Oklahoma Blood Institute

PurposeRural communities are among the most underserved and resource‐scarce populations in the United States. However, there are limited data on COVID‐19 outcomes in rural America. This study aims to compare hospitalization rates and inpatient mortality among SARS‐CoV‐2‐infected persons stratified by residential rurality.MethodsThis retrospective cohort study from the National COVID Cohort Collaborative (N3C) assesses 1,033,229 patients from 44 US hospital systems diagnosed with SARS‐CoV‐2 infection between January 2020 and June 2021. Primary outcomes were hospitalization and all‐cause inpatient mortality. Secondary outcomes were utilization of supplemental oxygen, invasive mechanical ventilation, vasopressor support, extracorporeal membrane oxygenation, and incidence of major adverse cardiovascular events or hospital readmission. The analytic approach estimates 90‐day survival in hospitalized patients and associations between rurality, hospitalization, and inpatient adverse events while controlling for major risk factors using Kaplan‐Meier survival estimates and mixed‐effects logistic regression.FindingsOf 1,033,229 diagnosed COVID‐19 patients included, 186,882 required hospitalization. After adjusting for demographic differences and comorbidities, urban‐adjacent and nonurban‐adjacent rural dwellers with COVID‐19 were more likely to be hospitalized (adjusted odds ratio [aOR] 1.18, 95% confidence interval [CI], 1.16‐1.21 and aOR 1.29, CI 1.24‐1.1.34) and to die or be transferred to hospice (aOR 1.36, CI 1.29‐1.43 and 1.37, CI 1.26‐1.50), respectively. All secondary outcomes were more likely among rural patients.ConclusionsHospitalization, inpatient mortality, and other adverse outcomes are higher among rural persons with COVID‐19, even after adjusting for demographic differences and comorbidities. Further research is needed to understand the factors that drive health disparities in rural populations.

Summary Background: Here we report a case of acute hemolytic transfusion reaction (HTR) due to anti-P1 and review our institutional database for prevalence of anti-P1 antibodies and frequency of anti-P1-mediated HTR. Anti-P1 antibodies, reported to be present in up to two-thirds of P2 individuals, are usually clinically insignificant. However, rare cases of acute HTR due to anti-P1 are reported. Case Report: We report the clinical and laboratory features of a mild acute HTR due to an IgM anti-P1 not detected by a routinely used antibody screening method. We reviewed our institutional database to investigate prevalence of anti-P1 antibodies identified in our patient population and frequency of HTR in patients with anti-P1. Results: Analysis of RBC transfusion recipient data over the 10-year period from 2006 to 2015 showed prevalence of anti-P1 identified in our laboratory of 174 per 100,000 individuals. Frequency of HTR in patients with anti-P1 identified in our laboratory over a 10-year period was 1 in 1,429 RBC transfusions (0.07%). Conclusion: Our reported case of HTR mediated by IgM anti-P1 reactive at 37 °C confirms the potential of antibody screening methods designed to detect IgG antibodies to miss rare clinically significant IgM antibodies.

Antibodies to Kell antigens can be clinically important but only limited data are published regarding anti-Ku. Missense nucleotide changes in KEL account for the numerous Kell antigens, the K(mod) phenotype, and even the K(null) phenotype. DNA and RNA were extracted from white blood cells and polymerase chain reaction-based assays, cloning, and sequencing were done using standard protocols. The anti-Ku in Proband 1, which caused hemolytic disease and anemia of the fetus and newborn, was a mixture of immunoglobulin (Ig)G1 and IgG2 and gave macrophage indexes ranging from 47.8 to 59.3 (>20 is clinically significant) in a monocyte monolayer assay. The proband, her daughter, and compatible sister had a heterozygous deletion of a G in Exon 18 (Nucleotide c.1972_1975delG) in a KEL*02 allele causing a frameshift. The mechanism for silencing of the other KE*02 allele was undetermined. Proband 2 was heterozygous for a nonsense change (KEL*382C/T; Arg128Stop), a missense change (KEL*244T/C; Cys82Arg), and KEL*578T/C (KEL*01/KEL*02). Direct sequencing of cDNA and cloning showed that the KEL*01 allele had 244C, 382C, 578T and the KEL*02 allele carried 244T, 382T, 578C. We report a novel single-nucleotide deletion, a novel nonsense allele, and a novel missense allele all resulting in the K(null) phenotype. The anti-Ku from Proband 1 was clinically important.

The primary purpose of this study was to investigate the role the ligamentum teres has in providing hip stability using a biomechanical model. The second purpose was to review arthroscopic findings in those with a complete ligamentum teres rupture and question them regarding instability to determine how clinical findings related to the biomechanical model. A string model was created to examine ligamentum teres excursion during various hip positions. A retrospective review of 350 consecutive surgical patients identified 20 subjects with a complete ligamentum teres rupture that was not repaired at the time of surgery. The model found the ligamentum teres to have the greatest excursion when the hip was externally rotated in flexion (ER/FLEX) and internally rotated in extension (IR/EXT). During operative assessment, it was noted that all 20 subjects had laxity during dynamic impingement testing when their hip was in a position of ER/FLEX. Nine (45%) of the 20 subjects with ligamentum teres rupture were available for follow-up (mean 31 months post-op). Five out of these 9 subjects noted instability: 5 of 9 with squatting (ER/FLEX) and 4 of 9 with crossing one leg behind of the other (IR/EXT). These 5 subjects had osseous risk factors that compromised hip stability including inferior acetabular insufficiency. The ligamentum teres may contribute to hip stability when the hip is in ER/FLEX and IR/EXT. Individuals with osseous risk factors for instability, including inferior acetabular insufficiency, may have instability with squatting (ER/FLEX) and crossing one leg behind of the other (IR/EXT). IV.

Understanding factors that encourage different racial and ethnic groups to donate is crucial for donor recruitment and retention. A 28-item self-administered questionnaire was completed in 2003 by 1862 Asian, 1479 black, 1641 Hispanic, and 2940 White US donors who had given whole blood within the past year. With a 1 to 5 scale, donors were asked to rate the importance of 17 factors in their last donation decision. Logistic regression was conducted to compare the odds of a factor being important or very important (score of 4 or 5) in one's decision to donate between race or ethnic groups, stratified by first-time and repeat status. More than 90 percent of each respondent group cited a desire, responsibility, or perceived duty to help others as an important or very important motivator. Being asked to donate at work was also an important motivator for all race and ethnic groups (56-70%). Getting the results of a health screen appealed to many (approx. 30% found it important or very important) and was most important to Black and Hispanic donors (odds ratios of 1.3-1.9 compared to White donors; p<0.003). Recruitment and retention programs should build on people's sense of social responsibility. Direct requests to donate are particularly effective motivators. Of a variety of incentives evaluated, offering more comprehensive health screens may motivate many donors, especially Black and Hispanic donors.