Altered blood group expression in a patient with congenital rubella infection

An infant with probable congenital rubella infection developed altered blood group expression. This was noted at 4 months of age. The child's blood was typed on seven separate occasions during the first 8 weeks of life as type A, but on repeat testing, her cells failed to agglutinate with anti-A and anti-A,B typing serum. The A antigen was present, however, because an eluate made after incubating her red cells with anti-A contained anti-A, and A antigen was demonstrated on buccal mucosa cells. Altered expression of blood group A (loss of agglutinability) has occurred previously only in association with hematologic malignancy.     

Promoting effective social work policy in end-of-life and palliative care

Policy developments in the health care arena in general, and in end-of-life and palliative care in particular, strongly influence the practice environment for the delivery of hospice and palliative care services and the diverse roles of social work practitioners. This article analyzes policy developments in two crucial areas-ethics and law and disenfranchisement and health disparities. It focuses on the recent social work literature and other key sources and provides recommendations to promote the roles of social workers in ethics consultation, public policy, and advocacy and to integrate better the perspectives and concerns of diverse communities into palliative care practice, education, and policy.