics and results of pregnancy, chlamydia, and gonorrhea testing in 1465 females seeking pregnancy testing at family-planning clinics in South Carolina. RESULTS The median age was 22 years (range 16-45), the race distribution consisted of 53% African Americans and 47% Caucasians, and 64% of subjects were pregnant. Chlamydia and gonorrhea were detected in 12% and 2% of subjects, respectively. Predictors of chlamydia and gonorrhea included younger age and African American race. Chlamydia and gonorrhea prevalence did not differ in pregnant vs nonpregnant subjects. CONCLUSION Chlamydia prevalence was high and gonorrhea prevalence low in women seeking pregnancy testing at family-planning clinics, and both were predicted by younger age and African American race but not pregnancy status. Because the majority seeking pregnancy testing were pregnant, chlamydia testing in this population at risk for chlamydia-associated morbidity has potential benefit.

Blood donations motivators and barriers: A descriptive study of African American and white voters

African American adults are half as likely to donate blood than whites. In order to understand this difference, African American and white participants completed a survey regarding demographics, medical and donation history, and motivators and barriers. The most agreed upon motivators to blood donation were more convenient place and times, being asked and taking less than hour. Motivator responses which differed by race included donating for infectious disease test and reward, and assurance donating is safe. The most agreed upon barriers were not having a convenient place, not knowing where (response differed by race) and fear of needles, pain and feeling faint.

The value of area-based analyses of donation patterns for recruitment strategies.

Lack of ready access to a donation site may be a potential barrier to or influence the frequency of blood donations. In this study, we applied geographic analysis to blood donor behavior and use of different donation sites.