Doctor of Philosophy

dissertationDue to the tremendous progress of modern medicine, more people are surviving cancer. A cancer diagnosis no longer connotes the end of life, but instead, a change in life. Recently, middle age and older adults with hematological cancer have become eligible for treatment with allogeneic hematopoietic cell transplantation (allo HCT), enabling them to survive their underlying cancer diagnosis. While some individuals fully recover from allo HCT, up to two thirds of allo HCT recipients develop new-onset diabetes. While research has been conducted on the physiological effect diabetes has on HCT outcomes, there is a knowledge gap regarding middle age and older adults' psychosocial response to the condition. The objective of this qualitative study was to explore the psychosocial experience of developing new-onset diabetes after allo HCT. Nineteen participants above 50 years of age were interviewed. Qualitative data generated through interviews were analyzed using constructivist grounded theory methods. The result was the mid-range theory of dealing with new-onset diabetes as a long-term effect of allo HCT. This theory had 4 stages; 1) finding out about diabetes, 2) formulating an understanding of diabetes in relation to cancer, 3) formulating a diabetes identity, and 4) dealing with diabetes after allo HCT. Three distinct patterns of movement through these stages emerged, depending on how participants recovered from their allo HCT. The first pattern occurred in the group of participants with no or minimal after allo HCT complications. The second pattern was seen in the group with episodic complications, iv and the third in those with ongoing complications. Two primary factors were responsible for these differences of moving through the stages, and ultimately, whether participants adapted to new-onset diabetes: the amount of treatment-related work and the perceptions of diabetes. The group with minimal complications was able to understand, identify, and integrate diabetes into their lives, while those with ongoing complications experienced barriers to socially constructing and identifying with their type of diabetes, and were subsequently unable to integrate diabetes into their lives. This mid-range theory provides a working framework for the development of clinical and educational interventions specific to this patient population

Blood group genotype analysis for the quality improvement of reagent test red blood cells

Background and Objectives Reagent red blood cells (RBCs) for antibody detection should express certain important antigens as a double dose, that is, the donors must be homozygous for the corresponding alleles. Traditionally, dose is determined by serological typing and known allele frequencies. However, RHD zygosity cannot be predicted serologically owing to the absence of an antithetical antigen, and FY zygosity is confounded by two variant haplotypes, FY*0 and FY*X. Furthermore, lack of reagents hampers our ability to type for some clinically important antigen pairs such as Do(a)/Do(b). Materials and Methods Genomic DNA was isolated from reagent RBC samples. Established, validated methods were used to determine the RHD, FY, and DO genotypes. Results Three of 52 D+ samples gave results that differed from the predicted genotype: two presumed (RR1)-R-1 samples and an (RR2)-R-2 sample were shown to be R(1)r" and R(2)r', respectively. Five of 59 samples that were from presumed homozygotes for either FY*A or FY*B were heterozygous, together with either FY*X (three samples) or FY*0 (two samples). Seventy-five samples tested for DO were DO*A/A (n = 14), DO*A/B (n = 39), or DO*B/B (n = 22). Conclusions The results show that serologically determined RhD and Duffy phenotypes of reagent RBCs are unreliable and that antigens we thought were represented as a double dose were single dose. The addition of Dombrock genotyping provides information which is useful in antibody identification. We conclude that selected genotype analyses are a valuable quality assurance measure to ensure that reagent RBCs comply with national and international recommendations for test sensitivity