W. Hallowell Churchill

Assessment of education and computerized decision support interventions for improving transfusion practice

BACKGROUND: Overuse of blood products is common, but prior efforts to improve transfusion decisions have met with limited success.

The influence of chemotherapy on response of patients with hematologic malignancies to influenza vaccine

Bivalent influenza vaccine (containing antigens A/Victoria and A/New Jersey) was administered to 52 patients with hematologic malignancies, and pre‐ and postvaccination antibody titers to both antigens were determined by hemagglutination‐inhibition. In comparison to healthy controls, mean antibody titer elevations were lower for both antigens in all disease groups, being significant (p < 0.05) for A/Victoria in patients with non‐Hodgkins lymphoma, acute leukemia and lymphoproliferative diseases, and for A/New Jersey in patients with Hodgkins and non‐Hodgkins lymphomas. In comparison to controls, significant depression of antibody response to both antigens was seen in patients on combination chemotherapy (p < 0.0005), to a lesser extent in patients on daily single alkylating agent chemotherapy (p < 0.05), while untreated patients did not differ significantly. Lymphopenia and depressed immunoglobulin levels were associated with a higher failure rate in eliciting “protective” ≧ fourfold antibody titer increases. The findings suggest that patients with hematologic malignancies who are receiving chemotherapy at the time of vaccination are unlikely to attain seroconversion to protective antibody levels with influenza vaccine.

Patients' willingness to pay for autologous blood donation

Most cost-effectiveness analyses of autologous blood donation show very small health benefits for a substantial increase in resource utilization. However, these analyses do not consider the psychological benefits of peace of mind to patients participating in the program. In order to quantitate these benefits, we employed contingent valuation methodology to measure the willingness of patients undergoing elective surgery, to pay for autologous blood donation. The internal consistency of patient responses was investigated through correlations of willingness-to-pay values with risk perceptions and patient characteristics. Two hundred and thirty-five patients completed the self-administered questionnaire which included demographic, willingness-to-pay and risk perception questions. Median population willingness to pay for autologous blood donation was approximately

Lymphocyte subpopulations of lymph nodes and spleens in Hodgkin's disease.

900 per patient. In multivariate analysis, willingness to pay varied significantly with dread of allogenic transfusion, perceived risk of requiring a blood transfusion and income. Patients who participate in autologous blood donation programs value the procedure highly and state they are willing to pay significant amounts out of pocket to assure themselves of available autologous blood. Willingness to pay correlated significantly with factors expected to influence value decisions.

Purification of human monocytes by continuous gradient sedimentation in ficoll.

Lymphocyte subpopulations have been defined for twenty‐five involved lymph nodes, ten involved spleens and twenty‐five uninvolved spleens of patients with Hodgkins disease. A predominance of T lymphocytes was observed in involved lymph nodes (77 ± 3% se) and also in involved and uninvolved spleens, with splenic tumor nodules demonstrating the highest T cell values for splenic tissue (75 ± 3% se). The T cell content of involved nodes, however, did not differ significantly from that of a group of hyperplastic nodes. The percentages of T lymphocytes in splenic tumor nodules (75 ± 3% se) and in uninvolved spleens (68 ± 2% se) of patients with Hodgkins disease were greater (p < 0.05) than those observed for the group of control spleens with traumatic rupture (54 ± 5% se). Histologically uninvolved spleens of patients with Hodgkins disease demonstrated a higher B cell content (22 ± 2% se) than splenic tumor nodules (13 ± 2% se). The percentage of B lymphocytes observed in spleens with traumatic rupture (47% ± 6% se) was significantly greater than those observed for involved and uninvolved spleens of patients with Hodgkins disease and those found in spleens of patients with various nonlymphoproliferative disorders. An unusual finding in these studies was the identification of IgMEA rosette forming lymphocytes which were significantly increased (p < 0.01) in nodes infiltrated by Hodgkins disease (9.3 ± 1.6% se) as compared with a group of hyperplastic nodes (1.6 ± 0.4% se), and in splenic tumor nodules (3.7 ± 0.8% se) as compared with spleens with traumatic rupture (0.4 ± 0.3% se).

Levamisole and Cell-Mediated Immunity

A new method of obtaining purified human monocytes has been developed. The peripheral blood mononuclear leukocytes are isolated by centrifugation over Ficoll--Hypaque and then further purified by sedimentation over a linear 5--10% Ficoll density gradient. In ten experiments, the average purity obtained was 77.1% macrophages and the mean yield was 22.4% of the monocytes contained in the peripheral blood leukocytes. Viability of monocytes isolated by this technique exceeded 95%. The cells were phagocytic and responded to human migration inhibitory factor.

Macrophage mediated cytotoxicity in man: role of hydrocortisone, trypan blue, chloroquine and prednisolone.

Current widespread interest in the contribution of host immunity to resistance to tumor growth is based on evidence from a variety of animal and human studies.1 Host resistance is mediated by sensi...

Mediator-induced macrophage activation, as shown by enhanced cytotoxicity for tumor, requires macrophage surface fucose and sialic acid☆

Abstract Human macrophages can be activated with mediator-rich supernatants from antigen-stimulated cells to kill human tumor cells. This system was utilized to study the role of cell contact and lysosomal enzyme release in the cytotoxicity of the mediator activated human macrophages. We found that contact between the effector and target cells was essential to obtain cytotoxicity. When the activated macrophages were incubated with drugs which stabilize lysosomal membranes such as trypan blue, hydrocortisone, chloroquine and prednisolone, the cytotoxic effects of these treated macrophages was inhibited. Recovery in cytotoxicity was observed as the dose of drug utilized was decreased. Cytotoxicity equivalent to that observed with no added drug was found at concentration of 4.2×10−6 M for trypan blue, 3.6×10−8 M for hydrocortisone and 5 × 10−7 M for both chloroquine and prednisolone. Pretreatment of macrophages with a dose of hydrocortisone known to inhibit cytotoxicity (3.6 × 10−5 M) resulted in decreased release of the lysosomal enzyme, acid phosphatase, in comparison to untreated macrophages. These results suggest that macrophage lysosomal enzymes contribute to macrophage mediated cytotoxicity in man.

Case 13-1981

Abstract Macrophage-activating factor (MAF) activates macrophages so that their cytotoxic capacity is enhanced. This effect of MAF is inhibited by removing fucose from the macrophage cell surface by incubation with fucosidase, or by removing sialic acid by treatment with neuraminidase. After incubation with fucosidase or neuraminidase the average inhibition of cytotoxicity was 92 and 73%, respectively. β-Galactosidase had no effect. Addition of the specific products, fucose or sialic acid, to the incubation mixture of macrophages and enzyme blocked the effect of the enzymes. Taken together these observations indicate that macrophage surface fucose and sialic acid are essential for the interaction of MAF with macrophages which results in enhanced cytotoxicity for tumor cells.

Chemical modification of macrophages enhances their response to human macrophage activation factor

Presentation of Case A 91-year-old woman was admitted to the hospital because of collapse. She was well until 21 years earlier, when hypertension was found and medication was prescribed. For severa...