RHD Group Research Articles

ABO and Rh- D Blood Group Distribution among Blood Donors at a Tertiary Level Hospital in North Assam

Background: ABO and Rhesus (Rh)-D blood group antigens are genetically determined integrated parts of the red blood cell membrane. They are hereditary characters and are useful in compatibility test in blood transfusion and organ transplant practices. They show a wide geographical and racial variation. The knowledge of ABO and Rh-D blood groups distribution among different population is essential in health care and transfusion practices. Materials and Methods: ABO and Rh-D grouping were done in 10,200 blood donors in the Blood Bank, Tezpur Medical College and Hospital, Tezpur, Assam. Data on the frequency of ABO and Rh-D blood groups were reported in simple numbers and percentages. Results and observations: The study revealed blood group O to be the commonest at 37.65% followed by blood group B at 32.0%, blood group A at 24.80% and blood group AB at 5.55%. The Rh-D positive phenotype was 96.86% and remaining 3.14% was Rh- D negative. Conclusion: The present study provides information about the distribution of the ABO and Rh-D blood groups in North Assam, which may be helpful in effective management of regional blood transfusion service of the area.

Production of Korean Idiomatic Utterances Following Left- and Right-Hemisphere Damage: Acoustic Studies.

This study investigates the effects of left- and right-hemisphere damage (LHD and RHD) on the production of idiomatic or literal expressions utilizing acoustic analyses. Twenty-one native speakers of Korean with LHD or RHD and in a healthy control (HC) group produced 6 ditropically ambiguous (idiomatic or literal) sentences in 2 different speech tasks: elicitation and repetition. Utterances were analyzed using durational and fundamental-frequency (F0) measures. Listeners' goodness ratings (how well each utterance represented its category: idiomatic or literal) were correlated with acoustic measures. During the elicitation tasks, the LHD group differed significantly from the HC group in durational measures. Significant differences between the RHD and HC groups were seen in F0 measures. However, for the repetition tasks, the LHD and RHD groups produced utterances comparable to the HC group's performance. Using regression analysis, selected F0 cues were found to be significant predictors for goodness ratings by listeners. Using elicitation, speakers in the LHD group were deficient in producing durational cues, whereas RHD negatively affected the production of F0 cues. Performance differed for elicitation and repetition, indicating a task effect. Listeners' goodness ratings were highly correlated with the production of certain acoustic cues. Both the acoustic and functional hypotheses of hemispheric specialization were supported for idiom production.

Association between ABO and Rh Blood Groups and Pregnancy-induced Hypertensive Disorders

ABSTRACT Objective To find out if there is any association between ABO and Rh blood groups and pregnancy-induced hypertensive (PIH) disorders, i.e. gestational hypertension (GH), preeclampsia (PE) and eclampsia (E). Materials and methods This was a 4-year retrospective study from Jan 2010 to Jan 2014, of all admitted primigravidas with singleton deliveries diagnosed with GH, PE or E. Using Chisquare test and multinomial logistic regression, association and relative risk with 95% confidence interval of pregnancyinduced hypertensive disorders with different blood groups were observed respectively. Results It was observed that pregnancy-induced hypertensive disorders are significantly associated with blood groups (p = 0.017). Primigravidas with AB blood group have about five times higher risk of developing eclampsia and blood group A has 50% more chance of developing pre-eclampsia when compared to blood group O. However, no association was found between PIH and RhD group. Conclusion Our findings in Indian population are consistent with other studies done so far. This may help us to improve the understanding of etiology of gestational hypertensive disorders, which will further predict the prognosis and decide the management guidelines. Thus, attention should be given to primigravidas with AB blood group to prevent complications of PIH and improve the prognosis. How to cite this article Sinha M, Maheshwari S, Gupta P. Association between ABO and Rh Blood Groups and Pregnancy-induced Hypertensive Disorders. J South Asian Feder Obst Gynae 2016;8(1):8-12.

Distribution of ABO and rhesus (D) blood group antigens among blood donors at a tertiary care teaching hospital blood bank in south India

Background: The ABO and Rhesus (Rh) blood group systems are important for transfusion of blood and its components, organ transplantation, genetic studies and in medico-legal issues. Despite the long list of several other blood groups discovered so far, the knowledge and distribution of ABO and Rh-D blood group are essential for effective management of blood bank inventory. Methods: We retrospectively studied the distribution of ABO and Rh blood group antigens in donors presenting to our tertiary care teaching hospital blood bank in south India during the period January 2007 to August 2014. Blood group was determined by commercially available standard monoclonal antisera by test tube agglutination technique. Results: A total of 49,110 donor samples were tested during the study period for ABO grouping and Rh-D typing. Out of these 96.9% were males. The frequency of O, B, A, AB and Bombay blood groups were 41.7%, 32.2% 20%, 6.1% and 0.03% respectively. Rh (D) positive and negative blood groups were seen in 92.8% and 7.2% respectively. The allele frequencies of the IA, IB and IO alleles were 0.1398, 0.2148 and 0.6454 respectively. In case of Rh-D group, the calculated gene frequencies for ID and Id were 0.7321 and 0.2679 respectively. Conclusion: Knowledge of blood group systems as documented in the present study helps in efficient manage- ment of blood bank and transfusion services in emergencies.

Mixed Fields on RHD Typing As an Indicator of Malignancy-Associated Loss of Heterozygosity on Chromosome 1p in Myeloid Neoplasm

BackgroundSpontaneous loss of RHD expression is unusual and may present on routine RHD typing with new “mixed field” (separate positive and negative subpopulation) reactions. Its detection has practical and mechanistic implications for underlying pathology, and such events have been associated with the development or progression of malignant disorders.CaseA 49-year-old gentleman with Acute Myelogenous Leukemia (AML) underwent standard induction chemotherapy with cytarabine and daunorubicin, achieving a remission. He moved from Saudi Arabia to Canada and presented to our center with an infected central venous catheter, whereupon a repeat marrow was performed, confirming remission (myeloblasts <5%) without peripheral blood count recovery. Review of the original diagnostic bone marrow revealed a predominance of promonocytes and monocytes, raising suspicions of pre-existing chronic myelomonocytic leukemia (CMML), while the presence of splenomegaly prompted investigation for a myeloproliferative neoplasm, wherein JAK2 and BCR-ABL testing ultimately proved negative. No cytogenetic abnormalities were noted at diagnosis or post-induction.His presenting transfusion laboratory sample typed as O, RHD-positive with a negative red cell antibody screen, and stable repeat grouping for two months. Platelet transfusion refractoriness developed (PRA 99%), and he qualified for HLA-matched platelets.Six months after dignosis, eleven weeks after last red cell transfusion (pRBC), and 44 days after the last blood bank sample, his AML relapsed and he was then found to have mixed field reactions on RHD grouping, with two distinct populations of O+ and O- cells. Cytogenetic re-analysis of marrow did not demonstrate any abnormalities by G-banding.MethodsRelapse versus post-re-induction bone marrow specimens with buccal mucosa serving as the non-hematopoeitic control were assessed by RH genotyping and chromosome 1p microsatellite mapping to deduce the basis for leukemia-associated loss of RHD expression.ResultsGenotyping analysis of peripheral blood demonstrated the RH genotype ccEe with D (R2r), although the ratio of e/E was out of the usual range for heterozygosity, with e predominant over E. Repeat testing with alternative sequencing primers ruled out unequal amplification of allele-specific polymorphisms at primer sites, while the absence of other out–of-range data for other antigens excluded chimerism. With the mixed field reactions indicating loss of the RHD, this suggested a specific deletion of an entire DcE (R2) allele at a clonal pre-erythroid level.Microsatellite analysis on DNA extracted from non-myeloid tissue (buccal mucosa) compared to DNA extracted from bone marrow sample at relapse demonstrated loss of heterozygosity (LOH) at four of six informative loci, allowing for mapping of a putative chromosomal region of deletion (Figure 2).ConclusionsLOH on chromosome 1 has been shown to be an important mechanism of RHD loss.[1] While such loss may be benign, the role of LOH in leukemogenesis has also been demonstrated,[2] as in this case. Alteration in RH expression may be either a surrogate for relapsed malignancy or the effect of an ongoing clonal evolutionary process. [Display omitted] [Display omitted] [1] Kormoczi GF, Dauber EM, Haas OA, Legler TJ, Clausen FB, Fritsch G, Raderer M, Buchta C, Petzer AL, Schonitzer D, Mayr WR, Gassner C. Mosaicism due to myeloid lineage restricted loss of heterozygosity as cause of spontaneous Rh phenotype splitting. Blood 2007;110: 2148-57.[2] Lahortiga I, Vazquez I, Belloni E, Roman JP, Gasparini P, Novo FJ, Zudaire I, Pelicci PG, Hernandez JM, Calasanz MJ, Odero MD. FISH analysis of hematological neoplasias with 1p36 rearrangements allows the definition of a cluster of 2.5 Mb included in the minimal region deleted in 1p36 deletion syndrome. Hum Genet 2005;116: 476-85 DisclosuresNo relevant conflicts of interest to declare.

Prevalence of Coronary Artery Disease in Patients of Rheumatic Heart Disease

Background: Few studies have focused on the prevalence of CAD in RHD. Coronary angiography should be routinely done in patients of valvular heart disease prior to surgery, especially in patients above 40 years of age. Overlooking CAD can lead to complications and poor results in post-operative period of valvular surgery. Clinical symptoms are common in both CAD and RHD. Indian studies by V. Jacob Jose and Satya N Gupta have studied this aspect in detail and their results are quite different from Western literature. Material & Methods: This study was conducted in all patients of valvular heart disease (RHD) above 40 years of age. Apart from basic investigations and echocardiography, coronary angiogram was done in all patients and were evaluated for presence of CAD (significant ≥ 50% or insignificant). They were also evaluated for SVD/DVD or TVD and risk factors (hypertension, diabetes mellitus, dyslipidemia) and symptoms especially angina were correlated to the presence of CAD. Results: Out of the 100 patients of RHD from Jan 2008- June 2009 at PGIMER, Chandigarh, 38 were males and 62 were females. 12 had significant CAD, while 9 had non-significant CAD. Mean age for significant CAD was 52.58 years. Age distribution was statistically significant in the 51-60 year age group. 66 patients had mitral valve disease, 31 had combined mitral and aortic valve disease, while 3 had predominantly aortic valve disease. Angina was the only symptom which correlated with presence of CAD especially in aortic valve disease group, but p value was non-significant. In risk factor category, only hypertension and total cholesterol were statistically significant with CAD. Conclusion: Prevalence of significant CAD was 12%. 5 patients had SVD, 4 had DVD & 3 had TVD. 2 patients with MS, 4 with MS/MR, 4 with MV+AV and 2 with predominant aortic valve group had significant CAD. Angina was not found to be a useful clinical symptom to predict CAD. Hypertension and total cholesterol were the only risk factors which could be correlated with CAD in RHD group. Keywords: Coronary artery disease, valvular heart disease. Read more →

Prevalence and distribution of ABO and Rh-D blood groups in the Barpeta district of lower Assam in north-east India: Importance in regional blood transfusion service

The knowledge of the distribution of ABO and Rh-D blood groups is essential for effective management of blood bank inventory by estimating the availability of compatible blood and also evaluating the probability of hemolytic disease in the new born. Among a total 35 blood groups systems and over 600 different blood group antigens discovered so far ABO and Rhesus are the most important blood group system. Importance of Rh-blood group system is due to immunogenicity, polymorphism and complexity of its antigens. ABO and Rh-D grouping were done in 40,915 samples from blood donors, transfusion recipients, antenatal cases and other routine medical cases in the Blood Bank, Fakhruddin Ali Ahmed Medical College & Hospital, Barpeta, Assam. Data on the frequency of ABO and Rh-D blood groups were reported in simple numbers and percentages. Among the various ABO and Rh-D blood groups, “O” (37.86%) group is the most common followed by “B” (32.96%), “A” (23.4%) and “AB” (5.78%) with a predominance’s of Rh positivity (96.28%). The remaining 3.72% was Rh-D negative. Study of distribution of blood group is not only important for effective management of blood bank and transfusion services but it is also essential for geographical information, genetic studies, clinical medicine and forensic medicine in addition to compatibility testing done before transfusion.

Distribution of ABO and Rh-D blood groups among blood donors at atertiary level hospital in lower Assam, India.

ABO and Rhesus-D blood group antigens are genetically determined integral parts of red blood cell membrane. Among a total 35 blood groups systems and over 600 different blood group antigens discovered so far ABO and Rhesus are the most important blood group system. Importance of Rh-blood group system is due to immunogenicity, polymorphism and complexity of its antigens. Knowledge of ABO and Rh-D antigens and its distribution in population is essential not only for proper management of blood transfusion practice, but also in population genetic studies, in resolving medico-legal issues and also in compatibility testing. ABO and Rh-D grouping were done in 11,100 blood donors in the Blood Bank, Fakhruddin Ali Ahmed Medical College & Hospital, Barpeta, Assam. Data on the frequency of ABO and Rh-D blood groups were reported in simple numbers and percentages. Among the various ABO and Rh -D blood groups, “O” (37.29%) group is the most common followed by “B” (33.88%), “A” (22.78%) and “AB” (6.05%) with a predominance’s of Rh positivity (97.34%). The remaining 2.66% was Rh-D negative. Study of distribution of blood group is not only important for effective management of blood bank and transfusion services but it is also essential for geographical information, genetic studies, clinical medicine and forensic medicine in addition to compatibility testing done before transfusion.

Paper-based device for rapid typing of secondary human blood groups

We report the use of bioactive paper for typing of secondary human blood groups. Our recent work on using bioactive paper for human blood typing has led to the discovery of a new method for identifying haemagglutination of red blood cells. The primary human blood groups, i.e., ABO and RhD groups, have been successfully typed with this method. Clinically, however, many secondary blood groups can also cause fatal blood transfusion accidents, despite the fact that the haemagglutination reactions of secondary blood groups are generally weaker than those of the primary blood groups. We describe the design of a user-friendly sensor for rapid typing of secondary blood groups using bioactive paper. We also present mechanistic insights into interactions between secondary blood group antibodies and red blood cells obtained using confocal microscopy. Haemagglutination patterns under different conditions are revealed for optimization of the assay conditions.

Maternal alloimmunization as a risk factor of haemolytic disease of the foetus and newborn in Owerri metropolis, Nigeria

Blood group incompatibility between mother and her foetus which usually arises as a result of heterospecific pregnancy causes haemolytic disease of the foetus and newborn (HDN). Five hundred (500) pregnant women attending antenatal clinic at Federal Medical Centre (FMC), Owerri were recruited for this research work. They were aged between 17 and 40 years. All subjects gave informed consent to participate in the study. They were screened for ABO blood groups RhD status and immune alloantibodies. Anti-A and anti-B from group O subjects compared with anti-A from group B women and anti-B from group A women among the trimester. The rate of RhD negativity (5.4%) was significantly lower than the RhD positively (94.6%) (P<0.005). Haemolysin tests were positive in 110 (22.0%) cases and negative in 390 (78.0%) cases. Group O women produced more alpha and / or beta haemolysins than either A or B women (P<0.005). Anti-A titres were higher in the trimesters than anti-B. Indirect antiglobulin test (IAT) was positive in 12(80.0%) cases among ABO group and positive in 3(20.0%) cases among RhD group. There was a higher prevalence of ABO HDN than RhD HDN in the ratio of 3:1 respectively. This study illustrates the presence of immune alloantibodies in the sera of allominiunized pregnant women and the rise in the antibody titres has helped to identify pregnancies at risk of foetal and neonatal HDN. Anti-D immunoprophylaxis has made HDN caused by sensitization to the D-antigen a preventable disease and prenatal deaths from allominization by immunoprophylaxis has been primarily responsible for the dramatic reduction in the diseases, although changes in family size and the quality of prenatal care have also contributed.

Evaluation of a blood group genotyping platform (BLOODchip® Reference) in Japanese samples

Blood-group genotyping arrays have been widely used in Caucasian and African American populations, but have not been thoroughly tested in Japanese subjects. To evaluate, using the BLOODchip(®) Reference genotyping system, the concordance of previously typed samples with expected phenotypes and the coverage of the Japanese variants. Blood samples from 100 Japanese donors were obtained. DNA was extracted with QIAsymphony (Qiagen, Hilden, Germany). Samples were typed by serological methods and processed with the BLOODchip(®) . When a non-concordant result was identified, further sequencing by polymerase chain reaction-single specific primer (PCR-SSP) was performed. Concordance between systems was 98% (736/751), and 98.8% (742/751) if only non-software-related non-concordances were considered. In the ABO group, 6 'No Call' (NC, inability of the BLOODchip(®) to assign a result) were ascribed to a variant of blood subtype A1 (A102; 467C>T), a common subtype in Asian populations, whereas three NC presented additional polymorphisms not contained in the BLOODchip(®) (A102/A205, A102/O06 and A204/O02). In the RhD group, one discrepancy was correctly genotyped as RHD*1227A (Del phenotype) by the BLOODchip(®) (phenotyped as partial D, RHD*DIVb). Another was phenotyped as D+ by the BLOODchip(®) (phenotyped weak D by serology) and confirmed as RHD*D-CE(2)-D heterozygous by sequencing. The 3 RhD NC can be solved by further software update. For RhCE, one discrepancy was correctly genotyped for both systems; however, only the BLOODchip(®) was able to detect RHCE*CX allele. By programming the A102 ABO variant into the system software with the new allele combinations, the BLOODchip(®) Reference is a suitable genotyping tool to be applied to Asian samples.

Maternal-neonatal transfusion compatibility irrespective of ABO mismatch – a prospective observational study

Objective: To determine transfusion compatibility of maternal RBCs for her neonate up to 4 weeks of age, irrespective of maternal-neonatal ABO mismatch.Methods: This was a prospective observational study involving eligible mothers with their neonates delivered in participating site from 1 July 2012 till 31 December 2012. Mother’s blood was collected before child birth. Neonatal blood sample was collected from placental end, shortly after birth. Blood Groups of mother–baby pair were individually tested for ABO and Rh-D groups. Pairs with negative Rh-D antigen/s or with same ABO blood groups were excluded. Thus, 28 pairs with both maternal and neonatal samples positive for Rh-D antigen and with different maternal neonatal ABO blood groups were included in the study. Blood samples were collected at birth and at 4 weeks. Cross matching was done at birth and at 4 weeks for each pair with standard blood bank protocols.Results: All 28 pairs showed positive compatibility with standard blood bank cross-matching protocols at birth and at 4 weeks.Conclusions: Maternal blood irrespective of ABO compatibility might be a viable and potentially acceptable option for her new born baby in neonatal period. This may be especially important in developing world with limited blood bank resources.

Clinical Utility of the Neuropsychological Assessment Battery (NAB) after Unilateral Stroke

The NAB is a comprehensive battery assessing five cognitive domains (Attention, Language, Memory, Spatial, Executive Function). Despite the advantage of co-normative domain data, its clinical utility is not well established because few studies have reported full-battery findings. The aim of this study was to determine if the NAB was sensitive to well documented hemispheric differences in language and spatial skills after unilateral stroke. We compared demographically matched control participants (n = 52) and individuals after left (LHD, n = 36) or right (RHD, n = 33) hemisphere damage due to stroke on the NAB, parts of the Western Aphasia Battery, and traditional visuospatial tasks. Both stroke groups showed impaired NAB Attention, Spatial, and Executive Functions relative to controls, while the LHD group was more impaired than control and RHD groups on Language and Memory modules. LHD patients with aphasia on traditional measures performed worse than control and non-aphasic LHD patients on all NAB domains. RHD patients with spatial impairment on traditional measures performed worse than controls, but not RHD patients without spatial impairment, on the NAB Spatial domain. Findings suggest the NAB is generally comparable to traditional language and visuospatial measures, and it sufficiently detects attention and executive deficits.

Supplementary Ultrafiltration May Improve Inflammation and Cardiac Dysfunction in Patients with High Interdialytic Weight Gain

Background/Aims: We tested the hypothesis that adding an ultrafiltration session per week may improve brain natriuretic peptide (BNP) and C-reactive protein (CRP) levels and left ventricular function in hypervolemic hemodialysis patients. Methods: Twenty-six patients (18 male, 8 female; mean age 57.2 ± 12.7 years) who had high BNP and CRP levels and interdialytic weight gain (IDWG) were recruited for the study. Patients were randomly allocated to one of two groups, namely the supplementary ultrafiltration (sUF) group (n = 13), who had additional ultrafiltrations for 8 weeks, and the regular hemodialysis (rHD) group (n = 13), who continued regular dialysis treatments. Results: There were significant decreases in mean CRP and BNP levels and mean arterial blood pressure and significant improvements in left ventricular function in the sUF group, with no changes in the rHD group. Higher IDWG was observed in the rHD group compared to the sUF group after 8 weeks. Conclusion: sUF may be effective in reducing inflammatory burden and improving cardiac function.

RhD blocking phenomenon implicated in an immunohaematological diagnostic dilemma in a case of RhD-haemolytic disease of the foetus.

Of all red blood cell antigens, RhD is second only to the ABO antigens in importance in blood transfusion. The Rh antigens are fully expressed at the time of birth unlike the weak expression of ABO antigens in neonates1. Immunisation to D antigen can occur in reaction to less than 0.1 mL of foetal blood, resulting in anti-D alloantibody in the maternal circulation2. Haemolytic disease of the foetus and newborn (HDFN) occurs when there is a destruction of foetal/neonatal red cells by IgG antibodies produced by the mother. When Anti-D is the cause of HDFN, the severe anaemia can cause foetal hydrops, tissue hypoxia and even foetal death in utero3. Sensitised pregnant women require close monitoring for early detection of foetal anaemia and to decide whether and, if so, when intrauterine transfusion is required. As a key part of any pre-transfusion testing, the ABO and RhD groups of recipient samples are determined. It has been reported that if a neonate’s red cells are heavily saturated with IgG antibodies, RhD typing with anti-D reagents may give either false negative or false positive results3. We report here the case of blocked RhD in a cord blood sample in a suspected case of RhD-HDFN which was detected in our hospital blood bank laboratory.

Lexical tone disruption in Shona after brain damage

Background: The issue of production and perception of lexical tone in patients with brain lesions has been investigated mainly through East Asian languages and Norwegian. The present study investigated the lateralisation of lexical tone in Shona, a Bantu language. Van Lancker (1980) proposed a continuum scale of the levels of functional pitch in the speech signal. According to the functional lateralisation account (FLH), the left hemisphere (LH) is associated with highly structured pitch contrasts, such as phonological tone, whereas the right hemisphere (RH) is specialised for the least structured pitch functions cueing emotional and personal information. The extant data show that the ability to produce and identify lexical tone is frequently more impaired as a result of lesions to the LH than RH lesions. Aims: The present investigation focused on the lateralisation of lexical tone in Shona speakers. The study sought to validate if the scale of hemispheric lateralisation as proposed by Van Lancker (1980) is also valid for Shona, a Bantu language. Methods & Procedures: We examined five LH damaged (LHD) patients and five RH (RHD) damaged patients using a confrontational picture-naming task and a lexical tone identification task of Shona lexical tone. The first experiment investigated the ability of LHD patients and RHD patients to identify Shona lexical tone in 60 disyllabic minimal pairs. The second experiment examined the ability of Shona brain-damaged patients to produce lexical tone using a confrontational picture-naming task with 120 lexical items. Outcomes & Results: We observed a dissociation in the performance of both the LHD and RHD patients in the two tasks. Both groups were impaired in the tone identification task relative to the non-brain-damaged controls. However, RHD patients performed significantly better than the LHD patients in the tone identification task. On the other hand, both LHD and RHD groups were equally impaired in the tone production task in comparison to the controls. Conclusions: The discrepancy in the production and perception of Shona lexical tone for this group of brain-damaged patients shows that, although the two modes are related, they do not always get disrupted at the same level after brain damage. The results from the tone identification task suggest to a certain extent that the FLH is also valid for Shona. In order to account for all the data there is need to carefully consider alternative accounts like the acoustic cue hypothesis (Van Lancker & Sidtis, 1992).

Meal Preparation Abilities After Left or Right Hemisphere Stroke

Poole JL, Sadek J, Haaland KY. Meal preparation abilities after left or right hemisphere stroke. Objective To examine meal preparation ability after right or left hemisphere damage (RHD, LHD) caused by stroke and whether cognitive (spatial abilities, aphasia, limb apraxia) and motor deficits are differentially associated with meal preparation. Design Observational cohort design. Setting Primary care Veterans Affair Medical Center and private medical center. Participants Volunteer right-handed sample of adults with LHD (n=30) or RHD (n=16) caused by stroke and healthy demographically matched adults (n=63) (N=109). Interventions Not applicable. Main Outcome Measures Total completion time, number and type of errors, and level of independence for a meal preparation task consisting of making a hot beverage and toast, eating part of the meal, and clean-up. Results Both stroke groups took significantly more time to complete the meal preparation task than the control group. Total errors and level of independence were worse in the group with LHD than other groups, but individual errors did not significantly differ between the 2 stroke groups. While correlations should be interpreted cautiously, especially in the relatively small RHD group, poorer ipsilesional motor performance was associated with longer completion time in the RHD group, and poorer contralesional motor performance and greater aphasia were associated with less independence in the LHD group. Conclusions These findings demonstrate impaired meal preparation after LHD or RHD but greater impairment after LHD. Poorer meal preparation is associated with different cognitive and motor deficits in the 2 stroke groups.

The trunk as a part of the kinematic chain for reaching movements in healthy subjects and hemiparetic patients

The aims of this study were first to further assess the role of the 3D trunk angular rotations as part of the kinematic chain for seated-reaching movements within arm's length in a large 3D workspace in healthy subjects and second, to assess if these degrees of freedom participate in the compensatory strategy in hemiparetic patients. Ten healthy subjects, eight patients with right, and eight patients with left hemiparesis following stroke were included. They performed seated reaching movements at a comfortable speed to nine targets positioned in a large 3D workspace within arm's length. An electromagnetic system was used to record kinematics of the trunk and hand. Trunk flexion, lateral flexion and torsion were analyzed as a function of target direction, distance and height. In both healthy subjects and patients, all three trunk rotations participated in the reaching movement (except for near targets in healthy subjects). Trunk flexion was greater in patients but followed a similar pattern to healthy subjects. Trunk torsion was more influenced by target distance in healthy subjects while in patients it was greatly influenced by direction. Trunk lateral flexion was similar between groups. Comparing the two patient groups, there was greater flexion to the external targets in the RHD group and different strategies in the use of torsion between groups. 3D trunk rotations thus seem to be tuned to the distance and direction of the target in the workspace in both healthy subjects and stroke patients for reaching movements within arm's length.

Effect of auditory feedback differs according to side of hemiparesis: a comparative pilot study

BackgroundFollowing stroke, patients frequently demonstrate loss of motor control and function and altered kinematic parameters of reaching movements. Feedback is an essential component of rehabilitation and auditory feedback of kinematic parameters may be a useful tool for rehabilitation of reaching movements at the impairment level. The aim of this study was to investigate the effect of 2 types of auditory feedback on the kinematics of reaching movements in hemiparetic stroke patients and to compare differences between patients with right (RHD) and left hemisphere damage (LHD).Methods10 healthy controls, 8 stroke patients with LHD and 8 with RHD were included. Patient groups had similar levels of upper limb function. Two types of auditory feedback (spatial and simple) were developed and provided online during reaching movements to 9 targets in the workspace. Kinematics of the upper limb were recorded with an electromagnetic system. Kinematics were compared between groups (Mann Whitney test) and the effect of auditory feedback on kinematics was tested within each patient group (Friedman test).ResultsIn the patient groups, peak hand velocity was lower, the number of velocity peaks was higher and movements were more curved than in the healthy group. Despite having a similar clinical level, kinematics differed between LHD and RHD groups. Peak velocity was similar but LHD patients had fewer velocity peaks and less curved movements than RHD patients. The addition of auditory feedback improved the curvature index in patients with RHD and deteriorated peak velocity, the number of velocity peaks and curvature index in LHD patients. No difference between types of feedback was found in either patient group.ConclusionIn stroke patients, side of lesion should be considered when examining arm reaching kinematics. Further studies are necessary to evaluate differences in responses to auditory feedback between patients with lesions in opposite cerebral hemispheres.

RBC alloimmunization is an important complication of FFP transfusion: A case report of immune anti-D induced by apheresis fresh frozen plasma

UK, Germany as well as the Council of Europe recommendation guide have set limits of RBC in clinical fresh frozen plasma (FFP), but current transfusion guidelines do not get the consensus opinion at recommending the D status of FFP to be considered before transfusion. We report a female group A, D- patient with cerebrovascular disease who was induced to develop IgG immune anti-D which can be detected on the 15th day of hospitalization after the relatively regular time interval of transfusion of 1800 ml apheresis FFP. Therefore, in making clinical decisions to transfuse FFP or apheresis FFP, the best choice is considered as the same or compatibility with RhD group, in case Rh immunization can be induced and trigger some potential serious problems in future emergent transfusion or pregnancy, especially in high incidence of D antigen countries.