Peter H. Pinkerton

Reporting of near-miss events for transfusion medicine: improving transfusion safety

BACKGROUND: Half of the reported serious adverse events from transfusion are a consequence of medical error. A no‐fault medical‐event reporting system for transfusion medicine (MERS‐TM) was developed to capture and analyze both near‐miss and actual transfusion‐related errors.

Utilization of frozen plasma in Ontario: a provincewide audit reveals a high rate of inappropriate transfusions

Frozen plasma (FP) is frequently transfused inappropriately, an intervention that results in risk without benefit for the patient. To better understand current utilization practices in our region, we undertook a provincewide prospective audit to evaluate the clinical indications and appropriateness of FP transfusion.

The natural-killer-cell-associated HNK-1 (Leu-7) antibody reacts with hypertrophic and malignant prostatic epithelium.

While using the natural killer (NK) cell‐associated HNK‐1 antibody in a panel of hematopoietic cell markers, the authors found that metastatic tumor cells in the bone marrow of a patient with disseminated prostatic carcinoma stained strongly with this antibody using an indirect immunofluorescence technique. More than 50% of cells from the patients prostate also reacted with HNK‐1. Subsequent study of frozen sections of prostate tissue from patients with benign prostatic hypertrophy (BPH) showed that HNK‐1 reacted with prostatic epithelium and the contents of the glandular lumina. Two other markers associated with NK cells (OKM1 and OKT3) were not detected on nonneoplastic or neoplastic prostatic epithelial cells using a two‐color immunofluorescence technique. Recent reports have shown that the HNK‐1 antibody also detects an antigen on cells of neuroectodermal origin. The authors have concluded that HNK‐1 also reacts with prognostic epithelium in patients with BPH and may be useful as another marker for metastatic carcinoma of the prostate.

Trisomy 14q in myelodysplastic syndromes

Abstract Two cases of myelodysplastic syndrome are described, both showing functional trisomy of the long arm of chromosome 14, supporting the concept that amplification of genes on chromosome 14 is associated with myeloproliferative and related diseases.

Essential thrombocythemia with the Philadelphia chromosome and BCR-ABL gene rearrangement: An entity distinct from chronic myeloid leukemia and Philadelphia chromosome-negative essential thrombocythemia

A 64-year-old woman presented with a platelet count of 3,225 x 10(9)/L. Bone marrow morphology showed massive megakaryocytic hyperplasia; cytogenetic studies showed the presence of the Philadelphia chromosome (Ph). The presence of a rearrangement involving the major breakpoint cluster region (mbcr) on chromosome 22 was confirmed by Southern blotting techniques. A diagnosis of Ph positive essential thrombocythemia (ET) was made. Such cases constitute less than 5% of patients with ET and it has been proposed that they be considered examples of chronic myelogenous leukemia (CML) because of a shared propensity to progress to blast crisis. An argument is presented for retaining Ph positive ET as an entity separate from Ph negative ET and Ph positive CML.

Deletion of the long arm of chromosome 5 in essential thrombocythemia

A 51-year-old woman with no history of prior chemotherapy or radiation therapy was diagnosed with essential thrombocythemia (ET) according to the diagnostic criteria established by the Polycythemia Vera Study Group (PVSG). Cytogenetic analysis of bone marrow metaphases revealed both normal female karyotype and a single clonal abnormality, 46,XX,del(5)(q22q35). While chromosomal abnormalities have been reported in ET, their incidence is very low, and no specific abnormality has been found. Many of the reported cases of ET with chromosomal aberrations, including 5q-, do not meet the diagnostic criteria proposed by the PVSG, and may represent one of the other myeloproliferative disorders or a myelodysplastic syndrome. Furthermore, it is important to distinguish the 5q- syndrome, which may present with thrombocytosis and megakaryocytic hyperplasia, from ET. Our patient appears to be the first example of untreated ET clearly meeting the PVSG criteria in which 5q- was the only clonal abnormality seen at diagnosis.

Chromosome Abnormalities in Chronic Myeloid Leukaemia

The last decade has been very exciting for cancer cytogeneticists. At the start of the decade, the role of cytogenetics in clinical medicine was still unclear. Many felt that such investigations were

Canada's transfusion medicine pioneer: Lawrence Bruce Robertson.

Lawrence Bruce Robertson (LBR) was born in Toronto on September 6, 1885, the third son in a well-to-do merchant family of Scottish extraction. He received part of his education at the leading Toronto school of the day for boys, Upper Canada College, from which he entered the University of Toronto in 1902.10 He graduated from the University of Toronto with the degrees of BA (1907) and MB (1909) (at that time, the basic medical degree in Toronto was a baccalaureate rather than a doctorate).11 His father died in 1904, and it is clear that thereafter his uncle, John Ross Robertson, stood somewhat in loco parentis. John Ross Robertson was a major figure in Toronto, proprietor of the “Evening Telegram” newspaper, a strong imperial loyalist, a prominent member of the Masonic Order, and a very active chairman of the Board of Governors of the Toronto Hospital for Sick Children (HSC) from 1880 until his death in 1918.12 Not surprisingly, therefore, LBR proceeded to internship at HSC after graduation.

Acquisition of additional primary chromosome abnormalities in the course of karyotype evolution in a case of FAB-M2 acute leukemia

Cytogenetic studies of bone marrow metaphases from a 17-year-old woman with acute myeloid leukemia revealed a leukemic clone characterized by the t(8;21)(q22;q22) characteristic of FAB-M2. The patient was treated and achieved transient remissions. On relapse, her leukemic clone had acquired, in addition to the t(8;21), the inv(16)(p13q22) characteristic of FAB-M4Eo and a 5q- of the type seen in various acute myeloid leukemias and myelodysplastic syndromes. This cell line persisted throughout the remainder of the patients clinical course. There were no other clonal chromosome abnormalities observed. The observation of multiple chromosome mutations, usually regarded separately as primary, in a single leukemic clone is most unusual and raises questions about our concepts of the nature of primary acquired chromosome mutations in cancer.

Rationalizing the clinical use of frozen plasma

Recognition of serious deficiencies in blood transfusion practices has led to greater scrutiny of transfusion medicine. Increasing attention is being paid not only to safety in the acquisition and processing of blood components, but also to the appropriateness of clinical transfusion practices and