Evaluation of the Sepacell RS-2000® (LeukoConnect) Sterile Dock Leukocyte Reduction Filter Set with Red Blood Cells Collected using Trima.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4113-4113
Author(s):  
Sandy C. Campbell ◽  
Jennifer E. Mauldin ◽  
Kristy L. McShan ◽  
M. Dean Elfath
Keyword(s):  
Blood Cell ◽  
Ambient Temperature ◽  
Red Blood Cell ◽  
Limit Of Detection ◽  
Hold Time ◽  
Additional Time ◽  
Filtration Time ◽  
Group A ◽  
Filtration Condition ◽  
Group B

Abstract As automated red blood cell (RBC) collections become more prevalent, sterile dock filtration will continue to be an important means of leukoreduction (LR). This study evaluated the performance of the Baxter Sepacell RS-2000 sterile dock leukocyte reduction filter set with RBCs collected using Trima, which were filtered either immediately at ambient temperature, or refrigerated and then filtered 6–8 or 68–72 hours post-collection. 180 RBC units were collected using Trima (Gambro BCT, Lakewood, CO) and filtered with the Sepacell RS-2000 (Baxter Healthcare, Deerfield, IL). Units within Group A (n=60) were filtered at ambient temperature immediately after collection. Units within Group B (n=60) and C (n=60) were refrigerated and filtered at 6–8 or 68–72 hours post-collection respectively. Pre- and Post-filtration hematocrits were performed on the Cell-Dyn 3700 (Abbott Laboratories, Abbott Park, IL) to determine RBC percent recovery. Residual leukocytes in the final product were counted using either the FACSCalibur flow cytometer (BD Biosciences, San Jose, CA). Relevant data is presented in Table 1 below. This study demonstrated that the Sepacell RS-2000 (LeukoConnect) sterile dock filter yielded red cell units that met or exceeded the FDA and AABB standards for leukoreduction when filtering refrigerated red blood cell (RBC) units collected on Trima at 6–8 or 68–72 hours post-collection. 60 out of 60 (100%) LR-RBC units in Groups B and C contained residual white blood cell (WBC) counts at or below the limit of detection of 0.3 x 105. 55 of 60 (92%) LR-RBC units in Group A contained residual WBC < 5x106. 38 of 60 (63 %) LR-RBC units within this group contained residual WBC = 1x106. The hold-time prior to ambient filtration for Group A averaged 1:37 ± 0:18. Filtration was initiated < 3 hours post-collection for all units within this group. There is speculation that a correlation may exist between the temperature of the unit at the time of filtration and leukocyte reduction performance for this filtration condition. This correlation was not assessed by this study and warrants further investigation. It was also noted that 11 out of 180 total units (6%) achieved RBC recovery results slightly less than 85%. Unexpected variability in volume recovery for these units can be attributed to inadequate drainage time of the filter. Allowing additional time for complete drainage of the filter would be expected to result in all units achieving > 85% recovery. Table 1 Parameters Group A Group B Group C Mean ± SD (n=60) (n=60) (n=60) Storage & Filtration Condition Ambient (< 3hrs) 1–6°C (6–8hrs) 1–6°C (68–72hrs) Filtration Time (min) 11 ± 1 24 ± 5 27 ± 6 Residual WBC count (1x106) 1.81 ± 3.33 0.30 ± 0.00 0.30 ± 0.00 % RBC Recovery 88 ± 2 87 ± 2 88 ± 2

scholarly journals Safety and Cost Effectiveness of a 10 × 109/L Trigger for Prophylactic Platelet Transfusions Compared With the Traditional 20 × 109/L Trigger: A Prospective Comparative Trial in 105 Patients With Acute Myeloid Leukemia

Blood ◽  
1998 ◽  
Vol 91 (10) ◽  
pp. 3601-3606 ◽  
Author(s):  
Hannes Wandt ◽  
Markus Frank ◽  
Gerhard Ehninger ◽  
Christiane Schneider ◽  
Norbert Brack ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Myeloid Leukemia ◽  
Platelet Transfusion ◽  
Bleeding Complications ◽  
Group A ◽  
Red Blood Cell Transfusions ◽  
Group B ◽  
Acute Myeloid

Abstract In 105 consecutive patients with de novo acute myeloid leukemia (French-American-British M3 excluded), we compared prospectively the risk of bleeding complications, the number of platelet and red blood cell transfusions administered, and the costs of transfusions using two different prophylactic platelet transfusion protocols. Two hundred sixteen cycles of induction or consolidation chemotherapy and 3,843 days of thrombocytopenia less than 25 × 109/L were evaluated. At the start of the study, each of the 17 participating centers decided whether they would use a 10 × 109/L prophylactic platelet transfusion trigger (group A/8 centers) or a 20 × 109/L trigger (group B/9 centers). Bleeding complications (World Health Organization grade 2-4) during treatment cycles were comparable in the two groups: 20 of 110 (18%) in group A and 18 of 106 (17%) in group B (P = .8). Serious bleeding events (grade 3-4) were generally not related to the patient's platelet count but were the consequence of local lesions and plasma coagulation factor deficiencies due to sepsis. Eighty-six percent of the serious bleeding episodes occurred during induction chemotherapy. No patient died of a bleeding complication. There were no significant differences in the number of red blood cell transfusions administered between the two groups, but there were significant differences in the number of platelet transfusions administered per treatment cycle: pooled random donor platelet concentrates averaged 15.4 versus 25.4 (P < .01) and apheresis platelets averaged 3.0 versus 4.8 (P < .05) for group A versus group B, respectively. This resulted in the cost of platelet therapy being one third lower in group A compared with group B without any associated increase in bleeding risk.

scholarly journals Safety and Cost Effectiveness of a 10 × 109/L Trigger for Prophylactic Platelet Transfusions Compared With the Traditional 20 × 109/L Trigger: A Prospective Comparative Trial in 105 Patients With Acute Myeloid Leukemia

Blood ◽  
1998 ◽  
Vol 91 (10) ◽  
pp. 3601-3606 ◽  
Author(s):  
Hannes Wandt ◽  
Markus Frank ◽  
Gerhard Ehninger ◽  
Christiane Schneider ◽  
Norbert Brack ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Myeloid Leukemia ◽  
Platelet Transfusion ◽  
Bleeding Complications ◽  
Group A ◽  
Red Blood Cell Transfusions ◽  
Group B ◽  
Acute Myeloid

In 105 consecutive patients with de novo acute myeloid leukemia (French-American-British M3 excluded), we compared prospectively the risk of bleeding complications, the number of platelet and red blood cell transfusions administered, and the costs of transfusions using two different prophylactic platelet transfusion protocols. Two hundred sixteen cycles of induction or consolidation chemotherapy and 3,843 days of thrombocytopenia less than 25 × 109/L were evaluated. At the start of the study, each of the 17 participating centers decided whether they would use a 10 × 109/L prophylactic platelet transfusion trigger (group A/8 centers) or a 20 × 109/L trigger (group B/9 centers). Bleeding complications (World Health Organization grade 2-4) during treatment cycles were comparable in the two groups: 20 of 110 (18%) in group A and 18 of 106 (17%) in group B (P = .8). Serious bleeding events (grade 3-4) were generally not related to the patient's platelet count but were the consequence of local lesions and plasma coagulation factor deficiencies due to sepsis. Eighty-six percent of the serious bleeding episodes occurred during induction chemotherapy. No patient died of a bleeding complication. There were no significant differences in the number of red blood cell transfusions administered between the two groups, but there were significant differences in the number of platelet transfusions administered per treatment cycle: pooled random donor platelet concentrates averaged 15.4 versus 25.4 (P < .01) and apheresis platelets averaged 3.0 versus 4.8 (P < .05) for group A versus group B, respectively. This resulted in the cost of platelet therapy being one third lower in group A compared with group B without any associated increase in bleeding risk.

scholarly journals An in vivo assessment of the use of Haematopan B12 in the treatment of experimentally induced anaemia in domestic rabbits.

2021 ◽  
Vol 32 (2) ◽  
pp. 301-307
Author(s):  
A. A. Adedapo ◽  
A. B. Saba ◽  
O.A. Dina
Keyword(s):  
Blood Cell ◽  
Red Blood Cell ◽  
Study Group ◽  
Group A ◽  
Domestic Rabbits ◽  
Group B ◽  
Hb Concentration ◽  
In Vivo Assessment ◽  
Rbc Count

A total of 15 domestic rabbits divided into 3 groups of 5 animals per group were used in this study Group A animals (control) were not bled but those in groups B and C were bled to induce anaemia. Group B were left to recover by normal haemopoiesis while those in group C were treated with Hematopan B12*, a commercially prepared haematinic. The post-bleeding treatment haematologic values were obtained at given intervals (7 days) and compared with the pre-bleeding values earlier obtained. The result of this study showed that the group B animals recovered gradually by physiologic haemopoeisis while animals in group C showed accelerated recovery since these animals had a better and faster response in terms of white blood cell (WBC), red blood cell (RBC) count and haemoglobin (Hb) concentration. Thus Haematopan B12 is an effective haematinic. 

Early vs. late treatment with darbepoetin alfa in patients with genitourinary tumors during chemotherapy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18583-18583
Author(s):  
K. Elandt ◽  
P. Horak ◽  
K. C. Schieder ◽  
R. Leikermoser ◽  
R. Altmann ◽  
...  
Keyword(s):  
Blood Cell ◽  
Red Blood Cell ◽  
Early Treatment ◽  
Darbepoetin Alfa ◽  
Red Blood Cell Transfusion ◽  
Rank Test ◽  
Late Treatment ◽  
Group A ◽  
The Mean ◽  
Group B

18583 Background: Anemia is a common complication in patients who receive anticancer therapy. We evaluated the efficacy of darbepoetin alfa in early vs. late treatment in patients with genitourinary tumors undergoing chemotherapy. We wanted to investigate whether an early onset of treatment with darbepoetin alfa reduces frequency of red blood cell transfusion and increases patients’ QoL. Methods: Patients on chemotherapeutic treatment for a urogenital neoplasia and a hemoglobin between 10–12 g/dl were randomized between an immediate start of treatment with darbepoetin alfa 150 μg sc weekly (group A) and a Hb below 10 g/dl or clinical symptoms (group B). Results: 52 patients out of 68 (76.5%) completed the trial, 7/40 patients (17%) in group A and 9/28 patients (32%) in group B withdraw from the study. An intent to treat analysis was performed and showed a significant superiority (p = 0.023, log-rank test) for the early treatment. In group A, only 12.5% of patients (5/40) received at least one red blood cell transfusion compared to group B, where 39% of the patients (11/28) received a transfusion. In group A the mean Hb level increased steadily, starting with a baseline value of 11.0 g/dl. In week 21 a mean Hb level of 12.8 g/dl was reached, resulting in an overall increase in Hb of 1.8 g/dl. In group B, which had a comparable baseline Hb level of 10.9 g/dl, the mean Hb value decreased initially during the first 4 weeks to 10.0 g/dl. In week 21 a level of 11.4 g/dl was reached, resulting in a total Hb-increase of 0.5 g/dl. When anemia treatment was initiated early, the mean Hb level always remained in the range of 11 to 13 g/dl from the beginning of the study, in the B group the mean level of 11 g/dl was first achieved after 12 weeks. 35% in group A compared to 54% in group B (p = 0.13) experienced a dose doubling. The mean values (EORTC-QLQ-C30) of all symptom scales in group A were markedly below those in group B with the highest difference for dyspnea, 29.1 points (p < 0.001). Conclusions: Early treatment with darbepoetin alfa in patients with urogenital cancer results in optimal hemoglobin levels according to EORTC guidelines and consequently in a reduction of red blood cells transfusion. Furthermore, in patients with earlier initiation of treatment a clinically significant improvement of dyspnea can be observed. [Table: see text]

Red Blood Cell Variables in Young and Mature High-Trained Football Players

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3749-3749
Author(s):  
Janet G. Grudeva ◽  
Nickolay Boyadjiev ◽  
Zdravko Taralov ◽  
Ilia Batashki
Keyword(s):  
Blood Cell ◽  
Cell Count ◽  
Red Blood Cell ◽  
Football Players ◽  
Working Capacity ◽  
Blood Cell Count ◽  
Corpuscular Haemoglobin ◽  
Group A ◽  
Mean Corpuscular Haemoglobin ◽  
Group B

Abstract A suboptimal values of the haematological variables has often been recorded in young athletes involved in intense physical activity. There have even been reports of “sports anemia” associated with intensive physical training. There are profound studies describing the haematological changes of the soccer players after training or 90 min match. Our previous studies demonstrated lower values of red blood cell count (RBC), packed cell volume (HCT), haemoglobin concentration (HGB) in highly trained football players than in untrained controls of the same pubescent age. THE AIM: It was a matter of interest to evaluate the haematological status of 2314 football players (15.11±2.89 yrs old) and to compare the results for pre-pubescent, pubescent and mature boys recruited in the study and also to relate the values obtained to the individulal aerobic functional capacity. MATERIAS: A total of 2314 highly trained football players were included in the study. Their mean±SD age, weight, and BMI were: 15.11±2.89 yrs, 56.33±13.28 kg, and 19.62±2.58 kg/m2. The sportsmen were divided into three groups in accordance with their age: pre-pubescent (9–14 years) group A (n=1178) − 13.22±1.05 yrs (158.6±12.6 months); pubescent (15–19 years) group B (n=1029) − 16.57±1.04 yrs (198.9±12.6 months); and mature (20–35 years) group C (n=107) − 24.30±3.78 yrs (291.6±45.3 months) old. Profound clinical examination of all sportsmen was performed at the day before obtaining the blood samples. Haematological variables including RBC, HCT, HGB, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin content (MCHC), white blood cell count (WBC) and platelet count (PLT) were analysed on a Sysmex K800 (Japan) analyser. Each football player passed also PWC170-test for assessment the working capacity on AT-104 Spiro-Ergo equipment (Schiller, Switzerland). RESULTS: All haematological variables in the groups were found in normal ranges, but the RBC was highest in group B (5.17±0.28 *1012/l vs. 5.03±0.28 *1012/l for group A, and 5.08±0.41 *1012/l for group C). Group A demonstrated not only lowest values for the RBC, but also for the HGB (144.7±6.4 g/l vs. 149.1±6.0 g/l for group B, and 151.8±7.5 g/l for group C, P&lt;0.001), and for HCT (0.437±0.02 vs. 0.451±0.02 for group B, and 0.451±0.03 for group C, P&lt;0.001). Group A demonstrated similar values for the above basic red blood cell parameters to these measured for great male group of same age. The pre-pubescent football players (group A) had lower MCV (87.1±2.8 fl), than the players of group B (87.5±2.9 fl) and than the players from group C (88.1±3.0 fl). No evidences for blood dilution as a result of long-term training had been found in groups B and C. There was not difference in the WBC and PLT between pre-pubescent, pubescent and mature footballers. The mature players (C-group) demonstrated higher PWC/kg than pre-pubescent (20.6±2.3 vs. 19.2±2.3 kgm/min/kg), and than pubescent boys (19.8±2.7 kgm/min/kg). Significant correlations were obtained between the age and HGB, and between the age and HCT in groups A (0.19 and 0.19 respectively) and B (0.24 and 0.15 respectively). Good correlations were found between RBC and PWC170/kg in all groups investigated. CONCLUSIONS: Pre-pubescent highly trained football players have lower values of the red blood cell variables than pubescent and mature footballers, which correlates with lower aerobic working capacity.

Red blood cell transfusion requirements for patients on extracorporeal membrane oxygenation

Perfusion ◽  
2021 ◽  
pp. 026765912199894
Author(s):  
Min H Choi ◽  
Nkosi H Alvarez ◽  
Brian M Till ◽  
Yevgeniy Tsypin ◽  
Bailey Sparks ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Blood Cell ◽  
Extracorporeal Membrane Oxygenation ◽  
Red Blood Cell ◽  
Transfusion Requirement ◽  
Bleeding Complications ◽  
Transfusion Requirements ◽  
Group A ◽  
Group B ◽  
Vv Ecmo

Background: Extracorporeal membrane oxygenation (ECMO) is a rescue procedure used for cardiac and pulmonary dysfunction. Patients on ECMO often require blood transfusions to maintain oxygen delivery and recover from bleeding complications. Goals of the current study were to determine transfusion requirements while on ECMO, and incidence and transfusion requirements for bleeding complications. Methods: Packed red blood cell (PRBC) transfusions and bleeding complications were identified by retrospective chart review of patients on ECMO from 2010 to 2018 at our institution. Patients were categorized into those who did not bleed (group A) and those who bled (group B). Incidence, sites of bleed, and transfusion requirement for each bleeding were analyzed. Results: Among 217 patients including veno-arterial (VA) ( n = 148) and veno-venous (VV) ( n = 69) ECMO, we identified 62 patients without bleeding complications (group A) and 155 patients with bleeding complications (group B). In group A, transfusion requirement was 0.6 PRBC/day for VA-ECMO ( n = 42) and 0.2 PRBC/day for VV-ECMO ( n = 20) (p = 0.0015). In group B, number of PRBC given per event per day for bleeding complications during ECMO was mediastinal/thoracic bleed (83 events, 4.7 PRBC/event/day), gastrointestinal bleed (59 events, 4.8 PRBC/event/day), cannulation site bleed (88 events, 3.6 PRBC/event/day), and nasopharyngeal bleed (103 events, 2.8 PRBC/event/day). Thirty-day hospital mortality rate was co-related to transfusion requirement (area under ROC curve: 0.70). Conclusion: Patients without clinical bleeding still required transfusion, with higher rates observed with VA- than VV-ECMO. Transfusion requirements dramatically increased when patients developed various bleeding complications and had a significant impact on 30-day mortality rate.

scholarly journals Effects of Aqueous Extract of Basella alba L. leaves on Blood Cell Count in Rats

2019 ◽  
Vol 22 (1) ◽  
pp. 73-78
Author(s):  
Farhana Sabrin ◽  
AF Mohammed Shafiqul Alam ◽  
Muhammad Rashedul Islam ◽  
Md Elias Al Mamun ◽  
Jakir Ahmed Chowdhury
Keyword(s):  
Blood Cell ◽  
Cell Count ◽  
Aqueous Extract ◽  
Control Group ◽  
P Value ◽  
Blood Cell Count ◽  
Basella Alba ◽  
Group A ◽  
Group B ◽  
Group D

The effect of aqueous extract of Basella alba (puishak) leaves on blood cell count of rats was studied. Forty rats of both sexes weighing between 100-150 gm were used. The rats were divided into four groups (7 rats in each group), with group A as the control group and experimental groups were denoted as B, C and D. With all aseptic precautions, aqueous extract of Basella alba (Puishak) leaves was administered into the three different doses (For group B: 60 mg/kg bw, group C: 80 mg/kg bw and group D: 100 mg/kg bw). Control group A also received distilled water as a placebo at the dose of 10 mg/kg bw for 14 days. At day 15, blood samples were collected and sent for haematological analysis. Data analysis of blood count profile of 28 rats revealed that there is an increased number of RBC, WBC and platelet count in experimental groups than in control group. ANOVA test revealed that increased blood cell counts following administration of aqueous leaves extract of keeves of B. alba were statistically significant (p value for each case was .0001<.05) than control group. Paired samples t test was performed to compare between baseline hematological parameters and parameters after 14 days of intervention. Then comparison between Group A & Group B, between Group A & Group C and between Group A & Group D were done. In all cases, probability (p) value < 0.05 was considered as statistically significant.This it is clearly evident that aqueous extract of B.alba has positive stimulant effect on blood cells count of rats. Moreover, it was found that increment of doses also increases the cell count that is positively correlated with the hypothesis. Bangladesh Pharmaceutical Journal 22(1): 73-78, 2019

scholarly journals Evaluation of a performance enhancing supplement in American Foxhounds during eventing

2014 ◽  
Vol 3 ◽  
Author(s):  
Janice L. Huntingford ◽  
Brent N. Kirn ◽  
Kerry Cramer ◽  
Sabine Mann ◽  
Joseph J. Wakshlag
Keyword(s):  
Blood Cell ◽  
Performance Enhancement ◽  
Human Subjects ◽  
Blood Chemistry ◽  
Serum Markers ◽  
Hunting Dogs ◽  
Cell Counts ◽  
Blood Cell Counts ◽  
Group A ◽  
Group B

AbstractEnhancing performance through dietary measures is constantly sought as some supplements have shown modest performance enhancement in rodents and human subjects. To evaluate a proprietary dietary supplement, a study was undertaken to assess the effect of diet and exercise on blood physiological parameters during a tracking American Fox Hound field championship. Ten dogs were assigned to two different groups. Group A received a commercial kibble and Group B received the same diet with the addition of a supplement added to the dietary premix for 4 weeks before the field event. Blood was collected at rest, immediately following days 1 and 2 of the event and 48 h after day 2. Blood chemistry, complete blood cell counts and cortisol concentrations were analysed. Competition performance was also documented for all dogs using a points system for tracking events. Many chemistry parameters and blood cell counts changed significantly due to exercise. Differences between the dietary groups showed that Group B had significantly lower aspartate aminotransferase on days 1 and 2 of exercise and lower creatine kinase on day 2. Based on tracking scores, dogs in Group B out-performed dogs in Group A. This study suggests that endurance hunting dogs develop changes in serum markers of musculoskeletal integrity that might be mitigated by the addition of the supplement, resulting in better performance. Although intriguing, follow-up controlled studies are needed to ensure that the enhanced performance was not biased due to lack of randomisation.

scholarly journals Subphenotypes in Patients with Septic Shock Receiving Vitamin C, Hydrocortisone, and Thiamine: A Retrospective Cohort Analysis

Nutrients ◽  
2019 ◽  
Vol 11 (12) ◽  
pp. 2976 ◽  
Author(s):  
Won-Young Kim ◽  
Jae-Woo Jung ◽  
Jae Chol Choi ◽  
Jong Wook Shin ◽  
Jae Yeol Kim
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Intensive Care ◽  
Vitamin C ◽  
Blood Cell ◽  
White Blood Cell ◽  
Blood Cell Count ◽  
Group A ◽  
Group B ◽  
Group D

This study aimed to identify septic phenotypes in patients receiving vitamin C, hydrocortisone, and thiamine using temperature and white blood cell count. Data were obtained from septic shock patients who were also treated using a vitamin C protocol in a medical intensive care unit. Patients were divided into groups according to the temperature measurements as well as white blood cell counts within 24 h before starting the vitamin C protocol. In the study, 127 patients included who met the inclusion criteria. In the cohort, four groups were identified: “Temperature ≥37.1 °C, white blood cell count ≥15.0 1000/mm3” (group A; n = 27), “≥37.1 °C, <15.0 1000/mm3” (group B; n = 30), “<37.1 °C, ≥15.0 1000/mm3” (group C; n = 35) and “<37.1 °C, <15.0 1000/mm3” (group D; n = 35). The intensive care unit mortality rates were 15% for group A, 33% for group B, 34% for group C, and 49% for group D (p = 0.051). The temporal improvement in organ dysfunction and vasopressor dose seemed more apparent in group A patients. Our results suggest that different subphenotypes exist among sepsis patients treated using a vitamin C protocol, and clinical outcomes might be better for patients with the hyperinflammatory subphenotype.

scholarly journals Blood Group Changed in a Patient with Acute Myelocytic Leukemia

2013 ◽  
Vol 14 (1) ◽  
pp. 77-79 ◽  
Author(s):  
Shah Md. Sarwer Jahan ◽  
A.K.M Kamruzzaman ◽  
Md. Ismail Hossain ◽  
Md. Abdul Matin ◽  
Md. Zakir Hossain
Keyword(s):  
Blood Cell ◽  
Blood Group ◽  
Red Blood Cell ◽  
Acute Myelocytic Leukemia ◽  
Blood Group A ◽  
Myelocytic Leukemia ◽  
Group A

Gain of red blood cell antigens has been described in patients with acute myelocytic leukemia (AML). This paper describes the gain of blood group A antigen in a patient with AML. At the time of diagnosis the patient’s red cellsshowed the 0 Rh (D) - phenotype. After induction of remission with one courses of Daunorubicin, Cytarabine, her blood group was changed to A Rh (D) - phenotype.DOI: http://dx.doi.org/10.3329/jom.v14i1.14559 J MEDICINE 2013; 14 : 77-79

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