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1

Delayed hemolytic transfusion reaction in children with sickle cell disease  

PubMed Central

Background Transfusion is a cornerstone of the management of sickle cell disease but carries a high risk of hemolytic transfusion reaction, probably because of differences in erythrocyte antigens between blood donors of European descent and patients of African descent. Patients may experience hemolytic transfusion reactions that are delayed by from a few days to two weeks and manifest as acute hemolysis (hemoglobinuria, jaundice, and pallor), symptoms suggesting severe vaso-occlusive crisis (pain, fever, and acute chest syndrome), and profound anemia, often with reticulocytopenia. This case-series study aims to describe the main characteristics of this syndrome, to discuss its pathophysiology, and to propose a management strategy. Design and Methods We identified 8 pediatric cases of delayed hemolytic transfusion reactions between 2006 and 2009 in the database of the Necker Hospital, France. All patients had received cross-matched red cell units compatible in the ABO, RH, and KEL systems. We reviewed the medical charts in the computerized blood transfusion databases. All patients were admitted to the intensive care unit. We progressively adopted the following strategy: intravenous immunoglobulins, and darbopoietin alpha when the reticulocyte count was below 150×109/L, without further blood transfusion during the acute episode unless absolutely necessary. Results The median time between the transfusion and the diagnosis of delayed hemolytic transfusion reaction was six days. All patients had severe bone pain; all but one had a high-grade fever. Five patients had hemoglobin levels less than than 4g/dL and 3 had reticulocytopenia. In 5 patients, no new antibody was found; one patient had weakly reactive antibodies. Only 2 patients had new allo-antibodies possibly responsible for the delayed hemolytic reaction. Conclusions The initial symptoms of delayed hemolytic transfusion reaction were complex and mimicked other complications of sickle cell disease. In most of our cases, no new antibody was identified, which underlines the complexity of the pathophysiology of this syndrome. PMID:21330322

de Montalembert, Mariane; Dumont, Marie-Dominique; Heilbronner, Claire; Brousse, Valentine; Charrara, Oussama; Pellegrino, Béatrice; Piguet, Christophe; Soussan, Valérie; Noizat-Pirenne, France

2011-01-01

2

Initiation and Regulation of Complement during Hemolytic Transfusion Reactions  

PubMed Central

Hemolytic transfusion reactions represent one of the most common causes of transfusion-related mortality. Although many factors influence hemolytic transfusion reactions, complement activation represents one of the most common features associated with fatality. In this paper we will focus on the role of complement in initiating and regulating hemolytic transfusion reactions and will discuss potential strategies aimed at mitigating or favorably modulating complement during incompatible red blood cell transfusions. PMID:23118779

Stowell, Sean R.; Winkler, Anne M.; Maier, Cheryl L.; Arthur, C. Maridith; Smith, Nicole H.; Girard-Pierce, Kathryn R.; Cummings, Richard D.; Zimring, James C.; Hendrickson, Jeanne E.

2012-01-01

3

ABO-mismatched platelet transfusions: strategies to mitigate patient exposure to naturally occurring hemolytic antibodies.  

PubMed

Clinically significant hemolysis is a rare but potentially severe complication of administering an ABO-mismatched platelet transfusion. Platelet products from Group O donors, particularly single donor platelets (SDP) are most commonly implicated in these reactions. This is due to the presence of unusually high titers of anti-A which can be found in the plasma of some Group O donors and the large plasma volume of SDPs. These products can cause significant hemolysis when infused into a Group A or AB recipient. Random donor platelets from Group O donors have also been implicated. In practice, platelets are frequently transfused across ABO barriers though, ideally, in order to prevent or mitigate these reactions, platelet transfusions that are matched for ABO should be administered. However, limited availability of donor platelets as well as an abundance of Group O donors makes this a difficult standard to adhere to since often out-of group products are the only ones available. Methods to improve the safety of Group O products have focused on defining a safe level of isohemagglutinins so that the risk of hemolysis is alleviated when mismatched products are transfused. Determining the critical titer which defines a level above which a mismatched product should not be administered has been challenging. Non-standardized methods of isohemagglutinin titering and varying reports in the literature where products with a wide range of titers have been implicated in acute hemolytic transfusion reactions have made it difficult to determine a cut-off for labeling a product as high titer and thereby restricting its use to O recipients. Standards in the US place the responsibility for designing and implementing policies for the use of mismatched platelet products on each individual hospital transfusion service. Compliance requires only that there be an existing written policy which addresses the transfusion of products containing incompatible ABO antibodies but no specific procedures are required. In sharp contrast, European strategies have defined the low-end titer for which an out-of-group transfusion should not be given to an ABO-incompatible recipient. This testing is performed centrally at the Blood Centers who then make the determination on the status of a "dangerous donor". The progress in this European strategy may serve the US to stimulate a re-examination of its practices and policies for the advancement of platelet transfusion safety. PMID:20034854

Josephson, Cassandra D; Castillejo, Marta-Inés; Grima, Kathleen; Hillyer, Christopher D

2010-02-01

4

Post-transfusion hypertension and seizure in congenital hemolytic anemia: a case report and literature review.  

PubMed

A rare syndrome of hypertension, seizures and intracranial bleed has been reported among patients with congenital hemolytic anemia who underwent multiple blood transfusions. We report this syndrome in a 12-year-old Malay girl with hemoglobin E-beta-thalassemia, who underwent intensive transfusion and subsequently had headache, visual loss, severe hypertension and seizures. A comprehensive literature review revealed 30 patients with this syndrome, of whom 15 had intracranial bleed and 12 among these 15 died. A less-intensive transfusion regimen among patients with chronic hemolytic anemia and prompt detection and management of hypertension may prevent this potentially fatal syndrome. PMID:24473404

Ngim, Chin Fang; Ng, Chen Siew; Lai, Nai Ming

2014-06-01

5

Acute hemorrhage and blood transfusions in horses.  

PubMed

Treatment of acute hemorrhage in the horse involves targeted medical management and also may involve surgical stabilization. This article provides an approach to the initial stabilization and information on available topical hemostats. The practice of blood collection and transfusion is also described, with attention to new information on viability of transfused equine blood, potential negative effects of blood transfusion, and methods of cell salvage. PMID:25016500

Mudge, Margaret C

2014-08-01

6

Hemolytic transfusion reactions in a dog with an alloantibody to a common antigen.  

PubMed

Alloantibodies to high-frequency red cell antigens, defined as inherited traits occurring in 92% to 99% or more of the general population, are recognized as a cause of hemolytic transfusion reactions in humans. Here we describe a dog (dog erythrocyte antigen [DEA] 1.2- and DEA 4-positive) sensitized by prior blood transfusion, for which a compatible blood donor could not be found; transfusion of DEA 1.1-negative blood resulted in hemolytic transfusion reactions. Patient serum from days 1 (before first transfusion) and 16 was available for further testing; using 4 dogs with different blood types as potential donors, the major crossmatches were compatible using serum from day 1. However the crossmatches were all incompatible with serum from day 16, indicating that the patient was sensitized to an antigen after the first transfusion. The presence of an alloantibody against DEA 1.1 was not ruled out in this patient, but the incompatibility reactions of patient serum with red cells from donors negative for DEA 1.1 indicated that an alloantibody against a red cell antigen other than DEA 1.1 or any other known DEA for which typing reagents were available (DEA 3, 5, and 7) was present. Subsequently, red cells from 1 of the patient's siblings (DEA 1.2-, 4-, and 7-positive) were found not to agglutinate when incubated with patient's serum from day 16, ruling out the presence of an anti-DEA 7 antibody, and suggesting that an alloantibody against a common red cell antigen missing in the patient and sibling was responsible for the blood incompatibility reactions.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8523326

Callan, M B; Jones, L T; Giger, U

1995-01-01

7

In Vitro Lysis and Acute Transfusion Reactions with Hemolysis Caused by Inappropriate Storage of Canine Red Blood Cell Products  

PubMed Central

Background Transfusion of red blood cell (RBC) products carries considerable risk for adverse reactions, including life-threatening hemolytic reactions. Objective To report the occurrence and investigation of life-threatening acute transfusion reactions with hemolysis in dogs likely related to inappropriate blood product storage. Animals Four dogs with acute transfusion reactions and other recipients of blood products. Methods Medical records were reviewed from 4 dogs with suspected acute hemolytic transfusion reactions after receiving RBC products at a veterinary clinic over a 1-month period. Medical records of other animals receiving blood products in the same time period also were reviewed. Blood compatibility and product quality were assessed, subsequent transfusions were closely monitored, and products were diligently audited. Results During or immediately after RBC product transfusion, 4 dogs developed hemolysis, hemoglobinuria, or both. Two dogs died and 1 was euthanized because of progressive clinical signs compatible with an acute hemolytic transfusion reaction. Blood type and blood compatibility were confirmed. RBC units from 2 blood banks were found to be hemolyzed after storage in the clinic’s refrigerator; no bacterial contamination was identified. After obtaining a new refrigerator dedicated to blood product storage, the problem of hemolyzed units and acute transfusion reactions with hemolysis completely resolved. Conclusions Acute life-threatening transfusion reactions can be caused by inappropriate storage of RBC products. In addition to infectious disease screening and ensuring blood-type compatibility, quality assessment of blood products, appropriate collection, processing, and storage techniques as well as recipient monitoring are critical to provide safe, effective transfusions. PMID:21615499

Patterson, J.; Rousseau, A.; Kessler, R.J.; Giger, U.

2012-01-01

8

[Transfusion-related acute lung injury (TRALI)].  

PubMed

Transfusion-related acute lung injury (TRALI) is primarily caused by transfusion of fresh frozen plasma or platelet concentrates and occurs by definition within 6 hours after transfusion with acute shortness of breath, hypoxemia and radiographically detectable bilateral infiltrates of the lung. Mostly leucocyte antibodies in the plasma of the blood donor (immunogenic TRALI) are responsible. Apart from antibodies, other substances such as biologically active lipids, mainly arising from the storage of platelet and red blood cell concentrates, can activate neutrophilic granulocytes and trigger a non-immunogenic TRALI. Pathophysiologically, granulocytes in the capillaries of the lung vessels release oxygen radicals and enzymes which damage the endothelial cells and cause pulmonary edema. Therapeutically, nasal oxygen administration may be sufficient. In severe cases, mechanical ventilation, invasive hemodynamic monitoring and fluid intake are required. Diuretics should be avoided. The administration of glucocorticoids is controversial. Antibody-related TRALI reactions occurred mainly after transfusion of fresh frozen plasma, which had been obtained from womenimmunized during pregnancy against leukocyte antigens. Therefore, in Germany, since 2009 only plasma from female donors without a history of prior or current pregnancy or negative testing for antibodies against HLA I, II or HNA has been used with the result that since then no TRALI-related death has been registered. PMID:25046684

Schweisfurth, H; Sopivnik, I; Moog, R

2014-09-01

9

Acute Transfusion Reactions (ATRs) in Intensive Care Unit (ICU): A Retrospective Study  

PubMed Central

Background: Blood transfusion is a frequent and integral part of critical care. Although life saving, it can occasionally be unsafe and result in a spectrum of adverse events. Acute transfusion reactions (ATRs) are probably under diagnosed in critically ill patients due to confusion of the symptoms with the underlying disease. Aim: To analyze the incidence and spectrum of ATRs occuring in critically ill patients. Materials and Methods: This was a retrospective review conducted from 1st April 2011 till 31st March 2013. The ATRs related to the administration of blood components in the patients admitted in various Intensive Care Units (ICUs) were recorded, analyzed and classified on the basis of their clinical features and laboratory tests. Results: During the study period 98651 blood components were issued. Out of these 21971 were issued to various ICUs. A total of 225 transfusion reactions were reported from the various critical care departments during this period. The most frequent were Febrile Non Hemolytic Transfusion Reactions (FNHTR) 136 (60.4%), allergic reactions 70 (31.2%), hemolytic reactions 1(0.4%) and non specific reactions 18 (8%). The incidence of ATRs in our study was found to be 1.09% in adult ICUs and 0.36% in pediatric ICUs. Conclusions: Blood transfusion is a vital therapeutic procedure with a potential risk to already critical patients. So a strict vigilance has to be kept and each transfusion has to be monitored carefully with prompt recognition and treatment of ATRs. A rational use of these products considering their deleterious effects can decrease transfusion related morbidity and mortality in the critically ill patients. PMID:24701502

Kumar, Rajesh; Gupta, Manvi; Gupta, Varun; Kaur, Amarjit; Gupta, Sonia

2014-01-01

10

Erythropoietin as Treatment for Late Hyporegenerative Anemia in Neonates with Rh Hemolytic Disease after in utero Exchange Transfusion  

Microsoft Academic Search

We report the effects of recombinant human erythropoietin (rHuEPO) in the treatment of late hyporegenerative anemia in 2 neonates with Rh hemolytic disease who had received several in utero exchange transfusions. In both cases anemia occurred at 6 weeks of age and we started therapy at approximately 70 days of age. We used rHuEPO at 250 U\\/kg three times a

Claire Nicaise; Catherine Gire; Paul Casha; Claude d’Ercole; Cécile Chau; Christian Palix

2002-01-01

11

Estimation of the prevalence and rate of acute transfusion reactions occurring in Windhoek, Namibia  

PubMed Central

Background Acute transfusion reactions are probably common in sub-Saharan Africa, but transfusion reaction surveillance systems have not been widely established. In 2008, the Blood Transfusion Service of Namibia implemented a national acute transfusion reaction surveillance system, but substantial under-reporting was suspected. We estimated the actual prevalence and rate of acute transfusion reactions occurring in Windhoek, Namibia. Methods The percentage of transfusion events resulting in a reported acute transfusion reaction was calculated. Actual percentage and rates of acute transfusion reactions per 1,000 transfused units were estimated by reviewing patients’ records from six hospitals, which transfuse >99% of all blood in Windhoek. Patients’ records for 1,162 transfusion events occurring between 1st January – 31st December 2011 were randomly selected. Clinical and demographic information were abstracted and Centers for Disease Control and Prevention National Healthcare Safety Network criteria were applied to categorize acute transfusion reactions1. Results From January 1 – December 31, 2011, there were 3,697 transfusion events (involving 10,338 blood units) in the selected hospitals. Eight (0.2%) acute transfusion reactions were reported to the surveillance system. Of the 1,162 transfusion events selected, medical records for 785 transfusion events were analysed, and 28 acute transfusion reactions were detected, of which only one had also been reported to the surveillance system. An estimated 3.4% (95% confidence interval [CI]: 2.3–4.4) of transfusion events in Windhoek resulted in an acute transfusion reaction, with an estimated rate of 11.5 (95% CI: 7.6–14.5) acute transfusion reactions per 1,000 transfused units. Conclusion The estimated actual rate of acute transfusion reactions is higher than the rate reported to the national haemovigilance system. Improved surveillance and interventions to reduce transfusion-related morbidity and mortality are required in Namibia. PMID:24333079

Meza, Benjamin P.L.; Lohrke, Britta; Wilkinson, Robert; Pitman, John P.; Shiraishi, Ray W.; Bock, Naomi; Lowrance, David W.; Kuehnert, Matthew J.; Mataranyika, Mary; Basavaraju, Sridhar V.

2014-01-01

12

Reducing Non-Infectious Risks of Blood Transfusion  

PubMed Central

Summary As screening for transfusion-associated infections has improved, non-infectious complications of transfusion now cause the majority of morbidity and mortality associated with transfusion in the United States. For example, transfusion-related acute lung injury, transfusion-associated circulatory overload, and hemolytic transfusion-reactions are the first, second, and third leading causes of death from transfusion respectively. These complications and others are reviewed here and several controversial methods for prevention of non-infectious complications of transfusion are discussed; universal leukoreduction of red cell units, use of male-only plasma, and restriction of red cell storage age. PMID:21792054

Gilliss, Brian M.; Looney, Mark R.; Gropper, Michael A.

2011-01-01

13

Tc-99m red blood cells for the study of rapid hemolytic processes associated with heterologous blood transfusions  

SciTech Connect

Chromium-51 labeled erythrocytes (Cr-51 RBC) are suitable for the study of hematologic disorders which involve relatively slow destruction of circulating erythrocytes, taking several days to several weeks. However, Cr-51 RBC are not suitable for investigating rapid hemolytic processes which occur within a matter of a few hours due to the variable and unpredictable elution of Cr-51 from the erythrocytes during the first 24 hours or so. Imaging, which could be useful in identifying organ systems involved in the hemolytic process, cannot be performed with Cr-51 RBC because of the high dose commitment caused by the low yield of gamma rays from Cr-51 (2). A method of labeling RBC with Tc-99m, which results in a radiopharmaceutical that combines the excellent dosimetric and imaging qualities of Tc-99m with an extremely stable bond between the Tc-99m and the RBC, is reported. The successful application of this technique in providing red cell support for a cancer patient with an unusual history of intravascular hemolytic transfusion reactions is also reported.

Benedetto, A.R.; Harrison, C.R.; Blumhardt, R.; Trow, L.L.

1984-10-01

14

Experimental Models of Transfusion-Related Acute Lung Injury (TRALI)  

PubMed Central

Transfusion-related acute lung injury (TRALI) is defined clinically as acute lung injury occurring within six hours of the transfusion of any blood product. It is the leading cause of transfusion-related death in the United States, but under-recognition and diagnostic uncertainty have limited clinical research to smaller case control studies. In this review we will discuss the contribution of experimental models to the understanding of TRALI pathophysiology and potential therapeutic approaches. Experimental models suggest that TRALI occurs when a host, with a primed immune system, is exposed to an activating agent such as anti-leukocyte antibody or a biologic response modifier such as lysophosphatidylcholines. Recent work has suggested a critical role for platelets in antibody-based experimental models and identified potential therapeutic strategies for TRALI. PMID:21134622

Gilliss, Brian M.; Looney, Mark R.

2010-01-01

15

Guideline on the investigation and management of acute transfusion reactions. Prepared by the BCSH Blood Transfusion Task Force.  

PubMed

Although acute non-haemolytic febrile or allergic reactions (ATRs) are a common complication of transfusion and often result in little or no morbidity, prompt recognition and management are essential. The serious hazards of transfusion haemovigilance organisation (SHOT) receives 30-40 reports of anaphylactic reactions each year. Other serious complications of transfusion, such as acute haemolysis, bacterial contamination, transfusion-related acute lung injury (TRALI) or transfusion-associated circulatory overload (TACO) may present with similar clinical features to ATR. This guideline describes the approach to a patient developing adverse symptoms and signs related to transfusion, including initial recognition, establishing a likely cause, treatment, investigations, planning future transfusion and reporting within the hospital and to haemovigilance organisations. Key recommendations are that adrenaline should be used as first line treatment of anaphylaxis, and that transfusions should only be carried out where patients can be directly observed and where staff are trained in manging complications of transfusion, particularly anaphylaxis. Management of ATRs is not dependent on classification but should be guided by symptoms and signs. Patients who have experienced an anaphylactic reaction should be discussed with an allergist or immunologist, in keeping with UK resuscitation council guidelines. PMID:22928769

Tinegate, Hazel; Birchall, Janet; Gray, Alexandra; Haggas, Richard; Massey, Edwin; Norfolk, Derek; Pinchon, Deborah; Sewell, Carrock; Wells, Angus; Allard, Shubha

2012-10-01

16

Acute Neurological Involvement in Diarrhea-Associated Hemolytic Uremic Syndrome  

PubMed Central

Background and objectives: Neurologic involvement is the most threatening complication of diarrhea-associated hemolytic uremic syndrome (D+HUS). Design, setting, participants, & measurements: We report a retrospective multicenter series of 52 patients with severe initial neurologic involvement that occurred in the course of D+HUS. Results: Verotoxigenic Escherichia coli infection was documented in 24. All except two patients had acute renal failure that required peritoneal dialysis, hemodialysis, or both techniques. A first group of eight patients remained with normal consciousness; five of them had protracted seizures. A second group of 23 patients had stuporous coma; five of these had protracted severe seizures, and 18 had a neurologic defect including pyramidal syndrome, hemiplegia or hemiparesia, and extrapyramidal syndrome. A third group of 21 patients had severe coma. Plasma exchanges were undertaken in 25 patients, 11 of whom were treated within 24 hours after the first neurologic sign; four died, two survived with severe sequelae, and five were alive without neurologic defect. Magnetic resonance imaging (MRI) for 29 patients showed that (1) every structure of the central nervous system was susceptible to involvement; (2) no correlation seemed to exist between special profile of localization on early MRI and the final prognosis; and (3) MRI did not exhibit any focal lesions in three patients. The overall prognosis of the series was marked by the death of nine patients and severe sequelae in 13. Conclusions: Neurologic involvement is associated with a severe renal disease but does not lead systematically to death or severe disability. PMID:20498239

Kwon, Thérésa; Elmaleh, Monique; Charbit, Marina; Launay, Emma Allain; Harambat, Jérôme; Brun, Muriel; Ranchin, Bruno; Bandin, Flavio; Cloarec, Sylvie; Bourdat-Michel, Guylhene; Pičtrement, Christine; Champion, Gérard; Ulinski, Tim; Deschęnes, Georges

2010-01-01

17

Disseminated fusariosis and endogenous fungal endophthalmitis in acute lymphoblastic leukemia following platelet transfusion possibly due to transfusion-related immunomodulation  

PubMed Central

Background To report a case of disseminated fusariosis with endogenous endophthalmitis in a patient with acute lymphoblastic leukemia. Transfusion-associated immune modulation secondary to platelet transfusion could play an important role in the pathophysiology of this case. Case Presentation A 9 year-old male with acute lymphoblastic leukemia complicated by pancytopenia and disseminated Intravascular coagulation was given platelet transfusion. He developed disseminated fusariosis and was referred to the ophthalmology team for right endogenous endophthalmitis. The infection was controlled with aggressive systemic and intravitreal antifungals. Conclusion Patients with acute lymphoblastic leukemia are predisposed to endogenous fungal endophthalmitis. Transfusion-associated immune modulation may further increase host susceptibility to such opportunistic infections. PMID:22044440

2011-01-01

18

Transfusion-Related Acute Lung Injury: The Work of DAMPs*  

PubMed Central

Current notions in immunology hold that not only pathogen-mediated tissue injury but any injury activates the innate immune system. In principle, this evolutionarily highly conserved, rapid first-line defense system responds to pathogen-induced injury with the creation of infectious inflammation, and non-pathogen-induced tissue injury with ‘sterile’ tissue inflammation. In this review, evidence has been collected in support of the notion that the transfusion-related acute lung injury induces a ‘sterile’ inflammation in the lung of transfused patients in terms of an acute innate inflammatory disease. The inflammatory response is mediated by the patient's innate immune cells including lung-passing neutrophils and pulmonary endothelial cells, which are equipped with pattern recognition receptors. These receptors are able to sense injury-induced, damage-associated molecular patterns (DAMPs) generated during collection, processing, and storage of blood/blood components. The recognition process leads to activation of these innate cells. A critical role for a protein complex known as the NLRP3 inflammasome has been suggested to be at the center of such a scenario. This complex undergoes an initial ‘priming’ step mediated by 1 class of DAMPs and then an ‘activating’ step mediated by another class of DAMPs to activate interleukin-1beta and interleukin-18. These 2 cytokines then promote, via transactivation, the formation of lung inflammation. PMID:23637644

Land, Walter G.

2013-01-01

19

Prevalence of Acute Blood Transfusion Reactions in Mazandaran Heart Center, Sari, Iran, 2010-2012  

PubMed Central

ABSTRACT Introduction: Although blood transfusion is life saving for patients, it is responsible for a series of complications and exposes the patients to a variety of risks. Therefore knowing different adverse effects of blood transfusion represents a great issue in managing recipient patients. Aim: The aim of the present work was to study the prevalence of blood transfusion complications among patients in the Mazandaran Heart Center, Sari, Iran, during a period of 2 years. Material and Methods: A retrospective review of all reported and evaluated acute transfusion reactions during a 2 years period in Mazandaran Heart Center was performed. Associated clinical signs and symptoms were evaluated. Results: In 9193 transfused blood products, there was 34 (0.4%) acute transfusion reactions. The commonest were discomfort and restlessness(0.16%), dyspnea(0.16%), rigors (0.13%), fever (0.08%), chest pain(0.06%), rash or urticaria (0.04%), nausea and vomiting(0.03%), palpitation(0.03%), hypertension(0.03%)flashing(0.02%), hypotension(0.02%). Conclusion: Acute transfusion reaction is seen in %0.4 of transfused patients therefore, we recommend a well-structured program for monitoring adverse reactions associated with blood transfusion and blood product administration (Hemovigilance program). PMID:24937941

Azizi, Soheil; Tabary, Shervin Ziabakhsh; Soleimani, Arya

2014-01-01

20

Sensitivity to a Metabolite of Diclofenac as a Cause of Acute Immune Hemolytic Anemia  

Microsoft Academic Search

A 75-year-old woman taking the nonsteroidal anti-inflam- RBCs by the patient's serum and was identified as the gluc- matory drug diclofenac (DCF) presented with acute Coombs- uronide ester of 4*-OH DCF by proton nuclear magnetic reso- positive hemolytic anemia and subsequently developed re- nance (NMR) analysis. Studies with a panel of RBCs showed nal failure. A drug-dependent antibody specific for

D. Bougie; S. T. Johnson; L. A. Weitekamp; R. H. Aster

21

Effect of transfusion in acute chest syndrome of sickle cell disease  

Microsoft Academic Search

Objective: To study the effects of transfusion on the clinical course and oxygenation indexes of children with sickle cell disease and acute chest syndrome. Methods: During a 2-year period, 36 children with sickle cell disease admitted with a total of 40 episodes of acute chest syndrome were examined. Patients were given a clinical severity score indicative of the degree of

Umit Emre; Scott T. Miller; Manuel Gutierez; Phillip Steiner; Sreedhar P. Rao; Madu Rao

1995-01-01

22

The Role of Neutrophils in the Pathogenesis of Transfusion-Related Acute Lung Injury (TRALI)  

PubMed Central

Transfusion-related acute lung injury (TRALI) is the major cause of transfusion related morbidity and mortality, world wide. Efforts to reduce or eliminate this serious complication of blood transfusion are hampered by an incomplete understanding of its pathogenesis. Currently, TRALI is thought to be mediated by donor alloantibodies directed against host leukocytes or the result of two distinct clinical events. For both proposed mechanisms the neutrophil (PMN) is the key effector cell. This paper reviews TRALI pathophysiology, explores the role of the PMN, details practical information for appropriate diagnosis, and promotes further studies into the pathogenesis of TRALI. PMID:19765516

Fung, Y.L.; Silliman, C.C.

2010-01-01

23

Platelet Transfusion – The New Immunology of an Old Therapy  

PubMed Central

Platelet transfusion has been a vital therapeutic approach in patients with hematologic malignancies for close to half a century. Randomized trials show that prophylactic platelet transfusions mitigate bleeding in patients with acute myeloid leukemia. However, even with prophylactic transfusions, as many as 75% of patients, experience hemorrhage. While platelet transfusion efficacy is modest, questions and concerns have arisen about the risks of platelet transfusion therapy. The acknowledged serious risks of platelet transfusion include viral transmission, bacterial sepsis, and acute lung injury. Less serious adverse effects include allergic and non-hemolytic febrile reactions. Rare hemolytic reactions have occurred due to a common policy of transfusing without regard to ABO type. In the last decade or so, new concerns have arisen; platelet-derived lipids are implicated in transfusion-related acute lung injury after transfusion. With the recognition that platelets are immune cells came the discoveries that supernatant IL-6, IL-27 sCD40L, and OX40L are closely linked to febrile reactions and sCD40L with acute lung injury. Platelet transfusions are pro-inflammatory, and may be pro-thrombotic. Anti-A and anti-B can bind to incompatible recipient or donor platelets and soluble antigens, impair hemostasis and thus increase bleeding. Finally, stored platelet supernatants contain biological mediators such as VEGF and TGF-?1 that may compromise the host versus tumor response. This is particularly of concern in patients receiving many platelet transfusions, as for acute leukemia. New evidence suggests that removing stored supernatant will improve clinical outcomes. This new view of platelets as pro-inflammatory and immunomodulatory agents suggests that innovative approaches to improving platelet storage and pre-transfusion manipulations to reduce toxicity could substantially improve the efficacy and safety of this long-employed therapy.

Stolla, Moritz; Refaai, Majed A.; Heal, Joanna M.; Spinelli, Sherry L.; Garraud, Olivier; Phipps, Richard P.; Blumberg, Neil

2015-01-01

24

The simultaneous incidence of acute pancreatitis and autoimmune hemolytic anemia: a rare duo in a patient with SLE  

PubMed Central

A young female presented with acute abdominal pain of two days duration consistent with acute pancreatitis. During her stay in the hospital she had a sudden drop in hemoglobin to 6 g/dl without any overt blood loss. On evaluation, it was evident that she had acute pancreatitis, in addition to displaying features of autoimmune hemolytic anemia. She had been a known case of systemic lupus erythematosus (SLE) and had discontinued her treatment. She was managed with methylprednisolone pulse therapy. Her clinical condition improved, and she has been regularly attending our clinic for the last 2 years. According to a literature search in Medline, it would appear that this is the first report of a case in which SLE with autoimmune hemolytic anemia has been associated with acute pancreatitis in a single case. PMID:25276114

Masoodi, Ibrahim

2014-01-01

25

Hemolytic uremic syndrome complicated with IgA nephropathy: a case report and literature review.  

PubMed

A previously healthy young female, presenting with nausea, vomiting, diarrhea, anemia, thrombocytopenia, and acute renal failure, was admitted to our hospital. Her clinical and histological features were consistent with both hemolytic uremic syndrome and IgA nephropathy, and she responded to steroid treatment, plasma transfusion, and gamma globulin therapy and did not need hemodialysis. In the following months, she achieved clinical remission except for low complement C3. Since hemolytic uremic syndrome is rarely associated with IgA nephropathy, we present this case and discuss potential connection between hemolytic uremic syndrome and IgA nephropathy. PMID:24290408

Wang, Rong; Zhang, Yiyan; Li, Shijun; Chen, Hao; Zeng, Caihong; Chen, Huiping; Tang, Zheng; Liu, Zhihong

2015-01-01

26

Transfusion-Related Acute Lung Injury (TRALI): Report of 2 Cases and a Review of The Literature  

PubMed Central

Transfusion of allogeneic blood products is given for correction of coagulation deficits and for the improvement in oxygen-carrying capacity or delivery. Blood transfusion has become safer following the advancement in blood testing using state-of-the-art viral assays; however, there continues to exist a variety of noninfectious transfusion risks that still remain and that cannot be entirely eliminated. Research is now directed towards understanding these lesser-known, but serious transfusion-related complications. This purpose of this review is to discuss a serious noninfectious cause of acute lung injury, transfusion-related acute lung injury (TRALI), which occurred in 2 recent cases in the intensive care unit, and to review the current literature of this syndrome. PMID:21603554

Nossaman, Bobby D.

2008-01-01

27

Pathogenesis of non-antibody mediated transfusion-related acute lung injury from bench to bedside.  

PubMed

Transfusion-related acute lung injury (TRALI) is a major cause of transfusion-related mortality. Causative factors are divided in antibody mediated TRALI and non-antibody mediated TRALI. Antibody mediated TRALI is caused by passive transfusion of cognate antibodies and non-antibody mediated TRALI is caused by transfusion of aged cellular blood products. This review focuses on mechanisms in non-antibody mediated TRALI which includes soluble mediators accumulating during storage of red blood cells (RBCs) and platelets (PLTs), as well as changes in morphology and function of aged PLTs and RBCs. These mediators cause TRALI in two-hit animal models and have been implicated in TRALI onset in clinical studies. Pre-clinical studies show a clear relation between TRALI and increased storage time of cellular blood products. Observational clinical studies however report conflicting data. Knowledge of pathophysiological mechanisms of TRALI is necessary to improve storage conditions of blood products, develop prevention strategies and develop a therapy for TRALI. PMID:25277811

Peters, Anna L; van Hezel, Maike E; Juffermans, Nicole P; Vlaar, Alexander P J

2014-09-20

28

Blood transfusion products contain mitochondrial DNA damage-associated molecular patterns: a potential effector of transfusion-related acute lung injury  

PubMed Central

Background Transfusion-related acute lung injury (TRALI) is the most frequent and severe complication in patients receiving multiple blood transfusions. Current pathogenic concepts hold that proinflammatory mediators present in transfused blood products are responsible for the initiation of TRALI, but the identity of the critical effector molecules is yet to be determined. We hypothesize that mtDNA damage-associated molecular patterns (DAMPs) are present in blood transfusion products, which may be important in the initiation of TRALI. Methods: DNA was extracted from consecutive samples of packed red blood cells, fresh frozen plasma (FFP), and platelets procured from the local blood bank. Quantitative realtime polymerase chain reaction was used to quantify ? 200 bp sequences from the COX1, ND1, ND6, and D-loop regions of the mitochondrial genome. Results A range of mtDNA DAMPs were detected in all blood components measured, with FFP displaying the largest variation. Conclusions We conclude that mtDNA DAMPs are present in packed red blood cells, FFP, and platelets. These observations provide proof of the concept that mtDNA DAMPs may be mediators of TRALI. Further studies are needed to test this hypothesis and to determine the origin of mtDNA DAMPs in transfused blood. PMID:25039013

Lee, Yann-Leei; King, Madelyn B.; Gonzalez, Richard P.; Brevard, Sidney B.; Frotan, M. Amin; Gillespie, Mark N.; Simmons, Jon D.

2015-01-01

29

Suspected Transfusion Related Acute Lung Injury Improving following Administration of Tranexamic Acid: A Case Report  

PubMed Central

A 16-year-old woman with craniofacial injury developed severe acute respiratory failure under the primary reconstructive surgical procedure requiring several units of blood and plasma. A transfusion related acute lung injury (TRALI) was suspected and supportive treatment was initiated. Because of the severity of symptoms, acute extracorporeal membrane oxygenation (ECMO) was planned. During preparation for ECMO, a single intravenous dose, 1?g of tranexamic acid, was administered and a remarkable improvement was observed shortly thereafter. The patient was placed on ECMO for 16 hours. The further course was uncomplicated and the patient was discharged from ICU on the 6th day after admission fully and she recovered. A clinical improvement was observed in a timely fashion following the administration of tranexamic acid. The handling of a suspected TRALI and potential benefit from administration of tranexamic acid are discussed in this case report. PMID:24995132

Ryniak, Stan; Harbut, Piotr; Östlund, Anders; Jakobsson, Jan G.

2014-01-01

30

Transfusion-related acute lung injury in the Canadian paediatric population  

PubMed Central

BACKGROUND: The incidence of transfusion-related acute lung injury (TRALI) in adults is approximately one per 5000 transfusions. The Canadian Paediatric Surveillance Program undertook the present study to determine the incidence of TRALI in the paediatric population and to describe the characteristics and outcomes of children with TRALI. METHODS: The present surveillance study was conducted over a three-year period. RESULTS: Four TRALI cases were reported, yielding an incidence rate of 1.8 per 100,000 transfusions. The degree of severity varied: in two patients, only supplemental oxygen was necessary, while the other two required mechanical ventilation. CONCLUSION: TRALI was reported much less often in the present study compared with adult studies; therefore, it needs to be determined whether TRALI occurs less frequently in children, or alternatively, whether TRALI is recognized less often in children. The possibility that neonates who undergo cardiac surgery are at greater risk of TRALI than other patients should be addressed in future studies. PMID:23633895

Gauvin, France; Robillard, Pierre; Hume, Heather; Grenier, Danielle; Whyte, Robin K; Webert, Kathryn E; Fergusson, Dean; Lau, Wendy; Froese, Norbert; Delage, Gilles

2012-01-01

31

Acute hemolytic anemia, methemoglobinemia, and heinz body formation associated with ingestion of red maple leaves by horses.  

PubMed

From June 1975 through June 1979, acute hemolytic anemia developed in 11 horses from 7 New York farms. Of the 7 horses that died, 6 had methemoglobinemia. In the 4 horses that recovered, methemoglobinemia was not observed. but Heinz body formation was seen in 3 of the 4. On 2 of the premises involved, frank methemoglobinemia was observed concurrently with Heinz body formation, suggesting a relationship between the pathogenesis of methemoglobinemia and Heinz body formation in the hemolytic process. In addition to the 11 cases described, 22 clinically similar cases were reported to us during the period of this investigation by practicing veterinarians from New York, Pennsylvania, and the New England states. All 33 cases of hemolytic anemia occurred between June and October of each year, and affected horses had access to outside paddocks or fields containing a variety of native grasses, weeds, and trees. On 2 farms, hemolytic anemia developed after the horses were observed browsing fallen branches of red maple trees (Acer rubrum). Red maple leaves and bark were obtained from 1 of these farms, and approximately 1 kg of a leaf and bark mixture was fed to each of 2 ponies. Within 48 hours, both ponies became ill. The syndrome was indistinguishable from that observed in clinical patients and was characterized by methemoglobinemia and intravascular hemolysis. The ponies died 5 and 6 days after which time the packed cell volumes were 6% and 7% respectively. It was concluded that many cases of hemolytic anemia in horses in northeastern states may be related to ingestion of leaves or bark from red maple trees. The studies did not, however, define the factors that predispose to poisoning and did not exclude the possibility that other environmental toxins may have been involved. PMID:7263466

Tennant, B; Dill, S G; Glickman, L T; Mirro, E J; King, J M; Polak, D M; Smith, M C; Kradel, D C

1981-07-15

32

Hemolytic Anemia  

MedlinePLUS

... from the NHLBI on Twitter. What Is Hemolytic Anemia? Hemolytic anemia (HEE-moh-lit-ick uh-NEE-me-uh) ... blood cells to replace them. However, in hemolytic anemia, the bone marrow can't make red blood ...

33

[Acute respiratory distress syndrome complicating an acute chest syndrome: potential benefit of early combination of exchange transfusion and prone positioning].  

PubMed

We report the case of an 8-year-old sickle cell anemia child admitted for acute respiratory failure complicating acute chest syndrome. Because of threatening respiratory failure, tracheal intubation was performed immediately after ICU admission. The patient met the criteria for ARDS with a PaO2/FiO2 ratio of 94mmHg. An exchange transfusion was performed immediately after admission. HbS fraction failed from 69 % to 30 %. Fluid resuscitation with crystalloids and continuous norepinephrine infusion was needed because of arterial hypotension. Due to persistent severe hypoxemia with PaO2/FiO2 ratio below 100, the patient was placed in prone positioning 16hours after admission, for a total duration of 14hours. A second 12-hour session of prone positioning was performed 41h after admission and PaO2/FiO2 ratio reached 300mmHg after. Treatment also included transfusion of two red-cell pack on day 1 and 2 after admission in order to maintain hemoglobin level above 8g/dL, and a daily folic acid supplementation. The control of hyperthermia was achieved by a systematic parenteral administration of paracetamol. Cefotaxime and erythromycine were continued until day 7 despite the negative results of all bacteriological samples. The outcome was favorable from day 3 and the patient met the criteria for extubation on day 5. A first attempt of extubation was performed on day 5, but re-intubation was required because of laryngeal edema. Steroids were given for 48h and the patient was successfully extubated on day 7. She was discharged from the ICU on day 8, and from the hospital on day 12. We discuss the various treatments available for the management of acute chest syndrome and their actual relevance in acute respiratory distress syndrome in the absence of strong evidence-based guidelines in pediatric ARDS. PMID:25458459

Dusacre, J-A; Pons, B; Piednoir, P; Soubirou, J-F; Thiery, G

2014-12-01

34

Transfusion Medicine and Immunohematology  

Microsoft Academic Search

Blood transfusion is essential and vital in the successful treatment of many malignant and nonmalignant hematological disorders.\\u000a Children with thalassemia, adults with myelodysplastic syndromes, and patients with autoimmune hemolytic anemias, leukemias,\\u000a or aplastic anemias become chronically dependent on blood transfusions. Modern treatment procedures such as high-dose chemotherapy\\u000a and progenitor cell transplantation require intensive support with blood components and products. The

Grace C. Tenorio; Snehalata C. Gupte; Reinhold Munker

35

Acute liver function decompensation in a patient with sickle cell disease managed with exchange transfusion and endoscopic retrograde cholangiography.  

PubMed

Sickle cell intrahepatic cholestasis is a relatively uncommon complication of homozygous sickle cell anemia, which may lead to acute hepatic failure and death. Treatment is mainly supportive, but exchange transfusion is used as salvage therapy in life threatening situations. We describe a case of a 16-year-old female with homozygous sickle cell anemia who presented to the emergency room with fatigue, malaise, dark urine, lower back pain, scleral icterus and jaundice. She was found to have marked hyperbilirubinemia, which persisted after exchange transfusion. Because of the concomitant presence of gallstones and choledocholithiasis, the patient underwent endoscopic ultrasound and laparoscopic cholecystectomy followed by endoscopic retrograde cholangiography and sphincterotomy. PMID:25177368

Papafragkakis, Haris; Ona, Mel A; Changela, Kinesh; Sadanandan, Swayamprabha; Jelin, Abraham; Anand, Sury; Duddempudi, Sushil

2014-09-01

36

Acute liver function decompensation in a patient with sickle cell disease managed with exchange transfusion and endoscopic retrograde cholangiography  

PubMed Central

Sickle cell intrahepatic cholestasis is a relatively uncommon complication of homozygous sickle cell anemia, which may lead to acute hepatic failure and death. Treatment is mainly supportive, but exchange transfusion is used as salvage therapy in life threatening situations. We describe a case of a 16-year-old female with homozygous sickle cell anemia who presented to the emergency room with fatigue, malaise, dark urine, lower back pain, scleral icterus and jaundice. She was found to have marked hyperbilirubinemia, which persisted after exchange transfusion. Because of the concomitant presence of gallstones and choledocholithiasis, the patient underwent endoscopic ultrasound and laparoscopic cholecystectomy followed by endoscopic retrograde cholangiography and sphincterotomy. PMID:25177368

Ona, Mel A.; Changela, Kinesh; Sadanandan, Swayamprabha; Jelin, Abraham; Anand, Sury; Duddempudi, Sushil

2014-01-01

37

Acute Renal Replacement Therapy in Children with Diarrhea-Associated Hemolytic Uremic Syndrome: A Single Center 16 Years of Experience  

PubMed Central

Acute kidney injury (AKI) is becoming more prevalent among hospitalized children, its etiologies are shifting, and new treatment modalities are evolving; however, diarrhea-associated hemolytic uremic syndrome (D+HUS) remains the most common primary disease causing AKI in young children. Little has been published about acute renal replacement therapy (ARRT) and its challenges in this population. We describe our single center's experience managing 134 pediatric patients with D+HUS out of whom 58 (43%) required ARRT over the past 16 years. In our cohort, all but one patient were started on peritoneal dialysis (PD). Most patients, 47 (81%), received acute PD on a pediatric inpatient ward. The most common recorded complications in our cohort were peritoneal fluid leaks 13 (22%), peritonitis 11 (20%), and catheter malfunction 5 (9%). Nine patients (16%) needed surgical revision of their PD catheters. There were no bleeding events related to PD despite a mean platelets count of 40.9 (±23.5)?×?103/mm3 and rare use of platelets infusions. Despite its methodological limitations, this paper adds to the limited body of evidence supporting the use of acute PD as the primary ARRT modality in children with D+HUS. PMID:21716936

Grisaru, Silviu; Morgunov, Melissa A.; Samuel, Susan M.; Midgley, Julian P.; Wade, Andrew W.; Tee, James B.; Hamiwka, Lorraine A.

2011-01-01

38

Hemolytic anemia  

MedlinePLUS

Jager U, Lechner K. Autoimmune hemolytic anemia. In: Hoffman R, Benz EJ Jr, Silberstein LE, et al., ... Price EA, Schrier SS. Extrinsic nonimmune hemolytic anemias. In: Hoffman R, Benz EJ Jr, Silberstein LE, et al., ...

39

[Immunological safety of transfusion].  

PubMed

Transfusion safety lies on the strict application of measures aimed: at avoiding the occurrence of acute hazards, as far as they can be prevented by e.g. the ABO compatibility for red blood cell concentrates and therapeutic plasma; at reducing the frequency of other acute accidents such as TRALI or post-transfusion GVH (based on the implementation of measures which prove to be largely efficacious though not completely); and at reducing delayed incidents and hazards. The implementation of such immunological safety measures also aim at favoring the transfusion efficacy, in avoiding the lysis of transfused red cells or platelets. Perfect immunological compatibility (match) is impossible because transfused cells expose several hundreds of molecular variants with antigenic properties. Adaptive immunity is largely based upon antigen/antibody conflicts and it predominates in transfusion immunological hazards, but inflammation (as well as other components of innate immunity) is now acknowledged as a major actor of transfusion immunological linked hazards. PMID:25578545

Muller, Jean-Yves; Chiaroni, Jacques; Garraud, Olivier

2015-02-01

40

Transfusion of polarized TH2-like cell populations into SCID mouse cardiac allograft recipients results in acute allograft rejection.  

PubMed

It has been hypothesized that TH1 cells mediate the archetypical cell-mediated immune response of acute allograft rejection, whereas TH2 cells promote allograft acceptance. To test this, we transfused SCID cardiac allograft recipients with polarized TH1-like or TH2-like graft-reactive T cells, and monitored graft function and graft-reactive immune responses in the graft recipients. Polarized THl-like cells, which were generated in vitro by stimulating syngeneic splenocytes with donor alloantigens in the presence of anti-IL-4 mAb, produced IFNg but not IL-4 when restimulated with donor alloantigen. Polarized TH2-like populations, which are generated in vitro by stimulating syngeneic splenocytes with donor alloantigens in the presence of IL-4, produced IL-4 but not IFNg when restimulated with donor alloantigen. Interestingly, bioassays of culture SN from restimulated TH1 but not TH2 cells revealed IL-2 production, although LDA analyses revealed that the TH1 and TH2 cells had identical frequencies of IL-2-producing cells. Transfusion of THl-like cells into SCID cardiac allograft recipients resulted in acute rejection within 7-10 days that was characterized by cellular infiltration, myocyte necrosis, and edema. Graft-infiltrating cells (GIC) recovered from TH1-transfused animals contained large numbers of graft-reactive IL-2-producing cells (68-269/10(6) GIC), but no LDA-detectable IL-4-producing cells. These data support the hypothesis that donor-reactive TH1 cells can promote acute allograft rejection. In contrast to the hypothesis, transfusion of the polarized TH2-like population into SCID cardiac allograft recipients also resulted in histologically similar acute rejection within 7-10 days. Infiltrating cells recovered from TH1-transfused allografts contained large numbers of graft-reactive (109-1458/10(6) GIC), LDA-detectable, IL-4-producing cells--indicating that the TH2 cells had arrived at the graft-but promoted acute allograft rejection rather than allograft acceptance. PMID:8755821

VanBuskirk, A M; Wakely, M E; Orosz, C G

1996-07-27

41

Transfusion-related acute lung injury (TRALI) during remission induction course of acute myeloid leukemia: a possible role for all-transretinoic-acid (ATRA)?  

PubMed

Transfusion-related acute lung injury (TRALI) is a clinical syndrome characterized by sudden onset of respiratory distress due to pulmonary edema during or following transfusion. Two proposed pathophysiologic mechanisms for TRALI were proposed: the antibody hypothesis and the two-event hypothesis. The two-event hypothesis postulates that a pathway to neutrophil activation and aggregation can occur without leukocyte antibodies. We report a case of TRALI occurring during remission induction course of acute myeloid leukemia in a 27-year-old woman who received All-transretinoic-acid (ATRA). We postulate that ATRA may have played a role in this life-threatening complication by priming neutrophil and enhancing their adherence and their activation in the pulmonary endothelium. TRALI improved with non-invasive ventilation support and use of high dose corticosteroids. PMID:18823719

Jeddi, R; Mansouri, R; Kacem, K; Gouider, E; Abid, H B; Belhadjali, Z; Meddeb, B

2009-09-01

42

Role of Riboflavin- and UV Light-Treated Plasma in Prevention of Transfusion-Related Acute Lung Injury  

PubMed Central

Summary Introduction Risk reduction strategies for transfusion-related acute lung injury (TRALI) include the preferential use of male donors to provide fresh frozen plasma (FFP). Implementing this measure based on FFP quarantine program is a very complex process. To improve FFP inventory management and the availability of FFP from male donors, the Mirasol Pathogen Reduction Technology® (PRT) system for FFP using riboflavin and UV light was adopted in our region in 2012. Methods The percentage of male/female FFP units issued and TRALI cases in patients receiving FFP in the period before implementing riboflavin and UV light (2010–2011) was compared with the period post implementation of riboflavin and UV light (2012–2013). Results In 2010 and 2011, there was one FFP transfusion-related TRALI case reported per year, when the proportion of male/female FFP distributed to the hospitals was 60/40. During 2012 and 2013, there have been no FFP transfusion-related TRALI cases, when the proportion of male/female FFP distributed to the hospitals was around 97/3. Mirasol PRT allows quick availability (24 h from collection) compared to quarantined FFP (?3 months from collection). Conclusion Thanks to its readiness, simplicity and feasibility, riboflavin- and UV light-treated FFP implementation can facilitate the preferential use of FFP from male donors as a TRALI prevention strategy. PMID:25053929

Jimenez-Marco, Teresa; Ruiz-Alderton, Daniel; Bautista-Gili, Antonia M.; Girona-Llobera, Enrique

2014-01-01

43

Atypical Hemolytic Uremic Syndrome  

PubMed Central

Summary Hemolytic uremic syndrome (HUS) is a triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. The atypical form of HUS is a disease characterized by complement overactivation. Inherited defects in complement genes and acquired autoantibodies against complement regulatory proteins have been described. Incomplete penetrance of mutations in all predisposing genes is reported, suggesting that a precipitating event or trigger is required to unmask the complement regulatory deficiency. The underlying genetic defect predicts the prognosis both in native kidneys and after renal transplantation. The successful trials of the complement inhibitor eculizumab in the treatment of atypical HUS will revolutionize disease management. PMID:24161037

Kavanagh, David; Goodship, Tim H.; Richards, Anna

2013-01-01

44

Blood Transfusions  

MedlinePLUS

... United States get blood transfusions. A Bit About Blood Blood is like the body's transportation system, busy ... his or her body. Continue What Is a Blood Transfusion? A transfusion is a relatively simple medical ...

45

Acute hemolytic anemia induced by oral administration of indole in ponies.  

PubMed

Eight ponies were allotted to 2 groups of 4. Group-1 ponies (1-4) were given 0.2 g of indole/kg of body weight orally and group-2 ponies (5 to 8) were given 0.1 g of indole/kg. Various physical, hematologic, and physiologic measurements were obtained after administration of indole. Intravascular hemolysis and hemoglobinuria were detected in both groups within 24 hours of dosing. Hemolysis was reflected by decreases in PCV, hemoglobin concentration, and RBC count, and an increase in indirect bilirubin. Erythrocyte fragility appeared to increase in both groups at 8 hours after dosing and peaked at 16 hours after dosing. At 72 hours after dosing, the RBC fragility value was less than predose measurements. Heinz body formation was noticed in group-2 ponies, but not in group 1. Plasma indole concentrations increased in both groups from the nondetectable predose concentrations. Group-1 values were 203% of group-2 values. In group 2, plasma indole was nondetectable by 12 hours, whereas low concentrations could still be measured in the group-1 ponies at 24 hours. Ponies in group 1 died or were euthanatized between 24 and 72 hours after dosing, whereas group-2 ponies were euthanatized between 48 and 120 hours. At necropsy, all body fat, mucous membranes, and elastic tissue were stained yellow. Hemoglobinuric nephrosis was the most prominent microscopic lesion. Results of this study indicated that indole, a metabolite of the amino acid tryptophan, causes acute intravascular hemolysis in ponies. PMID:1854101

Paradis, M R; Breeze, R G; Laegreid, W W; Bayly, W M; Counts, D F

1991-05-01

46

A Jehovah's Witness with Acute Myeloid Leukemia Successfully Treated with an Epigenetic Drug, Azacitidine: A Clue for Development of Anti-AML Therapy Requiring Minimum Blood Transfusions  

PubMed Central

Therapy for acute leukemia in Jehovah's Witnesses patients is very challenging because of their refusal to accept blood transfusions, a fundamental supportive therapy for this disease. These patients are often denied treatment for fear of treatment-related death. We present the first Jehovah's Witness patient with acute myeloid leukemia (AML) treated successfully with azacitidine. After achieving complete remission (CR) with one course of azacitidine therapy, the patient received conventional postremission chemotherapy and remained in CR. In the case of patients who accept blood transfusions, there are reports indicating the treatment of AML patients with azacitidine. In these reports, azacitidine therapy was less toxic, including hematoxicity, compared with conventional chemotherapy. The CR rate in azacitidine-treated patients was inadequate; however, some characteristics could be useful in predicting azacitidine responders. The present case is useful for treating Jehovah's Witnesses patients with AML and provides a clue for anti-AML therapy requiring minimum blood transfusions. PMID:25371835

Yamamoto, Yumi; Kawashima, Akihito; Kashiwagi, Eri

2014-01-01

47

A Computerized Prediction Model of Hazardous Inflammatory Platelet Transfusion Outcomes  

PubMed Central

Background Platelet component (PC) transfusion leads occasionally to inflammatory hazards. Certain BRMs that are secreted by the platelets themselves during storage may have some responsibility. Methodology/Principal Findings First, we identified non-stochastic arrangements of platelet-secreted BRMs in platelet components that led to acute transfusion reactions (ATRs). These data provide formal clinical evidence that platelets generate secretion profiles under both sterile activation and pathological conditions. We next aimed to predict the risk of hazardous outcomes by establishing statistical models based on the associations of BRMs within the incriminated platelet components and using decision trees. We investigated a large (n?=?65) series of ATRs after platelet component transfusions reported through a very homogenous system at one university hospital. Herein, we used a combination of clinical observations, ex vivo and in vitro investigations, and mathematical modeling systems. We calculated the statistical association of a large variety (n?=?17) of cytokines, chemokines, and physiologically likely factors with acute inflammatory potential in patients presenting with severe hazards. We then generated an accident prediction model that proved to be dependent on the level (amount) of a given cytokine-like platelet product within the indicated component, e.g., soluble CD40-ligand (>289.5 pg/109 platelets), or the presence of another secreted factor (IL-13, >0). We further modeled the risk of the patient presenting either a febrile non-hemolytic transfusion reaction or an atypical allergic transfusion reaction, depending on the amount of the chemokine MIP-1? (<20.4 or >20.4 pg/109 platelets, respectively). Conclusions/Significance This allows the modeling of a policy of risk prevention for severe inflammatory outcomes in PC transfusion. PMID:24830754

Nguyen, Kim Anh; Hamzeh-Cognasse, Hind; Sebban, Marc; Fromont, Elisa; Chavarin, Patricia; Absi, Lena; Pozzetto, Bruno; Cognasse, Fabrice; Garraud, Olivier

2014-01-01

48

Phase II trial of standard versus increased transfusion volume in Ugandan children with acute severe anemia  

PubMed Central

Background Severe anemia (SA, hemoglobin <6 g/dl) is a leading cause of pediatric hospital admission in Africa, with significant in-hospital mortality. The underlying etiology is often infectious, but specific pathogens are rarely identified. Guidelines developed to encourage rational blood use recommend a standard volume of whole blood (20 ml/kg) for transfusion, but this is commonly associated with a frequent need for repeat transfusion and poor outcome. Evidence is lacking on what hemoglobin threshold criteria for intervention and volume are associated with the optimal survival outcomes. Methods We evaluated the safety and efficacy of a higher volume of whole blood (30 ml/kg; Tx30: n?=?78) against the standard volume (20 ml/kg; Tx20: n?=?82) in Ugandan children (median age 36 months (interquartile range (IQR) 13 to 53)) for 24-hour anemia correction (hemoglobin >6 g/dl: primary outcome) and 28-day survival. Results Median admission hemoglobin was 4.2 g/dl (IQR 3.1 to 4.9). Initial volume received followed the randomization strategy in 155 (97%) patients. By 24-hours, 70 (90%) children in the Tx30 arm had corrected SA compared to 61 (74%) in the Tx20 arm; cause-specific hazard ratio?=?1.54 (95% confidence interval 1.09 to 2.18, P?=?0.01). From admission to day 28 there was a greater hemoglobin increase from enrollment in Tx30 (global P <0.0001). Serious adverse events included one non-fatal allergic reaction and one death in the Tx30 arm. There were six deaths in the Tx20 arm (P?=?0.12); three deaths were adjudicated as possibly related to transfusion, but none secondary to volume overload. Conclusion A higher initial transfusion volume prescribed at hospital admission was safe and resulted in an accelerated hematological recovery in Ugandan children with SA. Future testing in a large, pragmatic clinical trial to establish the effect on short and longer-term survival is warranted. Trial registration ClinicalTrials.Gov identifier: NCT01461590 registered 26 October 2011. Please see related commentary article http://www.biomedcentral.com/1741-7015/12/68/abstract. PMID:24767094

2014-01-01

49

Hemolytic anemia after methylene blue therapy for aniline-induced methemoglobinemia.  

PubMed

Methylene blue is utilized as the main treatment of methemoglobinemia conventionally, but it may be ineffective in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency. We report a G6PD-deficient patient who suffered from aniline-induced methemoglobinemia with initial good response Heinz body but hemolytic anemia appeared later 3 d after methylene blue therapy. G6PD deficiency was identified. He recovered uneventfully with hydration, packed blood transfusion and adjuvant luvela-N(dl-alpha-tocopheryl nicotinate) medication. Caution should be taken in using methylene blue as antidote of acute methemoglobinemia, especially when a history of G6PD deficiency is obscure. PMID:11824767

Liao, Yao-Pan; Hung, Dong-Zong; Yang, Dar-Yu

2002-02-01

50

Characterization of Transfusion-Elicited Acute Antibody-Mediated Rejection in a Rat Model of Kidney Transplantation  

PubMed Central

Animal models of antibody-mediated rejection (ABMR) may provide important evidence supporting proof of concept. We elicited donor-specific antibodies (DSA) by transfusion of donor blood (Brown Norway RT1n) into a complete mismatch recipient (Lewis RT1l) 3 weeks prior to kidney transplantation. Sensitized recipients had increased anti-donor splenocyte IgG1, IgG2b and IgG2c DSA 1 week after transplantation. Histopathology was consistent with ABMR characterized by diffuse peritubular capillary C4d and moderate microvascular inflammation with peritubular capillaritis + glomerulitis > 2. Immunofluorescence studies of kidney allograft tissue demonstrated a greater CD68/CD3 ratio in sensitized animals, primarily of the M1 (pro-inflammatory) phenotype, consistent with cytokine gene analyses that demonstrated a predominant T helper (TH)1 (interferon-?, IL-2) profile. Immunoblot analyses confirmed the activation of the M1 macrophage phenotype as interferon regulatory factor 5, inducible nitric oxide synthase and phagocytic NADPH oxidase 2 were significantly up-regulated. Clinical biopsy samples in sensitized patients with acute ABMR confirmed the dominance of M1 macrophage phenotype in humans. Despite the absence of tubulitis, we were unable to exclude the effects of T cell–mediated rejection. These studies suggest that M1 macrophages and TH1 cytokines play an important role in the pathogenesis of acute mixed rejection in sensitized allograft recipients. PMID:24708533

Huang, G.; Wilson, N. A.; Reese, S. R.; Jacobson, L. M.; Zhong, W.; Djamali, A.

2015-01-01

51

Management of non-transfusion-dependent thalassemia: a practical guide.  

PubMed

Despite their transfusion-independence, non-transfusion-dependent thalassemia (NTDT) patients experience a variety of serious clinical complications that require prompt and comprehensive management. Transfusion therapy may still be an important part of management of this disease, in cases of acute stress, to support growth and development in childhood, or to prevent clinical morbidities stemming from ineffective erythropoiesis or hemolytic anemia. Although splenectomy is associated with improvements in hemoglobin levels, it leads to several short- and long-term adverse events, warranting caution in application of this intervention. Fetal hemoglobin induction therapy has been evaluated in non-randomized studies, with benefits extending beyond hematologic improvements to lowering morbidity risk. Effective and safe iron chelation therapy is now available for NTDT patients in whom iron overload develops, irrespective of transfusions, due to increased intestinal absorption, ultimately leading to clinically high iron burden levels and subsequent morbidity. Optimal management of NTDT patients requires a holistic approach targeting all hallmarks of the disease to ensure favorable patient outcomes. PMID:25255924

Taher, Ali T; Cappellini, Maria Domenica

2014-10-01

52

Red blood cell alloimmunization in sickle cell disease: pathophysiology, risk factors, and transfusion management  

PubMed Central

Red blood cell transfusions have reduced morbidity and mortality for patients with sickle cell disease. Transfusions can lead to erythrocyte alloimmunization, however, with serious complications for the patient including life-threatening delayed hemolytic transfusion reactions and difficulty in finding compatible units, which can cause transfusion delays. In this review, we discuss the risk factors associated with alloimmunization with emphasis on possible mechanisms that can trigger delayed hemolytic transfusion reactions in sickle cell disease, and we describe the challenges in transfusion management of these patients, including opportunities and emerging approaches for minimizing this life-threatening complication. PMID:22563085

Ware, Russell E.

2012-01-01

53

Blood Transfusion  

MedlinePLUS

... from the NHLBI on Twitter. What Is a Blood Transfusion? A blood transfusion is a safe, common ... Very rarely, serious problems develop. Important Information About Blood The heart pumps blood through a network of ...

54

Transfusion practices in trauma  

PubMed Central

Resuscitation of a severely traumatised patient with the administration of crystalloids, or colloids along with blood products is a common transfusion practice in trauma patients. The determination of this review article is to update on current transfusion practices in trauma. A search of PubMed, Google Scholar, and bibliographies of published studies were conducted using a combination of key-words. Recent articles addressing the transfusion practises in trauma from 2000 to 2014 were identified and reviewed. Trauma induced consumption and dilution of clotting factors, acidosis and hypothermia in a severely injured patient commonly causes trauma-induced coagulopathy. Early infusion of blood products and early control of bleeding decreases trauma-induced coagulopathy. Hypothermia and dilutional coagulopathy are associated with infusion of large volumes of crystalloids. Hence, the predominant focus is on damage control resuscitation, which is a combination of permissive hypotension, haemorrhage control and haemostatic resuscitation. Massive transfusion protocols improve survival in severely injured patients. Early recognition that the patient will need massive blood transfusion will limit the use of crystalloids. Initially during resuscitation, fresh frozen plasma, packed red blood cells (PRBCs) and platelets should be transfused in the ratio of 1:1:1 in severely injured patients. Fresh whole blood can be an alternative in patients who need a transfusion of 1:1:1 thawed plasma, PRBCs and platelets. Close monitoring of bleeding and point of care coagulation tests are employed, to allow goal-directed plasma, PRBCs and platelets transfusions, in order to decrease the risk of transfusion-related acute lung injury. PMID:25535424

Ramakrishnan, V Trichur; Cattamanchi, Srihari

2014-01-01

55

Red cell transfusion and the immune system.  

PubMed

Understanding the complex immunological consequences of red cell transfusion is essential if we are to use this valuable resource wisely and safely. The decision to transfuse red cells should be made after serious considerations of the associated risks and benefits. Immunological risks of transfusion include major incompatibility reactions and transfusion-related acute lung injury, while other immunological insults such as transfusion-related immunomodulation are relatively underappreciated. Red cell transfusions should be acknowledged as immunological exposures, with consequences weighed against expected benefits. This article reviews immunological consequences and the emerging evidence that may inform risk-benefit considerations in clinical practice. PMID:25440393

Hart, S; Cserti-Gazdewich, C N; McCluskey, S A

2015-01-01

56

Massive Transfusion  

Microsoft Academic Search

\\u000a Massive transfusion is commonly defined as transfusion approximating or exceeding the patient’s blood volume within a 24-h\\u000a period (1). In the adult male who weighs 70 kg, this translates to an estimated replacement of 4–5 L of blood, or transfusion of 16–20\\u000a U of packed red blood cells (RBCs). These estimates are generally helpful only after the fact in classifying

Richard K. Spence

57

Platelet transfusions.  

PubMed Central

Platelets play a pivotal role in hemostasis by forming the initial hemostatic plug and augmenting the formation of the more permanent fibrin thrombus. Thrombocytopenia may lead to bleeding, which can be treated with therapeutic platelet transfusions or prevented with prophylactic transfusions. While many advances have been made in platelet transfusion technology, problems remain. These include the short storage life of liquid-stored platelets and the frequent development of alloantibodies (the refractory state) in patients receiving a number of transfusions. Significant progress, however, is being made in both areas. PMID:391376

Kelton, J G; Blajchman, M A

1979-01-01

58

MHC class I–specific antibody binding to nonhematopoietic cells drives complement activation to induce transfusion-related acute lung injury in mice  

PubMed Central

Transfusion-related acute lung injury (TRALI), a form of noncardiogenic pulmonary edema that develops during or within 6 h after a blood transfusion, is the most frequent cause of transfusion-associated death in the United States. Because development of TRALI is associated with donor antibodies (Abs) reactive with recipient major histocompatibility complex (MHC), a mouse model has been studied in which TRALI-like disease is caused by injecting mice with anti–MHC class I monoclonal Ab (mAb). Previous publications with this model have concluded that disease is caused by FcR-dependent activation of neutrophils and platelets, with production of reactive oxygen species that damage pulmonary vascular endothelium. In this study, we confirm the role of reactive oxygen species in the pathogenesis of this mouse model of TRALI and show ultrastructural evidence of pulmonary vascular injury within 5 min of anti–MHC class I mAb injection. However, we demonstrate that disease induction in this model involves macrophages rather than neutrophils or platelets, activation of complement and production of C5a rather than activation of Fc?RI, Fc?RIII, or Fc?RIV, and binding of anti–MHC class I mAb to non-BM–derived cells such as pulmonary vascular endothelium. These observations have important implications for the prevention and treatment of TRALI. PMID:22025304

Strait, Richard T.; Hicks, Wyenona; Barasa, Nathaniel; Mahler, Ashley; Khodoun, Marat; Köhl, Jörg; Stringer, Keith; Witte, David; Van Rooijen, Nico; Susskind, Brian M.

2011-01-01

59

Blood Transfusions  

MedlinePLUS

... marrow failure disease like aplastic anemia , MDS or PNH will receive at least one blood transfusion. When ... Finding a Trial More Information Paroxysmal Nocturnal Hemoglobinuria (PNH) Causes Symptoms Diagnosis Treatment Drug Information Androgens Folate ...

60

Antibody response to Shiga toxins in Argentinean children with enteropathic hemolytic uremic syndrome at acute and long-term follow-up periods.  

PubMed

Shiga toxin (Stx)-producing Escherichia coli (STEC) infection is associated with a broad spectrum of clinical manifestations that include diarrhea, hemorrhagic colitis, and hemolytic uremic syndrome (HUS). Systemic Stx toxemia is considered to be central to the genesis of HUS. Distinct methods have been used to evaluate anti-Stx response for immunodiagnostic or epidemiological analysis of HUS cases. The development of enzyme-linked immunosorbent assay (ELISA) and western blot (WB) assay to detect the presence of specific antibodies to Stx has introduced important advantages for serodiagnosis of HUS. However, application of these methods for seroepidemiological studies in Argentina has been limited. The aim of this work was to develop an ELISA to detect antibodies against the B subunit of Stx2, and a WB to evaluate antibodies against both subunits of Stx2 and Stx1, in order to analyze the pertinence and effectiveness of these techniques in the Argentinean population. We studied 72 normal healthy children (NHC) and 105 HUS patients of the urban pediatric population from the surrounding area of Buenos Aires city. Using the WB method we detected 67% of plasma from NHC reactive for Stx2, but only 8% for Stx1. These results are in agreement with the broad circulation of Stx2-expressing STEC in Argentina and the endemic behavior of HUS in this country. Moreover, the simultaneous evaluation by the two methods allowed us to differentiate acute HUS patients from NHC with a great specificity and accuracy, in order to confirm the HUS etiology when pathogenic bacteria were not isolated from stools. PMID:21559455

Fernández-Brando, Romina J; Bentancor, Leticia V; Mejías, María Pilar; Ramos, María Victoria; Exeni, Andrea; Exeni, Claudia; Laso, María del Carmen; Exeni, Ramón; Isturiz, Martín A; Palermo, Marina S

2011-01-01

61

Adverse events related to blood transfusion  

PubMed Central

The acute blood transfusion reactions are responsible for causing most serious adverse events. Awareness about various clinical features of acute and delayed transfusion reactions with an ability to assess the serious reactions on time can lead to a better prognosis. Evidence-based medicine has changed today's scenario of clinical practice to decrease adverse transfusion reactions. New evidence-based algorithms of transfusion and improved haemovigilance lead to avoidance of unnecessary transfusions perioperatively. The recognition of adverse events under anaesthesia is always challenging. The unnecessary blood transfusions can be avoided with better blood conservation techniques during surgery and with anaesthesia techniques that reduce blood loss. Better and newer blood screening methods have decreased the infectious complications to almost negligible levels. With universal leukoreduction of red blood cells (RBCs), selection of potential donors such as use of male donors only plasma and restriction of RBC storage, most of the non-infectious complications can be avoided. PMID:25535415

Sahu, Sandeep; Hemlata; Verma, Anupam

2014-01-01

62

Immune hemolytic anemia  

MedlinePLUS

... be caused by: Complication of another disease Past blood transfusions Pregnancy (if the baby's blood type is different ... cyclophosphamide (Cytoxan), and rituximab (Rituxan) have been used. Blood transfusions are given with caution, because the blood may ...

63

Group A Hemolytic Streptococcal Osteomyelitis in Children  

Microsoft Academic Search

Objective Little attention has been given to acute hematogenous osteomyelitis (AHO) caused by group A -hemolytic Streptococcus (GABHS), although up to 10% of cases are caused by this microorganism. The objective of this study was to define the clinical and laboratory characteristics of AHO caused by GABHS. Methods. Between January 1983 and June 1999, 29 patients were treated at Children's

Ekopimo O. Ibia; Menfo Imoisili; Andreas Pikis

2010-01-01

64

Transfusion medicine  

SciTech Connect

These proceedings contain 24 selections, including papers presented at the conference of American Red Cross held in May 1985, on the Subject of transfusion medicine. Some of the titles are: Fluosol/sup R/-DA in Radiation Therapy; Expression of Cloned Human Factor VIII and the Molecular Basis of Gene Defects that Cause Hemophilia; DNA-Probing Assay in the Detection of Hepatitis B Virus Genome in Human Peripheral Blood Cells; and Monoclonal Antibodies: Convergence of Technology and Application.

Murawski, K.; Peetoom, F.

1986-01-01

65

Blood Transfusion and Donation  

MedlinePLUS

... people in the United States receive life-saving blood transfusions. During a transfusion, you receive whole blood or ... have liver failure or a severe infection. Most blood transfusions go very smoothly. Some infectious agents, such as ...

66

Massive transfusion and massive transfusion protocol  

PubMed Central

Haemorrhage remains a major cause of potentially preventable deaths. Rapid transfusion of large volumes of blood products is required in patients with haemorrhagic shock which may lead to a unique set of complications. Recently, protocol based management of these patients using massive transfusion protocol have shown improved outcomes. This section discusses in detail both management and complications of massive blood transfusion.

Patil, Vijaya; Shetmahajan, Madhavi

2014-01-01

67

Serious Hazards of Transfusion (SHOT) haemovigilance and progress is improving transfusion safety  

PubMed Central

Summary The Serious Hazards of Transfusion (SHOT) UK confidential haemovigilance reporting scheme began in 1996. Over the 16 years of reporting, the evidence gathered has prompted changes in transfusion practice from the selection and management of donors to changes in hospital practice, particularly better education and training. However, half or more reports relate to errors in the transfusion process despite the introduction of several measures to improve practice. Transfusion in the UK is very safe: 2·9 million components were issued in 2012, and very few deaths are related to transfusion. The risk of death from transfusion as estimated from SHOT data in 2012 is 1 in 322 580 components issued and for major morbidity, 1 in 21 413 components issued; the risk of transfusion-transmitted infection is much lower. Acute transfusion reactions and transfusion-associated circulatory overload carry the highest risk for morbidity and death. The high rate of participation in SHOT by National Health Service organizations, 99·5%, is encouraging. Despite the very useful information gained about transfusion reactions, the main risks remain human factors. The recommendations on reduction of errors through a ‘back to basics’ approach from the first annual SHOT report remain absolutely relevant today. PMID:24032719

Bolton-Maggs, Paula H B; Cohen, Hannah

2013-01-01

68

Staff Responsibilities Flowchart for reporting a Transfusion Reaction  

E-print Network

Each blood product transfused carries a small risk of an acute or late adverse event. The most common immediate adverse reactions are fever, chills and urticaria. The most potentially significant reactions include acute and delayed haemolytic transfusion reactions, febrile non-haemolytic transfusion reaction, bacterial contamination of blood products, anaphylaxis and Transfusion Related Acute Lung Injury (TRALI). Transfusion reaction can be fatal, so it is important these incidents are recognised promptly and managed appropriately. Acute transfusion reaction can occur up to 24 hours following administration of the blood product. Delayed transfusion reactions occur days or even weeks following the transfusion. All significant adverse events should be reported immediately to the Blood Bank Transfusion Medicine Unit (TMU) and Consultant Haematologist for advice on immediate management and investigation. All cases will also be reviewed by the Hospital Transfusion Committee and reported to the supplier (ARCBS or CSL) when appropriate. Remember, report any adverse events immediately. If the cause is product related other patients may be at risk from components manufactured from the same blood donation.

Blood Transfusion

69

Red blood cell transfusion in newborn infants.  

PubMed

Red blood cell transfusion is an important and frequent component of neonatal intensive care. The present position statement addresses the methods and indications for red blood cell transfusion of the newborn, based on a review of the current literature. The most frequent indications for blood transfusion in the newborn are the acute treatment of perinatal hemorrhagic shock and the recurrent correction of anemia of prematurity. Perinatal hemorrhagic shock requires immediate treatment with large quantities of red blood cells; the effects of massive transfusion on other blood components must be considered. Some guidelines are now available from clinical trials investigating transfusion in anemia of prematurity; however, considerable uncertainty remains. There is weak evidence that cognitive impairment may be more severe at follow-up in extremely low birth weight infants transfused at lower hemoglobin thresholds; therefore, these thresholds should be maintained by transfusion therapy. Although the risks of transfusion have declined considerably in recent years, they can be minimized further by carefully restricting neonatal blood sampling. PMID:24855419

Whyte, Robin K; Jefferies, Ann L

2014-04-01

70

HEMOLYTIC ANEMIA Erythrocytes premature  

E-print Network

9/16/2013 1 HEMOLYTIC ANEMIA Erythrocytes premature destruction SCHISTOCYTES & SPHEROCYTES · Gallstones · Dark or Red Urine · Symptoms of Anemia · Thinning of Cortical Bone · Extramedullary RBC Defects · Immunohemolytic Anemias #12;9/16/2013 3 INTRINSIC DEFECTS · Membrane Defects

71

Autoimmune hemolytic anemia caused by cold agglutinins in a young pregnant woman.  

PubMed

Autoimmune hemolytic anemia is a rare disorder. A 34-year old woman presented with thrombophlebitis after her first delivery, during puerperium. A high titer of cold agglutinins was found. Lymphomas, systemic lupus erythematosus, and tumors were excluded. She conceived again. Due to the anemia she had frequent blood transfusions and she delivered at 38 weeks of gestation. PMID:16854701

Batalias, Labros; Trakakis, Eftihios; Loghis, Costas; Salabasis, Costas; Simeonidis, George; Karanikolopoulos, Panagiotis; Kassanos, Demetrios; Salamalekis, Emmanuel

2006-04-01

72

Blood Transfusion (For Parents)  

MedlinePLUS

... and help put your child at ease. About Blood Transfusions Blood is like the body's transportation system. ... blood of the person receiving it. Continue Why Blood Transfusions Are Performed The three main reasons why ...

73

Purpuric eruption in a transfused neonate receiving phototherapy.  

PubMed

We describe the clinical and biochemical findings in a neonate requiring multiple blood transfusions and phototherapy for alloimmune hemolytic anemia and unconjugated hyperbilirubinemia, respectively. In this newborn, a severe photosensitivity reaction developed and laboratory testing revealed elevated serum and urine porphyrins at the time of the eruption. The cause of the transient porphyrinemia was likely multifactorial. Possible mechanisms include poor hepatic metabolism and reticulocyte hemolysis. However, the exact pathogenesis remains unclear at this time. PMID:25424225

By, Charya C; Owens, Alexandra; Wesson, Stanton K

2014-01-01

74

Hemolytic uremic syndrome associated with Clostridium difficile infection.  

PubMed

We report 3 cases of Clostridium difficile-associated hemolytic uremic syndrome (HUS) with biopsy proven renal thrombotic microangiopathy. Two patients with acute renal failure were kidney transplants recipients whereas the third patient developed renal failure in the native kidneys. The presentation was preceded by acute diarrhea and stool. Clostridium difficile toxin was detected in all the 3 patients. Stool studies were negative for Escherichia coli, Shigella dysenteriae and other enteric pathogens. The diagnosis of Clostridium difficile-associated hemolytic uremic syndrome was suspected due to presence of thrombocytopenia, microangiopathic hemolytic anemia and biopsy proven renal thrombotic microangiopathy without another clinically apparent cause. This case series suggest that Clostridium difficile infection may cause renal failure due to thrombotic microangiopathy (TMA) and should be considered in the differential diagnosis of diarrhea-associated HUS. PMID:23320969

Alvarado, Anthony S; Brodsky, Sergey V; Nadasdy, Tibor; Singh, Neeraj

2014-04-01

75

Hemolytic Anemia and Metabolic Acidosis: Think about Glutathione Synthetase Deficiency.  

PubMed

Glutathione synthetase deficiency (GSSD) is a rare disorder of glutathione metabolism with varying clinical severity. Patients may present with hemolytic anemia alone or together with acidosis and central nervous system impairment. Diagnosis is made by clinical presentation and detection of elevated concentrations of 5-oxoproline in urine and low glutathione synthetase activity in erythrocytes or cultured skin fibroblasts. The prognosis seems to depend on early diagnosis and treatment. We report a 4 months old Tunisian male infant who presented with severe metabolic acidosis with high anion gap and hemolytic anemia. High level of 5-oxoproline was detected in her urine and diagnosis of GSSD was made. Treatment consists of the correction of acidosis, blood transfusion, and supplementation with antioxidants. He died of severe metabolic acidosis and sepsis at the age of 15 months. PMID:25166299

Ameur, Salma Ben; Aloulou, Hajer; Nasrallah, Fehmi; Kamoun, Thouraya; Kaabachi, Naziha; Hachicha, Mongia

2015-02-01

76

Blood Transfusion-Induced Immunomodulation  

Microsoft Academic Search

lood transfusion therapy is associated with many risks, including major or minor blood transfusion reaction, non-A non-B hepatitis, hepatitis B, and HIV infection. Blood transfusion may result in immunologic changes (immunomodulation) that are beneficial in some patients but harmful in others. After reports of increased renal allograft sur- vival in patients receiving pretransplant transfusion (l), Gantt (2) questioned whether transfusion

Dennis F. Landers; Gary E. Hill; K. C. Wong; Ira J. Fox

1996-01-01

77

Management of hemolytic uremic syndrome  

PubMed Central

Hemolytic uremic syndrome (HUS) is a disease characterized by hemolysis, thrombocytopenia, and acute kidney injury, although other organs may be involved. Most cases are due to infection with Shiga toxin-producing Escherichia coli (STEC). Early identification and initiation of best supportive care, with microbiological input to identify the pathogen, result in a favorable outcome in most patients. The remaining 10% of HUS cases are classed together as atypical HUS and have a diverse etiology. The majority are due to inherited or acquired abnormalities that lead to a failure to control complement activation. Atypical HUS occurring in other situations (for example, related to pregnancy or kidney transplantation) may also involve excessive complement activation. Plasma therapies can reverse defective complement control, and it is now possible to specifically target complement activation. This has led to improved outcomes in patients with atypical forms of HUS. We will review our current understanding of the pathogenesis of HUS and how this has led to advances in patient care.

Kavanagh, David; Raman, Shreya

2014-01-01

78

Long-term follow-up of acute and chronic nonA, non-B post-transfusion hepatitis: evidence of progression to liver cirrhosis  

Microsoft Academic Search

The long-term outcome of non-A, non-B post-transfusion hepatitis was evaluated in 21 patients who developed the illness after open-heart surgery and could be followed thereafter up to five years. Histological chronic sequelae were documented in 13 patients, and consisted of chronic persistent hepatitis in one case, chronic lobular hepatitis in two and chronic active hepatitis in 10, five of whom

G Realdi; A Alberti; M Rugge; A M Rigoli; F Tremolada; L Schivazappa; A Ruol

1982-01-01

79

Survival of 59Fe-labeled erythrocytes in cross-transfused equine blood.  

PubMed

Whole blood containing 59Fe-labeled erythrocytes (RBC) and unlabeled serum was transfused from a donor horse on 2 occasions into each of 6 recipient horses. Survival of transfused cells was monitored in the recipients as a function of time after transfusion by measuring RBC radioactivity in the recipients. After the 1st transfusion, RBC concentration of 59Fe remained at 60% to 100% of the transfused dose for 4 days, after which radioactivity values dropped to less than 10% of the dose by 6 days in 3 horses. In the 3 other horses, RBC radioactivity dropped immediately after transfusion, reaching minimal values in approximately 48 hours. After the 2nd transfusion, 1 horse retained 80% of the dose in circulating RBC for 4 days; 2 horses demonstrated a rapid loss of circulating radiolabeled RBC, reaching minimal values in 48 hours; and 2 horses demonstrated minimal radioactivity in the RBC mass even immediately after the transfusion. One horse died of anaphylactic shock during the 2nd transfusion. Erythrocyte compatibility tests, using the direct agglutination test, the antiglobulin test, and the hemolytic test, were not effective in predicting survival of transfused RBC. PMID:646196

Kallfelz, F A; Whitlock, R H; Schultz, R D

1978-04-01

80

Transfusion medicine and safety  

Microsoft Academic Search

Advances in safety of blood transfusion in clinical practice principally relate to preventing transfusion-transmitted infections (TTI). Epidemiological studies of TTI have resulted in the development, standardization, and implementation of an expanding array of immunoassays employed worldwide in routine screening of blood donated by voluntary blood donors. Exclusion of infected blood and their donors has remarkably reduced the risk of transmitting

Roger Dodd; W. Kurt Roth; Paul Ashford; Elizabeth M. Dax; Girish Vyas

2009-01-01

81

DEAP-HUS: Deficiency of CFHR plasma proteins and autoantibody-positive form of hemolytic uremic syndrome  

Microsoft Academic Search

DEAP-HUS [Deficiency of CFHR (complement factor H-related) plasma proteins and Autoantibody Positive form of Hemolytic Uremic Syndrome] represents a novel subtype of hemolytic uremic syndrome (HUS) with unique characteristics. It affects children and\\u000a requires special clinical attention in terms of diagnosis and therapy. DEAP-HUS and other atypical forms of HUS share common\\u000a features, such as microangiopathic hemolytic anemia, acute renal

Peter F. Zipfel; Christoph Mache; Dominik Müller; Christoph Licht; Marianne Wigger; Christine Skerka

2010-01-01

82

[Autoimmune hemolytic anemia].  

PubMed

Diagnosis of autoimmune hemolytic anemia (AIHA) requires both serologic evidence of an autoantibody and hemolysis. Based on the characteristic temperature reactivity of the autoantibody to red cell membranes, AIHA is classified into warm AIHA or cold AIHA (cold agglutinin disease and paroxysmal cold hemoglobinuria). Sensitized RBCs are destructed by intravascular and/or extravascular hemolysis. On the basis of etiology, AIHA are classified as idiopathic or secondary. The common cause of secondary AIHA is lymphoproliferative disorders, autoimmune diseases, and infections. The first line therapy of patients with warm AIHA is glucocorticoids and primary treatment for cold AIHA is avoiding cold exposure. The other standard treatments include splenectomy and immunosuppressive drugs. Recently, rituximab, a monoclonal anti-CD20 antibody, has been used in refractory AIHA with excellent responses. PMID:18326320

Karasawa, Masamitsu

2008-03-01

83

CLINICAL FELLOWSHIP PROGRAM IN TRANSFUSION MEDICINE  

E-print Network

CLINICAL FELLOWSHIP PROGRAM IN TRANSFUSION MEDICINE The Department of Pathology and Laboratory FELLOWSHIP IN TRANSFUSION MEDICINE INTRODUCTION and BACKGROUND The Fellowship Program in Transfusion Medicine ­ Edmonton Zone Transfusion Medicine service is the largest zonal transfusion service served by Canadian

MacMillan, Andrew

84

How Is Hemolytic Anemia Treated?  

MedlinePLUS

... of red blood cell destruction. Blood and Marrow Stem Cell Transplant In some types of hemolytic anemia, such ... their normal lifespan is over. Blood and marrow stem cell transplants may be used to treat these types ...

85

Atypical hemolytic uremic syndrome  

PubMed Central

Hemolytic uremic syndrome (HUS) is defined by the triad of mechanical hemolytic anemia, thrombocytopenia and renal impairment. Atypical HUS (aHUS) defines non Shiga-toxin-HUS and even if some authors include secondary aHUS due to Streptococcus pneumoniae or other causes, aHUS designates a primary disease due to a disorder in complement alternative pathway regulation. Atypical HUS represents 5 -10% of HUS in children, but the majority of HUS in adults. The incidence of complement-aHUS is not known precisely. However, more than 1000 aHUS patients investigated for complement abnormalities have been reported. Onset is from the neonatal period to the adult age. Most patients present with hemolytic anemia, thrombocytopenia and renal failure and 20% have extra renal manifestations. Two to 10% die and one third progress to end-stage renal failure at first episode. Half of patients have relapses. Mutations in the genes encoding complement regulatory proteins factor H, membrane cofactor protein (MCP), factor I or thrombomodulin have been demonstrated in 20-30%, 5-15%, 4-10% and 3-5% of patients respectively, and mutations in the genes of C3 convertase proteins, C3 and factor B, in 2-10% and 1-4%. In addition, 6-10% of patients have anti-factor H antibodies. Diagnosis of aHUS relies on 1) No associated disease 2) No criteria for Shigatoxin-HUS (stool culture and PCR for Shiga-toxins; serology for anti-lipopolysaccharides antibodies) 3) No criteria for thrombotic thrombocytopenic purpura (serum ADAMTS 13 activity > 10%). Investigation of the complement system is required (C3, C4, factor H and factor I plasma concentration, MCP expression on leukocytes and anti-factor H antibodies; genetic screening to identify risk factors). The disease is familial in approximately 20% of pedigrees, with an autosomal recessive or dominant mode of transmission. As penetrance of the disease is 50%, genetic counseling is difficult. Plasmatherapy has been first line treatment until presently, without unquestionable demonstration of efficiency. There is a high risk of post-transplant recurrence, except in MCP-HUS. Case reports and two phase II trials show an impressive efficacy of the complement C5 blocker eculizumab, suggesting it will be the next standard of care. Except for patients treated by intensive plasmatherapy or eculizumab, the worst prognosis is in factor H-HUS, as mortality can reach 20% and 50% of survivors do not recover renal function. Half of factor I-HUS progress to end-stage renal failure. Conversely, most patients with MCP-HUS have preserved renal function. Anti-factor H antibodies-HUS has favourable outcome if treated early. PMID:21902819

2011-01-01

86

Hemolytic anemia due to warm autoantibodies.  

PubMed

The diagnosis of autoimmune hemolytic anemia (AHA) requires evidence of shortened red blood cell (RBC) survival mediated by autoantibodies directed against autologous RBCs. About 80 percent of patients with AHA have warm-reactive antibodies of the IgG isotype; the remainder exhibit cold-reactive autoantibodies. Typical patients exhibit anemia, reticulocytosis, spherocytes and polychromasia on the blood film and a positive direct antiglobulin test (DAT). Increased indirect serum bilirubin, urinary urobilinogen and serum lactate dehydrogenase (LDH), and decreased serum haptoglobin are not required for the diagnosis, but are frequently present. Patients with AHA and no underlying associated disease are said to have primary or idiopathic AHA. AHA in patients with associated autoimmune disease and certain malignant or infectious diseases is classified as secondary. The etiology of AHA is unknown. Patients with symptomatic anemia require transfusion of RBCs. Prednisone and splenectomy may provide long term remission. Rituximab, intravenous immunoglobulin, immunosuppressive drugs and danazol have been effective in refractory cases and for patients who are poor candidates for surgery. PMID:17904259

Packman, Charles H

2008-01-01

87

Intravenous Immunoglobulin G Treatment in ABO Hemolytic Disease of the Newborn, is it Myth or Real?  

PubMed

Intravenous Immunoglobulin G (IVIG) therapy has been used as a component of the treatment of hemolytic disease of the newborn. There is still no consensus on its use in ABO hemolytic disease of the newborn routinely. The aim of this study is to determine whether administration of IVIG to newborns with ABO incompatibility is necessary. One hundred and seventeen patients with ABO hemolytic disease and positive Coombs test were enrolled into the study. The subjects were healthy except jaundice. Infants were divided into two groups: Group I (n = 71) received one dose of IVIG (1 g/kg) and LED phototherapy whereas Group II (n = 46) received only LED phototherapy. One patient received erythrocyte transfusion in Group I, no exchange transfusion was performed in both groups. Mean duration of phototherapy was 3.1 ± 1.3 days in Group I and 2.27 ± 0.7 days in Group II (p < 0.05). Mean duration of hospital stay was 5.34 ± 2.2 days in Group I and 3.53 ± 1.3 days in Group II (p < 0.05). Mean duration of phototherapy was 4.0 ± 1.5 days and 2.73 ± 1.1 days in double and single doses of IVIG respectively, and this was statistically significant (p < 0.05). IVIG therapy didn't decrease neither phototherapy nor hospitalization duration in infants with ABO hemolytic disease. Meticulus follow-up of infants with ABO hemolytic disease and LED phototherapy decreases morbidity. IVIG failed to show preventing hemolysis in ABO hemolytic disease. PMID:24554813

Beken, Serdar; Hirfanoglu, Ibrahim; Turkyilmaz, Canan; Altuntas, Nilgun; Unal, Sezin; Turan, Ozden; Onal, Esra; Ergenekon, Ebru; Koc, Esin; Atalay, Yildiz

2014-03-01

88

Unchanging attitudes to autologous transfusion in the UK.  

PubMed

Our aim was to assess changes in attitudes to autologous transfusion amongst surgeons over a 10-year period in response to scientific evidence, public awareness, published guidelines, management and the increasing cost of blood products. Surgeons across the north-west of England completed questionnaires on knowledge, experience and attitude towards autologous transfusion in 1990, 1994 and 1999. Main outcome measures were changes in knowledge, experience and utilization of autologous transfusion; perceived advantages of autologous transfusion, obstacles to its implementation in surgical practice and preferences for specific techniques (preoperative autologous donation, acute normovolaemic haemodilution, intraoperative and postoperative cell salvage). There has been little change in practice over 10 years. Many more surgeons were keen to employ autologous transfusion than were using it. Autologous transfusion was only used in general, orthopaedic and cardiothoracic surgery. Safety and patient preference were the main arguments for implementation and logistics the main obstacles. Autologous transfusion was used sporadically in surgical practice. Clinical trials are needed to guide clinicians in the choice of transfusion techniques. PMID:11328567

Torella, F; Haynes, S L; Lardi, A; O'Dwyer, S T; McCollum, C N

2001-02-01

89

Granulocyte transfusion therapy.  

PubMed

Bacterial and fungal infections continue to be a major cause of morbidity and mortality in severely neutropenic patients undergoing aggressive chemotherapy regimens or hematopoietic stem cell transplantation. Traditional granulocyte transfusion therapy, a logical approach in treating these infections, has been available for many years, and several controlled studies have shown this therapy to be useful. However, granulocyte transfusion therapy fell out of favor because the results were not clinically impressive, and adverse results were reported. These disappointing results were felt to be, in part, because of the low doses of granulocytes provided. More recent studies have attempted to increase the numbers of transfused cells by stimulating normal granulocyte donors with G-CSF (+/-corticosteroids). With these techniques, the number of granulocytes transfused can be increased 3-4 fold. The cells have been shown to circulate in recipients, and daily transfusions are capable of maintaining normal or near-normal blood neutrophil counts in previously severely neutropenic patients. The cells appear to function normally by a variety of in vitro and in vivo tests. Clinical benefit, as defined by survival or clearance of infection, has not been definitively determined. Results of an ongoing randomized controlled clinical trial should be available in the near future. PMID:23920161

Marfin, Anthony A; Price, Thomas H

2015-02-01

90

Hemolytic anemias due to hemoglobinopathies.  

PubMed

Hemoglobinopathies responsible for hemolytic anemias may be divided into two groups. The first one corresponds to thalassemias and the second to the presence of a structurally abnormal hemoglobin (Hb). In thalassemia, the primary biochemical abnormality is a quantitative defect in the biosynthesis of one type of Hb chain. This defect leads to an overall deficit of Hb accumulation in the erythrocyte (hypochromia) together with the presence of an excess of the normally synthesized chains. The unpaired subunits which are less soluble than HbA precipitate, bind to the membrane and ultimately lead to hemolysis. In the second group, the hemolytic anemia is a direct consequence of the physicochemical properties of the structurally abnormal Hb. This molecule may polymerize, precipitate or crystallize within the red blood cell (RBC) leading to membrane alterations and to the destruction of the cell. This chapter will emphasize several examples of structurally abnormal Hbs, such as sickle cell disease and congenital Heinz body hemolytic anemia (CHBHA). PMID:8813715

Poyart, C; Wajcman, H

1996-04-01

91

Drug-induced immune hemolytic anemia  

MedlinePLUS

... Jager U, Lechner K. Autoimmune hemolytic anemia. In: Hoffman R, Benz EJ Jr, Silberstein LE, Heslop HE, ... EA, Schrier SL, Extrinsic nonimmune hemolytic anemias. In: Hoffman R, Benz EJ Jr, Silberstein LE, Heslop HE, ...

92

Chimerism in transfusion medicine  

PubMed Central

Transfusion therapy is complicated by the production of alloantibodies to antigens present in the donor and lacking in the recipient through the poorly-understood but likely multi-factorial process of alloimmunization. The low prevalence of alloimmunization in transfused patients (6.1%)1 suggests that processes central to immunologic tolerance may be operating in the vast majority of transfused patients who do not produce alloantibodies. Using RhD as a prototype, evidence is reviewed that the ability to make antibodies to red blood cell (RBC) antigens may result in part from immunologic tolerance acquired in utero. These ideas are extended to other examples of maternal microchimerism (MMc) of other non-inherited maternal antigens (NIMA). An evolutionary argument is offered that multi-generational immunity supports the hypothesis that MMc may partly explain the “non-responder” phenotype in RBC alloimmunization. PMID:24196285

Brunker, Patricia AR

2013-01-01

93

Transfusion problems associated with transplantation  

SciTech Connect

Researchers have reviewed the role of blood transfusions in renal and marrow graft recipients. Striking contrasts are evident: while transfusions may promote successful kidney grafting, any transfusions before initiation of the transplant conditioning regimen may jeopardize the treatment of severe aplastic anemia by marrow transplantation. Researchers have suggested guidelines for the transfusion support of transplant candidates before transplantation and for marrow graft recipients after transplantation. It is important to recognize that after conditioning for marrow transplantation, all patients will be profoundly pancytopenic for a limited period of time, and intensive transfusion support is vital to patient survival.

Storb, R.; Weiden, P.L.

1981-04-01

94

Hemolytic Uremic Syndrome: Toxins, Vessels, and Inflammation  

PubMed Central

Hemolytic uremic syndrome (HUS) is characterized by thrombotic microangiopathy of the glomerular microcirculation and other vascular beds. Its defining clinical phenotype is acute kidney injury (AKI), microangiopathic anemia, and thrombocytopenia. There are many etiologies of HUS including infection by Shiga toxin-producing bacterial strains, medications, viral infections, malignancy, and mutations of genes coding for proteins involved in the alternative pathway of complement. In the aggregate, although HUS is a rare disease, it is one of the most common causes of AKI in previously healthy children and accounts for a sizable number of pediatric and adult patients who progress to end stage kidney disease. There has been great progress over the past 20?years in understanding the pathophysiology of HUS and its related disorders. There has been intense focus on vascular injury in HUS as the major mechanism of disease and target for effective therapies for this acute illness. In all forms of HUS, there is evidence of both systemic and intra-glomerular inflammation and perturbations in the immune system. Renewed investigation into these aspects of HUS may prove helpful in developing new interventions that can attenuate glomerular and tubular injury and improve clinical outcomes in patients with HUS. PMID:25593915

Cheung, Victoria; Trachtman, Howard

2014-01-01

95

Autologous cord blood transfusion.  

PubMed

Newborn piglets were exsanguinated (60% of blood volume) and retransfused 1 h later. One test group received adult pig red blood cells, the other piglet cord blood cells; controls were infused with plasma. While all controls died, satisfactory results were achieved in piglets transfused with either adult or foetal blood. The feasibility of collecting human cord blood for transfusion was assessed in 100 samples of human cord blood. Blood was collected aseptically and aerobic and anaerobic cultures set up. All samples of cord blood were sterile, and all were Mycoplasma negative. Coagulation parameters were analysed in eight cord plasma samples stored at -20 degrees C for 45 days. No significant abnormalities were found immediately after birth or after storage. PMID:7949798

Ballin, A; Kenet, G; Gutman, R; Samra, Z; Zakut, H; Meytes, D

1994-07-01

96

Thrombelastography guides transfusion strategy.  

PubMed

During surgery for an abdominal aortic aneurysm, coagulation may be impaired and the use of thrombelastography (TEG) is described in six patients with a perioperative blood loss of 3L. During surgery blood products were infused but not platelets. When the patients were admitted to the intensive care unit, the TEG report demonstrated a lowered MA value indicating impaired function of platelets. The use of TEG may guide transfusion strategy. PMID:23675134

Bay Nielsen, Henning

2009-06-01

97

Thrombelastography Guides Transfusion Strategy  

PubMed Central

During surgery for an abdominal aortic aneurysm, coagulation may be impaired and the use of thrombelastography (TEG) is described in six patients with a perioperative blood loss of 3L. During surgery blood products were infused but not platelets. When the patients were admitted to the intensive care unit, the TEG report demonstrated a lowered MA value indicating impaired function of platelets. The use of TEG may guide transfusion strategy. PMID:23675134

Bay Nielsen, Henning

2009-01-01

98

Megadose Methylprednisolone (MDMP) Treatment in a Patient with Autoimmune Hemolytic Anemia (AIHA) Resistant to Conventional Corticosteroid Administration: A Case Report  

PubMed Central

A female in the Netherlands with severe autoimmune hemolytic anemia (AIHA) was treated with conventional corticosteroid (2 mg/kg/d in divided doses) and blood transfusions for 18 months without improvement. The presented patient responded to megadose methylprednisolone (MDMP) 30 mg/kg/d for 3 d, followed by 20 mg/kg for 4 d, and subsequently 10, 5, 2, and 1 mg/kg/d each for 1 week. Conflict of interest:None declared. PMID:24385786

Özsoylu, ?inasi; Berenschot, Henriette WA

2013-01-01

99

Transfusion of Prematures (TOP) Trial: Does a Liberal Red Blood Cell Transfusion  

E-print Network

Transfusion of Prematures (TOP) Trial: Does a Liberal Red Blood Cell Transfusion Strategy Frequency ofBlood Transfusions in Neonatal Units........................................................... 2 2.4 Failure of Other Strategies to Prevent Allogeneic Red Blood Cell Transfusions

Baker, Chris I.

100

An In vivo Drug Screening Model Using Glucose-6-Phosphate Dehydrogenase Deficient Mice to Predict the Hemolytic Toxicity of 8-Aminoquinolines  

PubMed Central

Anti-malarial 8-aminoquinolines drugs cause acute hemolytic anemia in individuals with glucose-6-phosphate dehydrogenase deficiency (G6PDD). Efforts to develop non-hemolytic 8-aminoquinolines have been severely limited caused by the lack of a predictive in vivo animal model of hemolytic potential that would allow screening of candidate compounds. This report describes a G6PDD mouse model with a phenotype closely resembling the G6PDD phenotype found in the African A-type G6PDD human. These G6PDD mice, given different doses of primaquine, which used as a reference hemolytic drug, display a full array of hemolytic anemia parameters, consistently and reproducibly. The hemolytic and therapeutic indexes were generated for evaluation of hemotoxicity of drugs. This model demonstrated a complete hemolytic toxicity response to another known hemolytic antimalarial drug, pamaquine, but no response to non-hemolytic drugs, chloroquine and mefloquine. These results suggest that this model is suitable for evaluation of selected 8-AQ type candidate antimalarial drugs for their hemolytic potential. PMID:23530079

Zhang, Peng; Gao, Xiugong; Ishida, Hiroshi; Amnuaysirikul, Jack; Weina, Peter J.; Grogl, Max; O'Neil, Michael T.; Li, Qigui; Caridha, Diana; Ohrt, Colin; Hickman, Mark; Magill, Alan J.; Ray, Prabhati

2013-01-01

101

Humanized mouse model of glucose 6-phosphate dehydrogenase deficiency for in vivo assessment of hemolytic toxicity  

PubMed Central

Individuals with glucose 6-phosphate dehydrogenase (G6PD) deficiency are at risk for the development of hemolytic anemia when given 8-aminoquinolines (8-AQs), an important class of antimalarial/antiinfective therapeutics. However, there is no suitable animal model that can predict the clinical hemolytic potential of drugs. We developed and validated a human (hu)RBC-SCID mouse model by giving nonobese diabetic/SCID mice daily transfusions of huRBCs from G6PD-deficient donors. Treatment of SCID mice engrafted with G6PD-deficient huRBCs with primaquine, an 8-AQ, resulted in a dose-dependent selective loss of huRBCs. To validate the specificity of this model, we tested known nonhemolytic antimalarial drugs: mefloquine, chloroquine, doxycycline, and pyrimethamine. No significant loss of G6PD-deficient huRBCs was observed. Treatment with drugs known to cause hemolytic toxicity (pamaquine, sitamaquine, tafenoquine, and dapsone) resulted in loss of G6PD-deficient huRBCs comparable to primaquine. This mouse model provides an important tool to test drugs for their potential to cause hemolytic toxicity in G6PD-deficient populations. PMID:24101478

Rochford, Rosemary; Ohrt, Colin; Baresel, Paul C.; Campo, Brice; Sampath, Aruna; Magill, Alan J.; Tekwani, Babu L.; Walker, Larry A.

2013-01-01

102

Current understanding of allergic transfusion reactions: incidence, pathogenesis, laboratory tests, prevention and treatment  

PubMed Central

Non-haemolytic transfusion reactions are the most common type of transfusion reaction and include transfusion-related acute lung injury, transfusion-associated circulatory overload, allergic reactions, febrile reactions, post-transfusion purpura and graft-versus- host disease. Although life-threatening anaphylaxis occurs rarely, allergic reactions occur most frequently. If possible, even mild transfusion reactions should be avoided because they add to patients' existing suffering. During the last decade, several new discoveries have been made in the field of allergic diseases and transfusion medicine. First, mast cells are not the only cells that are key players in allergic diseases, particularly in the murine immune system. Second, it has been suggested that immunologically active undigested or digested food allergens in a donor's blood may be transferred to a recipient who is allergic to these antigens, causing anaphylaxis. Third, washed platelets have been shown to be effective for preventing allergic transfusion reactions, although substantial numbers of platelets are lost during washing procedures, and platelet recovery after transfusion may not be equivalent to that with unwashed platelets. This review describes allergic transfusion reactions, including the above-mentioned points, and focusses on their incidence, pathogenesis, laboratory tests, prevention and treatment. PMID:23215650

Hirayama, Fumiya

2013-01-01

103

Posterior reversible encephalopathy syndrome secondary to blood transfusion.  

PubMed

The appearance of posterior reversible encephalopathy syndrome (PRES) after blood transfusion is rare and has only been reported in three patients to our knowledge. We report a fourth patient with PRES secondary to blood transfusion. A 36-year-old woman with a history of menorrhagia presented to the emergency department with severe fatigue. She had a hemoglobin of 1.7g/dl and received four units of red blood cells over 15hours. On day 6 post-transfusion she returned with confusion, headache and a generalized tonic-clonic seizure. The MRI of her brain was consistent with PRES. The following day her confusion worsened, repeat MRI of the brain showed new T2-weighted lesions. Over next 10days her mental status gradually improved close to her baseline. A repeat MRI of the brain showed resolution of the T2-weighted lesions. The clinical presentation, radiological findings and disease progression in our patient was consistent with PRES. Other than the blood transfusions, there were no apparent risk factors for PRES. The prior three patients with post-transfusion PRES have been reported in middle-aged women with uterine fibroids. It is suspected that these patients have a subacute to chronic anemic state due to ongoing menorrhagia. It is interesting to note that no cases of PRES post-transfusion have been reported in the setting of acute blood loss, such as from trauma. It is postulated that an abrupt increase in hemoglobin causes a rapid rise in blood viscosity and loss of hypoxic vasodilation. Subsequent endothelial damage and brain capillary leakage results in PRES. This constellation of changes may not occur after transfusion in patients with more acute blood loss. PMID:25542590

Singh, Karanbir; Gupta, Rajesh; Kamal, Haris; Silvestri, Nicholas J; Wolfe, Gil I

2015-03-01

104

Gemcitabine-Induced Hemolytic Uremic Syndrome in Pancreatic Cancer: A Case Report and Review of the Literature  

PubMed Central

Hemolytic uremic syndrome (HUS) is a rare thrombotic complication characterized by a triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. HUS may be caused by several different conditions, including infection, malignancy, and chemotherapeutic agents, such as mitomycin, cisplatin, and most recently, gemcitabine. The outcome of gemcitabine-induced HUS is poor, and the disease has a high mortality rate. This study reports a case of gemcitabine-induced HUS in a patient with pancreatic cancer in Korea. PMID:24516709

Lee, Hye Won; Kang, Huapyong; Choi, Heun; Choi, Youn Jeong; Lee, Kyung Joo; Lee, Seung Woo; Han, Seung Hyuk; Kim, Jin Seok; Song, Si Young

2014-01-01

105

Transfusion Induced Bone Marrow Transplant Rejection Due to Minor Histocompatibility Antigens  

PubMed Central

Traditionally, alloimmunization to transfused blood products has focused exclusively upon recipient antibodies recognizing donor alloantigens present on the cell surface. Accordingly, the immunological sequelae of alloimmunization have been antibody mediated effects (i.e. hemolytic transfusion reactions, platelet refractoriness, anti-HLA and anti-HNA effects, etc.). However, in addition to the above sequelae, there is also a correlation between the number of antecedent transfusions in humans and the rate of bone marrow transplant (BMT) rejection - under reduced intensity conditioning with HLA matched or HLA identical marrow. BMT of this nature is the only existing cure for a series of non-malignant hematological diseases (e.g. sickle cell disease, thalassemias, etc.); however, rejection remains a clinical problem. It has been hypothesized that transfusion induces subsequent BMT rejection through immunization. Studies in animal models have observed the same effect and have demonstrated that transfusion induced BMT rejection can occur in response to alloimmunization. However, unlike traditional antibody responses, sensitization in this case results in cellular immune effects, involving populations such as T cell or NK cells. In this case, rejection occurs in the absence of alloantibodies, and would not be detected by existing immune-hematological methods. We review human and animal studies in light of the hypothesis that, for distinct clinical populations, enhanced rejection of BMT may be an unappreciated adverse consequence of transfusion which current blood bank methodologies are unable to detect. PMID:24090731

Patel, Seema R; Zimring, James C

2014-01-01

106

Transfusion-associated bacterial sepsis.  

PubMed Central

The incidence of sepsis caused by transfusion of bacterially contaminated blood components is similar to or less than that of transfusion-transmitted hepatitis C virus infection, yet significantly exceeds those currently estimated for transfusion-associated human immunodeficiency and hepatitis B viruses. Outcomes are serious and may be fatal. In addition, transfusion of sterile allogenic blood can have generalized immunosuppressive effects on recipients, resulting in increased susceptibility to postoperative infection. This review examines the frequency of occurrence of transfusion-associated sepsis, the organisms implicated, and potential sources of bacteria. Approaches to minimize the frequency of sepsis are discussed, including the benefits and disadvantages of altering the storage conditions for blood. In addition, the impact of high levels of bacteria on the gross characteristics of erythrocyte and platelet concentrates is described. The potentials and limitations of current tests for detecting bacteria in blood are also discussed. PMID:7923050

Wagner, S J; Friedman, L I; Dodd, R Y

1994-01-01

107

Blood transfusion practices in neuroanaesthesia  

PubMed Central

Neuroanaesthesia practice is associated with risk of significant blood loss resulting in anaemia in the intraoperative and postoperative period. The transfusion triggers in a neurologically injured brain are not clearly defined. Both a low haematocrit and a high haematocrit have not shown any improvement in the outcome. Transfusion of red blood cells may improve the cerebral oxygenation on neurophysiological monitors. However, these benefits have not been translated into clinical practice. Transfusion in subarachnoid haemorrhage leads to increased incidence of vasospasm and a poor outcome. Restrictive transfusion strategy is seen to have a lower incidence of pneumonia, urinary tract infection, bacteremia and septic shock in severe head injury. Current evidence suggests that a haemoglobin (Hb) level of <7 g/dl may be deleterious to the neurosurgical population. Target Hb of 8-9 g/dl may be desirable intraoperatively. Different transfusion triggers may hold true for different neurosurgical pathologies.

Ali, Zulfiqar; Hassan, Nelofar; Syed, Sumaya

2014-01-01

108

Blood transfusion and alloimmunization in patients with thalassemia: multicenter study.  

PubMed

One of transfusion's side effects is alloimmunization against red blood cell (RBC) antigens. Early diagnosis by antibody screening is an important step in the detection of these alloantibodies. The authors studied the frequency of alloimmunization in thalassemic patients of 4 centers (2 adult and 2 pediatric centers) and compared the rates in children (up to 15 years) and adults. Antibody screening tests were performed by gel method according to its standard pattern and respective program. In positive cases, antibody identification test by gel method was performed. Eight hundred thirty-five patients were studied; 548 (65.6%) were adults (mean age = 24.5), and 287 (34.4%) cases were pediatrics (mean age = 10.05). Of these patients, 74.1% had no history of transfusion reaction, whereas 21 (2.5%) had hemolytic complications. Seventy-eight (9.3%) exhibited allergic symptoms, and 117 (14%) cases experienced febrile reactions during transfusion. Antibody screening showed positive results in 22 pediatric cases (7.7%) and 79 adults (14.4%); 72 (71.3%), 19 (18.8%), 3 (3%), and 1 (1%) cases exhibited single, double, triple, and autoantibodies, respectively. Anti-Kell antibody was seen in 34 (33.7%) cases, anti-D was seen in 11 (10.9%) cases, and anti-E in was seen in 10 (9.9%) cases. The authors observed 8 anti-D+C (7.9%) cases, 1 anti-D+E (1%), 3 anti-Kell+E, 3 anti-Kell+Kpa (3%), and 1 anti-Kell+D double antibodies. These antibodies were also a combination of Rh subgroups or Rh and Kell subgroups. The authors observed meaningful relations between history of transfusion reactions and age with antibody screening results (P = .005). Based on alloantibodies types, more than two thirds of them were Rh subgroups and Kell groups. Phenotype determination of RBCs before beginning chronic blood transfusion and careful cross-matching with Kell and Rh subgroups in addition to ABO may help reduce alloimmunization in chronic transfusion patients. PMID:21854216

Azarkeivan, Azita; Ansari, Shahla; Ahmadi, Mohammad Hossein; Hajibeigy, Bashir; Maghsudlu, Mahtab; Nasizadeh, Soheila; Shaigan, Mojgan; Toolabi, Abdolmajid; Salahmand, Mitra

2011-09-01

109

JAMA Patient Page: Blood Transfusion  

MedlinePLUS

... day. In addition to red blood cells, other components (products in blood) are available for transfusion when needed. These other blood components include platelets, freshly frozen plasma, cryoprecipitate, and specific ...

110

Transfusion medicine as of 2014  

PubMed Central

Transfusion of blood components is one of the most common medical treatments, and in spite of the time that has evolved since we started to transfuse blood routinely in the 1930s, there are issues associated with its use that we are still trying to improve. Issues such as when to transfuse and adverse effects associated with the transfusion are fields where new evidence is being generated that ideally should help us to indicate when and what to transfuse to the patients. The recognition that the evidence generated in randomized control trials was not widely applied to guide the indication of the transfusion of blood components has provoked the development of initiatives that try to reduce its unnecessary usage. Those initiatives, grouped under the name of patient blood management, have represented a significant paradigm change, and a growing number of activities in this field are performed in health-care facilities around the world. This article tries to summarize the latest publications in those fields. PMID:25580259

Cid, Joan

2014-01-01

111

Lipid peroxidation in the hemolytic uremic syndrome.  

PubMed

Based on recent evidence of a genetic influence on prognosis (1) and the existence of red cell membrane phospholipid depletion with low or absent serum alpha-tocopherol (2) levels in three children with the Hemolytic Uremic Syndrome (H.U.S.), we wish to suggest the existence of an inborn error of antioxident capacity as the basic pathogenetic mechanism in the development of the hemolytic uremic syndrome (H.U.S.). PMID:713892

O'Regan, S; Fong, J S

1978-01-01

112

Fatal autoimmune hemolytic anemia due to immunoglobulin g autoantibody exacerbated by epstein-barr virus.  

PubMed

Most cases of autoimmune hemolytic anemia (AIHA) are caused by the production of an autoantibody that targets determinants on red blood cells (RBCs). This autoantibody can be immunoglobulin (Ig) G, IgM, or IgA. Some autoantibodies react optimally at 0° to 4°C (ie, cold agglutinin) and usually are clinically insignificant. High-titer cold agglutinins are associated with IgM autoantibody and complement fixation induced by infectious agents, including the Epstein-Barr virus (EBV). This case report describes a 31-year-old man who had jaundice, a hemoglobin of 6.0 gdL, and was diagnosed with a hemolytic crisis of AIHA. He received a total of 11 RBC transfusions during a 15-hour period without sustained response and later died. The direct antiglobulin test results for this patient were positive, whereas the cold-agglutinin-testing results were negative. We detected EBV DNA in blood via polymerase chain reaction (PCR). We report a rare case of AIHA associated with an IgG autoantibody and exacerbated by EBV infection, causing a fatal hemolytic anemia. PMID:25617394

Fadeyi, Emmanuel A; Simmons, Julie H; Jones, Mary Rose; Palavecino, Elizabeth L; Pomper, Gregory J

2015-01-01

113

Occurrence of hemolytic anemia in patients with GBS treated with high-dose IVIg  

PubMed Central

Objective: We describe an underrecognized side effect of high-dose IV immunoglobulin (IVIg), hemolytic anemia. Background: There are no established guidelines on treating patients with Guillain-Barré syndrome (GBS) who relapse or do not improve after a standard course of treatment (IVIg or plasma exchange). Some centers will opt for a second course of the initial treatment. There is an ongoing trial of a second course of IVIg in patients with severe GBS. Methods: We retrospectively reviewed 4 patients with severe GBS who received high-dose IVIg. One patient inadvertently received a high dose of IVIg for Miller Fisher syndrome. All patients received a total of at least 2 courses of the standard dose of IVIg (total >4 g/kg). We review their clinical course and side effects. Results: All patients with non-O blood types developed clinically significant hemolytic anemia requiring blood transfusion. Conclusion: Hemolytic anemia may limit doses of IVIg for treatment of severe GBS in patients with non-O blood types. PMID:25520957

Biliciler, Suur; Wahed, Amer; Sheikh, Kazim

2014-01-01

114

Effect of Transfusion Therapy on Arteriographic Abnormalities and on Recurrence of Stroke in Sickle Cell Disease  

Microsoft Academic Search

Stroke is a relatively frequent and severe complication of sickle cell disease. We performed cerebral arteriograms in 30 patients with sickle cell disease to evaluate the cause of acute neurologic deficits and to assess the effects of transfusion therapy given for a year or more after the acute episode. Twenty-three patients with motor and speech deficits had multiple abnormalities of

Marie Olivieri Russell; Herbert I. Goldberg; Andrew Hodson; Haewon C. Kim; Joanne Halus; Martin Reivich; Elias Schwartz

1984-01-01

115

Early intravenous immunoglobin (two-dose regimen) in the management of severe Rh hemolytic disease of newborn—a prospective randomized controlled trial  

Microsoft Academic Search

Phototherapy is the standard treatment in moderately severe hemolytic disease of newborn (HDN), whereas exchange transfusion\\u000a (ET) is the second line in progressive cases. Intravenous immunoglobin (IVIG) has been suggested to decrease the need for\\u000a ET. We aimed at assessing the efficacy of early two-dose regimens of IVIG to avoid unnecessary ET in severe Rh HDN. The study\\u000a included 90

Mohsen Saleh Elalfy; Nancy Samir Elbarbary; Heba Wegdan Abaza

2011-01-01

116

Treatment of autoimmune hemolytic anemias  

PubMed Central

Autoimmune hemolytic anemia (AIHA) is a relatively uncommon disorder caused by autoantibodies directed against self red blood cells. It can be idiopathic or secondary, and classified as warm, cold (cold hemagglutinin disease (CAD) and paroxysmal cold hemoglobinuria) or mixed, according to the thermal range of the autoantibody. AIHA may develop gradually, or have a fulminant onset with life-threatening anemia. The treatment of AIHA is still not evidence-based. The first-line therapy for warm AIHA are corticosteroids, which are effective in 70–85% of patients and should be slowly tapered over a time period of 6–12 months. For refractory/relapsed cases, the current sequence of second-line therapy is splenectomy (effective approx. in 2 out of 3 cases but with a presumed cure rate of up to 20%), rituximab (effective in approx. 80–90% of cases), and thereafter any of the immunosuppressive drugs (azathioprine, cyclophosphamide, cyclosporin, mycophenolate mofetil). Additional therapies are intravenous immunoglobulins, danazol, plasma-exchange, and alemtuzumab and high-dose cyclophosphamide as last resort option. As the experience with rituximab evolves, it is likely that this drug will be located at an earlier point in therapy of warm AIHA, before more toxic immunosuppressants, and in place of splenectomy in some cases. In CAD, rituximab is now recommended as first-line treatment. PMID:25271314

Zanella, Alberto; Barcellini, Wilma

2014-01-01

117

Massive Bleeding and Massive Transfusion  

PubMed Central

Massive bleeding in trauma patients is a serious challenge for all clinicians, and an interdisciplinary diagnostic and therapeutic approach is warranted within a limited time frame. Massive transfusion usually is defined as the transfusion of more than 10 units of packed red blood cells (RBCs) within 24 h or a corresponding blood loss of more than 1- to 1.5-fold of the body's entire blood volume. Especially male trauma patients experience this life-threatening condition within their productive years of life. An important parameter for clinical outcome is to succeed in stopping the bleeding preferentially within the first 12 h of hospital admission. Additional coagulopathy in the initial phase is induced by trauma itself and aggravated by consumption and dilution of clotting factors. Although different aspects have to be taken into consideration when viewing at bleedings induced by trauma compared to those caused by major surgery, the basic strategy is similar. Here, we will focus on trauma-induced massive hemorrhage. Currently there are no definite, worldwide accepted algorithms for blood transfusion and strategies for optimal coagulation management. There is increasing evidence that a higher ratio of plasma and RBCs (e.g. 1:1) endorsed by platelet transfusion might result in a superior survival of patients at risk for trauma-induced coagulopathy. Several strategies have been evolved in the military environment, although not all strategies should be transferred unproven to civilian practice, e.g. the transfusion of whole blood. Several agents have been proposed to support the restoration of coagulation. Some have been used for years without any doubt on their benefit-to-risk profile, whereas great enthusiasm of other products has been discouraged by inefficacy in terms of blood transfusion requirements and mortality or significant severe side effects. This review surveys current literature on fluid resuscitation, blood transfusion, and hemostatic agents currently used during massive hemorrhage in order to optimize patients’ blood and coagulation management in emergency medical aid. PMID:22670125

Meißner, Andreas; Schlenke, Peter

2012-01-01

118

Non-transfusion-dependent thalassemias  

PubMed Central

Non-transfusion-dependent thalassemias include a variety of phenotypes that, unlike patients with beta (?)-thalassemia major, do not require regular transfusion therapy for survival. The most commonly investigated forms are ?-thalassemia intermedia, hemoglobin E/?-thalassemia, and ?-thalassemia intermedia (hemoglobin H disease). However, transfusion-independence in such patients is not without side effects. Ineffective erythropoiesis and peripheral hemolysis, the hallmarks of disease process, lead to a variety of subsequent pathophysiologies including iron overload and hypercoagulability that ultimately lead to a number of serious clinical morbidities. Thus, prompt and accurate diagnosis of non-transfusion-dependent thalassemia is essential to ensure early intervention. Although several management options are currently available, the need to develop more novel therapeutics is justified by recent advances in our understanding of the mechanisms of disease. Such efforts require wide international collaboration, especially since non-transfusion-dependent thalassemias are no longer bound to low- and middle-income countries but have spread to large multiethnic cities in Europe and the Americas due to continued migration. PMID:23729725

Musallam, Khaled M.; Rivella, Stefano; Vichinsky, Elliott; Rachmilewitz, Eliezer A.

2013-01-01

119

Experimental studies on the hemolytic-uremic syndrome.  

PubMed

Ultrastructural studies of blood cells during the acute stage of the hemolytic-uremic syndrome (HUS) revealed striking, but transient, changes in erythrocyte structure. These included membrane disruption, vacuolar degeneration, and Heinz body formation. There was also evidence of platelet injury, and there were peculiar tactile interactions between histiocytes and impaired red cells. These changes disappeared as the patients recovered. These changes were considered to be important in the pathogenesis of the hemolytic and thrombolytic features of HUS, and studies were directed at reproducing them in vitro and in vivo. Treatment of red cells with purified clostridial phospholipase C induced changes in red cells and platelets that were comparable to those encountered in HUS. Rats infused with phospholipase C developed hemolysis, thrombocytopenia, and hemoglobinuria. Their kidneys did not, however, reveal glomerular alterations similar to those seen in patients with HUS. It is proposed that HUS in some cases might be initiated by a nonspecific infectious injury to the intestinal mucosa thereby allowing increased absorption of toxins derived from indigenous gut flora and that these toxins could be responsible for the hemolysis, thrombolysis, and even the renal injury. PMID:3974783

Bolande, R P; Kaplan, B S

1985-01-01

120

Pathology Case Study: Transfusion Reaction  

NSDL National Science Digital Library

This is a case study presented by the University of Pittsburgh Department of Pathology in which a man with a history of renal failure complained of hemorrhoidal bleeding. Visitors are given charts, test results, transfusion information and patient history, to provide the opportunity for viewers to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in transfusion pathology.

Kohler, Lisa J.

121

Transfusion transmitted infections in solid organ transplantation.  

PubMed

While the risk of infectious disease transmission through blood transfusion has been greatly reduced as a result of improved screening methods, transfusion-transmissible infections remain a concern for transplant recipients, especially those receiving multiple transfusions. Although transfusion and transplant recipients are at risk for similar infections, the current reporting requirements for infections transmitted by transfusions and organ transplantation vary greatly and remain distinctly separate with no communication between reporting systems. This article reviews 23 past reports of transfusion-transmitted infections in organ recipients acquired through transfusions. While cytomegalovirus was a major focus of such reports in the 1980s, more recent reports have focused on West Nile virus transmission. Additionally, this article highlights challenges in determining transfusion-transmitted infection risk in transplant recipients related to the current reporting systems. PMID:25612502

Mezochow, A K; Henry, R; Blumberg, E A; Kotton, C N

2015-02-01

122

Group A ?-hemolytic streptococcal pharyngotonsillitis outbreak  

PubMed Central

The aim was to describe an outbreak of group A ?-hemolytic streptococcal pharyngotonsillitis in health care professionals. This is a cross-sectional descriptive study of 17 clients who dined at the same table in a restaurant in Barcelona in July 2012. The frequency, timing and severity of symptoms were analyzed, as were demographic variables and others concerning the food ingested. The attack rate was 58.8%. Six of the 10 clients were positive for group A ?-hemolytic streptococcal. Six of the 13 individuals who handled the food involved in the dinner had symptoms. No association was identified with the food consumed. There is epidemiological evidence of foodborne group A ?-hemolytic streptococcal transmission, but respiratory transmission could not be ruled out. PMID:24897054

Culqui, Dante R; Manzanares-Laya, Sandra; Van Der Sluis, Sarah Lafuente; Fanlo, Albert Anton; Comas, Rosa Bartolomé; Rossi, Marcello; Caylá, Joán A

2014-01-01

123

Hemolytic anemia and methemoglobinemia in a preterm baby as a complication of antenatal intraamnial injection of toluidine blue.  

PubMed

A late preterm infant was born 4.5 h after intraamniotic injection of 90 mg of Toluidine blue to confirm premature rupture of membranes. Due to the fetal exposition to the dye, the entire body of the patient was blue stained and the baby suffered from methemoglobinemia, Heinz' body positive hemolytic anemia and hyperbilirubinaemia requiring exchange transfusion. These complications underline that antenatal exposition of toluidine blue may result in considerable postnatal infant morbidity. Therefore intraamniotic application of toluidine blue should be discouraged. PMID:23519748

Mehler, K; Oberthuer, A; Weisshaar, G; Valter, M; Vierzig, A; Eifinger, F

2013-09-01

124

Director of Transfusion Service Department of Pathology  

E-print Network

. The current director, Lawrence Tim Goodnough, M.D. will continue to direct the Transfusion Medicine Fellowship be a Co-Director of the Transfusion Medicine Program at Stanford, and in those roles they will work. The Stanford Transfusion Medicine Fellowship program that Dr. Goodnough established has two ACGME

Bogyo, Matthew

125

Department and function: Director, Transfusion Medicine  

E-print Network

Department and function: Director, Transfusion Medicine Education: 1981-1987 Universities of Bochum and Essen, Medicine 1996 Specialist in Transfusion Medicine Positions: 1987-1988 University of Marburg and Oncology 1993-1998 Humboldt-University of Berlin, Transfusion Medicine 1998 Hannover Medical School

Manstein, Dietmar J.

126

Department and function: Institute for Transfusion Medicine  

E-print Network

Department and function: Institute for Transfusion Medicine Education: 1996 MD, Friedrich-Alexander-University Erlangen 2002 Medical specialist in transfusion medicine 2003 W1-Professor for molecular immunohematology Leader, Institute for Transfusion Medicine, Hanover Medical School, Hanover, Germany 2003-recent: W1

Manstein, Dietmar J.

127

Highland Procedures Center Blood Transfusion Referral Process  

E-print Network

Highland Procedures Center Blood Transfusion Referral Process Telephone: 585.341.0078 Fax: 585 to the Highland Procedures Center before a date and time will be given for blood transfusion. Fax number is 585. Current medication list. 6. Consent for blood transfusion signed and dated by MD/NP/PA, and patient

Goldman, Steven A.

128

Loss of red cell chemokine scavenging promotes transfusion-related lung inflammation  

PubMed Central

Red cell transfusions are associated with the development of acute lung injury in the critically ill. Recent evidence suggests that storage induced alterations of the red blood cell (RBC) collectively termed the “storage lesion” may be linked with adverse biologic consequences. Using a 2-event model of systemic endotoxemia followed by a secondary challenge of RBC transfusion, we investigated whether purified RBC concentrates from syngeneic C57BL/6 mice altered inflammatory responses in murine lungs. Transfusion of RBCs stored for 10 days increased neutrophil counts, macrophage inflammatory protein-2 (MIP-2) and chemokine (KC) concentrations in the airspaces, and lung microvascular permeability compared with transfusion of less than 1-day-old RBCs. Because RBCs have been shown to scavenge inflammatory chemokines through the blood group Duffy antigen, we investigated the expression and function of Duffy during storage. In banked human RBCs, both Duffy expression and chemokine scavenging function were reduced with increasing duration of storage. Transfusion of Duffy knockout RBCs into Duffy wild-type en-dotoxemic mice increased airspace neutrophils, inflammatory cytokine concentrations, and lung microvascular permeability compared with transfusion of Duffy wild-type RBCs. Thus, reduction in erythrocyte chemokine scavenging is one functional consequence of the storage lesion by which RBC transfusion can augment existing lung inflammation. PMID:19064726

Mangalmurti, Nilam S.; Xiong, Zeyu; Hulver, Mei; Ranganathan, Mrunalini; Liu, Xiang Hong; Oriss, Timothy; Fitzpatrick, Meghan; Rubin, Marc; Triulzi, Darrell; Choi, Augustine

2009-01-01

129

Single versus multiple dose intravenous immunoglobulin in combination with LED phototherapy in the treatment of ABO hemolytic disease in neonates.  

PubMed

Intravenous immunoglobulin (IVIG) has been found to decrease hemolysis in neonatal jaundice due to blood group incompatibility, but a consensus on its usage has not been reached. We conducted a study to compare single versus multiple dose of IVIG in combination with light emitting diode (LED) phototherapy in patients with neonatal jaundice secondary to ABO blood incompatibility, and compared the efficacy of these treatments with that in a group of patients who received LED phototherapy solely. Thirty-nine term neonates with ABO blood group incompatibility were enrolled in the study. Group I received one dose of IVIG (1 g/kg) and LED phototherapy, and group II two doses of IVIG (1 g/kg) and LED phototherapy, whereas group III received LED phototherapy only. In group I, exchange transfusion was performed in one patient (6%) and in group II in one patient (10%). In the control group, none of the patients required exchange transfusion. Duration of LED phototherapy was 4.3 ± 0.7 days in group I + II (IVIG group), 3.9 ± 0.6 days in group III (P = 0.06). Lowest hematocrit level in group I + II was 35.0 ± 7.8 and group III was 38.9 ± 4.2, this was statistically significant (P = 0.034). IVIG therapy, single or multiple, did not affect exchange transfusion, need of erythrocyte transfusion and hospitalization time when used in combination with LED phototherapy in the treatment of ABO hemolytic jaundice in neonates. PMID:21617887

Demirel, Gamze; Akar, Melek; Celik, Istemi Han; Erdeve, Omer; Uras, Nurdan; Oguz, Serife Suna; Dilmen, Ugur

2011-06-01

130

Microangiopathic hemolytic anemia (MAHA) as paraneoplastic syndrome in metastasized signet ring cell carcinomas: case reports and review of the literature.  

PubMed

We report on two spontaneous cases of microangiopathic hemolytic anemia (MAHA) as first manifestation due to metastasized signet ring carcinoma, one of gastric and one of unknown origin. The patients presented with an acute onset of Coombs negative hemolytic anemia and fragmentocytes in the peripheral blood smear which are typical for MAHA. These case reports present MAHA as a rare paraneoplastic syndrome in patients with metastasized signet ring carcinoma. Parallel to symptomatic treatment we started chemotherapy treatment (ELF and PLF regimen, respectively). In both cases we were able to control the MAHA and cancer progression. PMID:16088769

Arkenau, H-T; Müssig, O; Buhr, T; Jend, H H; Porschen, R

2005-08-01

131

Heinz-body hemolytic anemia associated with ingestion of methylene blue in a river otter.  

PubMed

Heinz-body hemolytic anemia and nephrosis associated with hemoglobinuria were diagnosed in a North American river otter. Fluids were administered, and the signs of renal failure improved immediately. Severe anemia developed, and the otter received a semisynthetic hemoglobin product to maintain the oxygen-carrying capacity of the blood until a blood transfusion could be given. Immediate clinical improvement was observed following hemoglobin administration, and adverse effects were not seen. Six days after admission, the otter began to produce its own RBC and recovered without complications. The Heinz-body anemia was determined to be caused by methylene blue that was in the water of minnows consumed by the otter the night before it became ill. Methylene blue is a common ingredient in products used to extend the life of bait fish. Bait fish kept in water treated with methylene blue should not be used as food for fish-eating animals. PMID:11829270

Narurkar, Neelesh S; Thomas, Jennifer S; Phalen, David N

2002-02-01

132

When pure is not so pure: chloramine-related hemolytic anemia in home hemodialysis patients.  

PubMed

Worldwide, chloramines are used as the preferred disinfectant for city water supplies. Although they have distinct advantages compared with chlorine and are deemed harmless to the general population, hemodialysis (HD) patients are at risk from chloramine-induced hemolytic anemia. In recent years, this has been highlighted in regional dialysis units but not as frequently in the home HD group. We report on 2 home HD patients who succumbed to severe oxidative hemolysis due to high mains water chloramine concentrations. Both patients were extensively investigated for other cause of anemia before a definitive diagnosis was reached. Delays in diagnosing this uncommon condition can be costly in terms of significant morbidity and excessive usage of recombinant erythropoietin and blood transfusion. Prevention primarily involves enforcing strict water quality control and establishing regular communication with water supply boards and home HD patients. Double (inline) carbon filters should be installed in patient's homes as an effective means for removing high incoming chloramine concentrations. PMID:20618875

Junglee, Naushad A; Rahman, Saeed U; Wild, Mike; Wilms, Anke; Hirst, Sarah; Jibani, Mahdi; Seale, Jim R C

2010-07-01

133

Bone marrow replacement in the treatment of hemolytic disease in mice  

SciTech Connect

Bone marrow replacement therapy following whole-body x- or gamma-irradiation has until now proven to be of limited value in the treatment of individuals with hemolytic disease. The large doses of radiation required for destruction of defective erythropoietic tissues coupled with their resultant high mortality appears to limit its usefulness. Techniques have been developed by the authors to limit the extent of exposure and to improve survival following irradiation. These techniques include shielding of all parts of the body except the hind limbs, prophylactic use of antibiotics, and preparatory blood transfusion to suppress the development of indigenous defective erythrocytes. Using these combined techniques we were able to establish high rates of survival, successful engraftment, and long-term clinical improvement in mice with several hemolytic disorders emanating from hereditary defects in spectrin production and incorporation. Evidence is presented indicating that complete bone marrow replacement occurs even in nonirradiated portions of the erythron and that only donor type red blood cells appear in the circulation.

Bernstein, S.E.; Deveau, S.A. (Jackson Lab., Bar Harbor, ME (USA))

1989-11-01

134

Serotypes of beta-hemolytic Treponema hyodysenteriae.  

PubMed Central

Cultures form 13 isolates of pathogenic, beta-hemolytic Treponema hyodysenteriae from 11 geographically separate outbreaks and 2 experimentally induced cases of swine dysentery were lyophilized and extracted with hot phenol-water. The resulting water phases were examined serologically with antisera produced in rabbits against whole-cell bacterins of the 13 isolates for evidence of antigenic classes within the species. Water-phase antigens gave precipitin reactions with homologous antisera. Results from cross-testing of each water phase with each antiserum showed four serologically distinct groups among the isolants examined. Based on precipitin reactions in agarose gel, four serotypes of pathogenic, beta-hemolytic T. hyodysenteriae are proposed. Images PMID:115788

Baum, D H; Joens, L A

1979-01-01

135

Management of hemolytic-uremic syndrome in children  

PubMed Central

Acute renal failure associated with a fulminant, life-threatening systemic disease is rare in previously healthy young children; however, when it occurs, the most common cause is hemolytic-uremic syndrome (HUS). In most cases (90%), this abrupt and devastating illness is a result of ingestion of food or drink contaminated with pathogens that produce very potent toxins. Currently, there are no proven treatment options that can directly inactivate the toxin or effectively interfere with the cascade of destructive events triggered by the toxin once it gains access to the bloodstream and binds its receptor. However, HUS is self-limited, and effective supportive management during the acute phase is proven to be a life saver for children affected by HUS. A minority of childhood HUS cases, approximately 5%, are caused by various genetic mutations causing uncontrolled activation of the complement system. These children, who used to have a poor prognosis leading to end-stage renal disease, now have access to exciting new treatment options that can preserve kidney function and avoid disease recurrences. This review provides a summary of the current knowledge on the epidemiology, pathophysiology, and clinical presentation of childhood HUS, focusing on a practical approach to best management measures. PMID:24966691

Grisaru, Silviu

2014-01-01

136

Red blood cell alloimmunization is influenced by recipient inflammatory state at time of transfusion in patients with sickle cell disease.  

PubMed

Sickle cell disease (SCD) patients are at increased risk of red blood cell (RBC) alloimmunization. Recipient inflammatory state at time of transfusion has been shown to regulate alloimmunization in murine models, but evidence is lacking in SCD patients. We retrospectively studied a cohort of alloimmunized SCD patients to determine the influence of pro-inflammatory SCD-related complications at time of transfusion on alloimmunization. For each transfusion, the presence of pro-inflammatory state, degree of RBC antigen matching, unit age, storage solution and alloantibody detection date were ascertained. Transfusion-associated pro-inflammatory events were compared between transfusions resulting and not resulting in new alloantibodies. Univariate analysis and multivariate logistic regression were performed. Fifty-two patients received 3166 pre-storage leuco-reduced transfusions of which 128 resulted in alloantibodies. Transfusions during inflammatory events were associated with increased alloantibody risk on univariate and multivariate analysis; acute chest syndrome and vaso-occlusive crisis showed strongest associations with alloimmunization. Increased antigen matching demonstrated a protective effect on alloimmunization (univariate and multivariate analysis). Although an association was seen between citrate-phosphate-dextrose (adenine) stored units and alloimmunization on univariate analysis, no effect was found on multivariate analysis. Identifying recipient pro-inflammatory states at time of transfusion that promote alloimmunization can impact RBC unit selection decisions for SCD patients at risk for alloimmunization. PMID:25256676

Fasano, Ross M; Booth, Garrett S; Miles, Megan; Du, Liping; Koyama, Tatsuki; Meier, Emily Riehm; Luban, Naomi L C

2015-01-01

137

Remission of transfusion-dependent myelodysplastic syndrome in association with respiratory tract infection.  

PubMed

We describe a case of blood transfusion-dependent myelodysplastic syndrome (refractory anaemia), associated with macrocytosis and elevated percentage of hypochromic cells. Following an acute hospital admission with a respiratory tract infection, the patient entered a complete and sustained remission. PMID:15800787

Murphy, Philip T; Fay, Michael; Quinn, John; O'Donnell, J Rory

2005-09-01

138

Mode of hepatitis C infection not associated with blood transfusion among chronic hemodialysis patients  

Microsoft Academic Search

In a retrospective study carried out on about 730 patients with chronic renal failure who underwent ambulatory hemodialysis from January 1991 to June 1994, 49 patients were found to have developed acute hepatitis C, as confirmed by seroconversion for anti-HCV antibodies without blood transfusion in the preceding 6-month period. Epidemiological survey disclosed that two patients undergoing dialysis at consoles separated

Kunio Okuda; Haruyuki Hayashi; Susumu Kobayashi; Yasubumi Irie

1995-01-01

139

Clinical Response and Transfusion Reactions of Sheep Subjected to Single Homologous Blood Transfusion  

PubMed Central

Studies in relation to blood conservation and responses to transfusion are scarce for ruminants. We evaluated the clinical manifestations of sheep that received a single homologous transfusion of whole blood, focusing on transfusion reactions. Eighteen adult sheep were subjected to a single phlebotomy to withdraw 40% of the total blood volume, which was placed into CPDA-1 bags and then divided into G0, animals that received fresh blood, and G15 and G35, animals that received blood stored for 15 or 35 days, respectively. Clinical observations were recorded throughout the transfusion, whereas heart rate, respiratory rate, and rectal temperature were assessed at the following times: 24 hours after phlebotomy and before transfusion; 30 minutes, six, twelve, 24, 48, 72, and 96 hours and eight and 16 days after transfusion. All groups presented transfusion reactions, among which hyperthermia was the most frequent (50% of animals). Tachycardia occurred most frequently in the G35 animals (50% of them). During transfusion G35 animals presented more clinical manifestation (P < 0.05). Transfusion of fresh or stored total blood improved the blood volume, but transfusion reactions occurred, demonstrating that a single transfusion of fresh or stored blood can cause inflammatory and febrile nonhemolytic transfusion reactions in sheep.

Sousa, Rejane Santos; Minervino, Antonio Humberto Hamad; Araújo, Carolina Akiko Sato Cabral; Rodrigues, Frederico Augusto Mazzocca Lopes; Oliveira, Francisco Leonardo Costa; Zaminhan, Janaina Larissa Rodrigues; Moreira, Thiago Rocha; Sousa, Isadora Karolina Freitas; Ortolani, Enrico Lippi; Barręto Júnior, Raimundo Alves

2014-01-01

140

Assessment of Hemolytic and Bactericidal Complement Activities in Normal and Mastitic Bovine Milk  

Microsoft Academic Search

Bactericidal and hemolytic comple- ment activities were investigated in 51 quarter milk samples of 13 cows in late lactation. Hemolytic activity was in all of the samples but one, after accounting for whey inhibitory activity. Mean hemolytic activity and inhibitory activities were .18 and .34 complement hemolytic units. Inflammation, in relation to infection status, increased hemolytic titers and heat-labile bactericidal

P. Rainard; B. Poutrel; J. P. Caffin

1984-01-01

141

Alemtuzumab Plus Cyclosporine Treatment of the Autoimmune Hemolytic Anemia in an Adult Bowel Transplant  

PubMed Central

An adult male underwent a bowel transplant for tufting enteropathy, receiving alemtuzumab, tacrolimus, and steroids as immunosuppressants. Five years later, he developed an autoimmune hemolytic anemia (AIHA), anti-IgG positive, with reduced reticulocyte count, leukopenia, and thrombocytopenia with antiplatelet antibodies. After an unsuccessful initial treatment with high dose steroids, reduction in tacrolimus dose, and intravenous immunoglobulin (IVIG), a bone marrow biopsy revealed absence of erythroid maturation with precursor hyperplasia. The patient was switched to sirolimus and received four doses of rituximab plus two courses of plasmapheresis, which decreased his transfusion requirements. After a febrile episode one month later, the AIHA relapsed with corresponding decreases in platelet and leukocyte count: cyclosporine A (CsA) was started with a second course of rituximab and IVIG without response, even though repeat bone marrow biopsy did not reveal morphology correlated to an acquired pure red cell aplasia (APRCA). Considering the similarity in his clinical and laboratory findings to APRCA, alemtuzumab was added (three doses over a week) with CsA followed by steroids. The patient was eventually discharged transfusion-independent, with increasing hemoglobin (Hb) levels and normal platelet and leukocyte count. One year later he is still disease-free with functioning graft. PMID:25177510

Lauro, A.; Stanzani, M.; Finelli, C.; Zanfi, C.; Morelli, M. C.; Pasqualini, E.; Dazzi, A.; Ravaioli, M.; Di Simone, M.; Giudice, V.; Pironi, L.; Pinna, A. D.

2014-01-01

142

Hemolytic crisis in a G6PD-deficient infant after ingestion of pumpkin.  

PubMed

A 8 month-old infant presented with acute onset of severe jaundice, anemia requiring transfusion and Glucose-6-Phosphate Dehydrogenase deficiency. The infant did not take drugs, he did not consume fava beans, but fava beans DNA was found on pumpkin he consumed the day before jaundice onset. This is the first case of hemolysis triggered by ingestion of food cross-contaminated with fava beans. PMID:25048415

Zuccotti, Gian Vincenzo; Redaelli, Francesca; Gualdi, Valentina; Rizzi, Valeria; Mameli, Chiara; Dilillo, Dario; Fabiano, Valentina

2014-01-01

143

Hemolytic crisis in a G6PD-deficient infant after ingestion of pumpkin  

PubMed Central

A 8 month-old infant presented with acute onset of severe jaundice, anemia requiring transfusion and Glucose-6-Phosphate Dehydrogenase deficiency. The infant did not take drugs, he did not consume fava beans, but fava beans DNA was found on pumpkin he consumed the day before jaundice onset. This is the first case of hemolysis triggered by ingestion of food cross-contaminated with fava beans. PMID:25048415

2014-01-01

144

Application of reticulated platelets to transfusion management during autologous stem cell transplantation  

PubMed Central

Background The immature (or reticulated) platelet fraction (IPF) is rich in nucleic acids, especially RNA, and can be used as a predictive factor for platelet recovery in platelet immunomediated consumption or in postchemotherapy myelosuppression. Our aim was to determine if transfusions with IPF-rich solutions, during autologous peripheral blood stem cell transplantation, reduce the occurrence of bleeding and hemorrhagic complications. Patients and methods Transfusions were administered to 40 children, affected with hematological pathologies, who underwent autologous peripheral hematopoietic progenitor cell transplantation. There were two groups of 20 patients, one group treated with IPF-poor and the other with IPF-rich solutions. In the two groups, the conditioning regimen was the same for the same pathology (hematological pathologies: 14 acute lymphoblastic leukemia; twelve acute myelocytic leukemia; four non-Hodgkin’s lymphoma; two Hodgkin’s lymphoma; eight solid tumors). A new automated analyzer was used to quantify the IPF: the XE2100 (Sysmex, Kobe, Japan) blood cell counter with upgraded software. Results The 20 patients who received solutions with a high percentage of IPF (3%–9% of total number of infused platelets) required fewer transfusions than the 20 patients who received transfusions with a low percentage of IPF (0%–1% of total number of infused platelets): 83 versus 129 (mean of number of transfusions 4.15 versus 6.45) and a significant difference was found between the two groups by using the Mann–Whitney test (P < 0.001). The prophylactic transfusions decreased from three to two per week. There was only one case of massive hemorrhage. Conclusion The use of IPF solutions reduces the number of transfusions and bleedings after peripheral blood stem cell transplantation in pediatric patients. PMID:22334789

Parco, Sergio; Vascotto, Fulvia

2012-01-01

145

Patient blood management: a fresh look at a new approach to blood transfusion.  

PubMed

The overall use of allogeneic blood transfusions in clinical practice remains relatively high and still varies widely among centres and practitioners. Moreover, allogeneic blood transfusions have historically been linked with risks and complications: some of them (e.g. transfusion reactions and transmission of pathogens) have been largely mitigated through advancements in blood banking whereas some others (e.g. immunomodulation and transfusion--related acute lung injury) appear to have more subtle aetiologies and are more difficult to tackle. Furthermore, blood transfusions are costly and the supply of blood is limited. Finally, evidence indicates that a great number of the critically ill patients who are being transfused today may not be having tangible benefits from the transfusion. Patient blood management is an evidence--based, multidisciplinary, multimodal, and patient--tailored approach aimed at reducing or eliminating the need for allogeneic transfusion by managing anaemia, perioperative blood conservation, surgical haemostasis, and blood as well as plasma--derivative drug use. From this point of view, the reduction of allogeneic blood usage is not an end in itself but a tool to achieve better patient clinical outcome. This article focuses on the three--pillar matrix of patient blood management where the understanding of basic physiology and pathophysiology is at the core of evidence--based approaches to optimizing erythropoiesis, minimising bleeding and tolerating anaemia. Anaesthesiologists and Critical Care physicians clearly have a key role in patient blood management programmes are and should incorporate its principles into clinical practice--based initiatives that improve patient safety and clinical outcomes. PMID:25311950

Liumbruno, G M; Vaglio, S; Grazzini, G; Spahn, D R; Biancofiore, G

2014-10-14

146

Indications and organisational methods for autologous blood transfusion procedures in Italy: results of a national survey  

PubMed Central

Introduction Pre-operative donation of autologous blood is a practice that is now being abandoned. Alternative methods of transfusing autologous blood, other than predeposited blood, do however play a role in limiting the need for transfusion of allogeneic blood. This survey of autologous blood transfusion practices, promoted by the Italian Society of Transfusion Medicine and Immunohaematology more than 2 years after the publication of national recommendations on the subject, was intended to acquire information on the indications for predeposit in Italy and on some organisational aspects of the alternative techniques of autotransfusion. Materials and methods A structured questionnaire consisting of 22 questions on the indications and organisational methods of autologous blood transfusion was made available on a web platform from 15 January to 15 March, 2013. The 232 Transfusion Services in Italy were invited by e-mail to complete the online survey. Results Of the 232 transfusion structures contacted, 160 (69%) responded to the survey, with the response rate decreasing from the North towards the South and the Islands. The use of predeposit has decreased considerably in Italy and about 50% of the units collected are discarded because of lack of use. Alternative techniques (acute isovolaemic haemodilution and peri-operative blood salvage) are used at different frequencies across the country. Discussion The data collected in this survey can be considered representative of national practice; they show that the already very limited indications for predeposit autologous blood transfusion must be adhered to even more scrupulously, also to avoid the notable waste of resources due to unused units. Users of alternative autotransfusion techniques must be involved in order to gain a full picture of the degree of use of such techniques; multidisciplinary agreement on the indications for their use is essential in order for these indications to have an effective role in “patient blood management” programmes. PMID:25350961

Catalano, Liviana; Campolongo, Alessandra; Caponera, Maurizio; Berzuini, Alessandra; Bontadini, Andrea; Furlň, Giuseppe; Pasqualetti, Patrizio; Liumbruno, Giancarlo M.

2014-01-01

147

Common variable immunodeficiency complicated with hemolytic uremic syndrome  

PubMed Central

Common variable immunodeficiency is a primary immunodeficiency disease characterized by reduced serum immunoglobulins and heterogeneous clinical features. Recurrent pyogenic infections of upper and lower respiratory tracts are the main clinical manifestations of common variable immunodeficiency. Hemolytic uremic syndrome is a multisystemic disorder characterized by thrombocytopenia, microangiopathic hemolytic anemia, and organ ischemia due to platelet aggregation in the arterial microvasculature. This is one of the rare cases of patients diagnosed with common variable immunodeficiency, which was complicated by hemolytic uremic syndrome. PMID:22059898

2012-01-01

148

Case Report: Severe form of hemolytic-uremic syndrome with multiple organ failure in a child: a case report  

PubMed Central

Introduction: Hemolytic-uremic syndrome (HUS) is a leading cause of acute renal failure in infants and young children. It is traditionally defined as a triad of acute renal failure, hemolytic anemia and thrombocytopenia that occur within a week after prodromal hemorrhagic enterocolitis. Severe cases can also be presented by acute respiratory distress syndrome (ARDS), toxic megacolon with ileus, pancreatitis, central nervous system (CNS) disorders and multiple organ failure (MOF). Case presentation: A previously healthy 4-year old Caucasian girl developed acute renal failure, thrombocytopenia and hemolytic anemia following a short episode of abdominal pain and bloody diarrhea. By the end of the first week the diagnosis of the typical HUS was established. During the second week the disease progressed into MOF that included ileus, pancreatitis, hepatitis, coma and ARDS, accompanied by hemodynamic instability and extreme leukocytosis. Nonetheless, the girl made a complete recovery after one month of the disease. She was successfully treated in the intensive care unit and significant improvement was noticed after plasmapheresis and continuous veno-venous hemodialysis. Conclusions: Early start of plasmapheresis and meticulous supportive treatment in the intensive care unit, including renal placement therapy, may be the therapy of choice in severe cases of HUS presented by MOF. Monitoring of prognostic factors is important for early performance of appropriate diagnostic and therapeutical interventions. PMID:25075296

Mijatovic, Dino; Blagaic, Ana; Zupan, Zeljko

2014-01-01

149

Transfusion-associated cytomegalovirus mononucleosis.  

PubMed Central

Transfusion-associated cytomegalovirus mononucleosis is generally considered only as a complication of extracorporeal circulation following cardiac surgery. Three cases following trauma were recognized in less than one year. Both massive and limited volume blood transfusions were involved. Hectic fever was a characteristic feature in these otherwise remarkably asymptomatic individuals, without the classic features of heterophile-positive infectious mononucleosis. Since the illness developed several weeks into the post-operative period after extensive thoracic or abdominal trauma surgery, the presence of an undrained abscess was naturally the major diagnostic concern. Atypical lymphocytosis, markers of altered immunity (cold agglutinins, rheumatoid factor) and moderate hepatic dysfunction were important laboratory clues. In one case, focal isotope defects in the spleen scan misleadingly suggested a septic complication. A false-positive monospot test initially obscured the correct serologic diagnosis in the same patient. Failure to consider this selflimited viral infection may be a critical factor leading to unnecessary surgery. Other viral agents capable of eliciting a similar syndrome are cited. Images Fig. 1. PMID:190955

Lerner, P I; Sampliner, J E

1977-01-01

150

Emerging viral infections relevant to transfusion medicine  

Microsoft Academic Search

The development of new technologies leads to the discovery of new viruses. For each of these new infectious agents relevance to transfusion needs to be assessed. The questions to be answered are transmissibility by transfusion, pathogenicity, prevalence in blood donors, persistence and the availability of screening assays. Since 1995, three new viruses have been identified and extensively studied. GB virus-C\\/hepatitis

J.-P. Allain

2000-01-01

151

Psychrobacter arenosus Bacteremia after Blood Transfusion, France  

PubMed Central

We report a case of transfusion-associated bacteremia caused by Psychrobacter arenosus. This psychrotolerant bacterium was previously isolated in 2004 from coastal sea ice and sediments in the Sea of Japan, but not from humans. P. arenosus should be considered a psychrotolerant bacterial species that can cause transfusion-transmitted bacterial infections. PMID:23764120

Recule, Christine; Pouzol, Patricia; Lafeuillade, Bruno; Mallaret, Marie-Reine; Maurin, Max; Croize, Jacques

2013-01-01

152

Psychrobacter arenosus bacteremia after blood transfusion, France.  

PubMed

We report a case of transfusion-associated bacteremia caused by Psychrobacter arenosus. This psychrotolerant bacterium was previously isolated in 2004 from coastal sea ice and sediments in the Sea of Japan, but not from humans. P. arenosus should be considered a psychrotolerant bacterial species that can cause transfusion-transmitted bacterial infections. PMID:23764120

Caspar, Yvan; Recule, Christine; Pouzol, Patricia; Lafeuillade, Bruno; Mallaret, Marie-Reine; Maurin, Max; Croize, Jacques

2013-07-01

153

Post-Transfusion Purpura Following Cardiac Surgery.  

PubMed

Post-transfusion purpura (PTP) is a rare disorder characterized by severe thrombocytopenia developing after a blood component transfusion. Ninety percent of the reported cases are women. In this article, we present a case of PTP in a male patient who underwent coronary artery bypass grafting and discuss its management. PMID:25327777

Demir, Tolga; Sahin, Mazlum; El, Helin; Sezer, Husnu

2014-10-17

154

[Documents and transfusion acts: Heterogeneous practices].  

PubMed

Blood transfusion is currently a delegated medical act in patient care services. Blood transfusion safety depends on the strict respect of processes from the prescription of blood products and required patient immuno-hematology exams to the administration of blood products and follow-up of the patient. We conducted a survey among haemovigilance correspondents to establish the documents needed to practice blood transfusion. Blood products delivery depends on the hospitals local organizations and blood products traceability relies on hospitals levels of computerization. We notice heterogeneous practices. Consequently, an updating of the December 15th 2003 circular relative to the transfusion act seems necessary and could thus lead to blood transfusions homogenous practices. PMID:25270982

Damais-Cépitélli, A; Lassale, B

2014-11-01

155

Hemolytik: a database of experimentally determined hemolytic and non-hemolytic peptides  

PubMed Central

Hemolytik (http://crdd.osdd.net/raghava/hemolytik/) is a manually curated database of experimentally determined hemolytic and non-hemolytic peptides. Data were compiled from a large number of published research articles and various databases like Antimicrobial Peptide Database, Collection of Anti-microbial Peptides, Dragon Antimicrobial Peptide Database and Swiss-Prot. The current release of Hemolytik database contains ?3000 entries that include ?2000 unique peptides whose hemolytic activities were evaluated on erythrocytes isolated from as many as 17 different sources. Each entry in Hemolytik provides comprehensive information about a peptide, like its name, sequence, origin, reported function, property such as chirality, types (linear and cyclic), end modifications as well as details pertaining to its hemolytic activity. In addition, tertiary structure of each peptide has been predicted, and secondary structure states have been assigned. To facilitate the scientific community, a user-friendly interface has been developed with various tools for data searching and analysis. We hope, Hemolytik will be useful for researchers working in the field of designing therapeutic peptides. PMID:24174543

Gautam, Ankur; Chaudhary, Kumardeep; Singh, Sandeep; Joshi, Anshika; Anand, Priya; Tuknait, Abhishek; Mathur, Deepika; Varshney, Grish C.; Raghava, Gajendra P. S.

2014-01-01

156

The transfusion medicine we want  

PubMed Central

The Associaçăo Brasileira de Hematologia e Hemoterapia (ABHH), through its Board of Directors, hosted a national symposium called "Forum: The Transfusion Medicine we want", to discuss proposed policies and techniques related to the area. This meeting was held in Săo Paulo on August 19 and 20, 2010, with the participation of experts, authorities and representatives of organized groups of patients and users. The discussions were organized around three specific issues selected from over 100 suggestions sent to the ABHH through public consultation on the web: 1. Strategies; 2. Financing; 3. Blood products. A plenary session, held at the end of the meeting, adopted recommendations that are relevant to the different discussion topics. This document contains actions proposed by the ABHH to meet the demands discussed. PMID:23284248

2011-01-01

157

Ceftriaxone-induced Hemolytic Anemia: Case Report and Review of Literature.  

PubMed

Ceftriaxone is a frequently used empiric antibiotic in children. Acute hemolysis is a rare side effect of ceftriaxone therapy associated with a high mortality rate. A 14-year-old boy suffering from Crohn disease developed bacterial pneumonia that was treated with ceftriaxone. We report successful management of ceftriaxone-induced hemolytic anemia (CIHA) in this patient and review the CIHA literature in pediatric patients. Early recognition of CIHA with prompt discontinuation of ceftriaxone therapy may have a beneficial role in reduction of high mortality seen in these patients. PMID:24878619

Northrop, Michael S; Agarwal, Hemant S

2015-01-01

158

Genetics Home Reference: Atypical hemolytic-uremic syndrome  

MedlinePLUS

... Hemolytic anemia occurs when red blood cells break down (undergo hemolysis) prematurely. In atypical hemolytic-uremic syndrome, red blood cells can break apart as they squeeze past clots within small blood vessels. Anemia results if these cells are destroyed faster ...

159

Blood transfusion effects in kidney transplantation.  

PubMed

Within the three decades since the beginnings of the field of clinical renal transplantation there have been four phases in blood transfusion policies, swinging from liberal transfusions to avoidance of transfusions, followed by a repeat cycle of deliberate transfusions and at present turning back to abstinence again. Because of improving skills at the prevention and treatment of rejections, the beneficial effects of random transfusions in the transplant population as a whole is marginal. This comes at a time when community fears of blood-borne infections and the prospects of supporting red cell production by the use of EPO have emerged as new factors in blood banking. Observations on patients at risk for graft loss, namely those having rejection episodes, indicate that a beneficial blood transfusion effect still exists, however. Future application of deliberate HLA antigen exposure in conjunction with novel immunological manipulations may provide a more effective avenue to tolerance induction. The use of blood transfusions matched for one HLA-DR antigen with the recipient has produced major benefits in preliminary trials and represents one starting point in this direction. PMID:2149898

Carpenter, C B

1990-01-01

160

Indications for blood and blood product transfusion  

PubMed Central

Transfusion of blood products carries certain inherent risks and hence it should be undertaken only if it improves patient outcome. A review of the literature was carried out to find the indications and effects of transfusion on morbidity and mortality of patients. There is high-quality evidence showing that restrictive blood transfusion with a transfusion trigger of haemoglobin of 7-8 g/dl or the presence of symptoms of anaemia is safe and not associated with increased mortality compared with liberal transfusion. Thus, restrictive strategy is strongly recommended in surgical and critically ill-patients. There is moderate evidence for the use of plasma and platelet transfusion in patients receiving massive blood transfusion. There is not enough evidence to support the use of plasma, platelets and cryoprecipitate in any other clinical setting. Retrospective studies show improved survival after high plasma and platelet to red blood cell ratio of 1:1:1, but this has not been confirmed in randomised trials.

Yaddanapudi, Sandhya; Yaddanapudi, LN

2014-01-01

161

Hemolytic activity of five different calcium silicates.  

PubMed Central

Mineral characteristics and the in vitro hemolytic activity of three synthetic and two natural calcium silicates (CaSi) are compared. Hemolysis is higher for the synthetic compounds than for the natural ones. The difference is accentuated by weak ultrasonication of the minerals. No variation was observed within the two groups, including both acicular and fibrous forms. Calcium was released from the minerals during storage in Tris-buffered saline. At the same time, hemolysis decreased, and crystallographic alterations occurred in the leached minerals. Treatment of the CaSi with calcium chelators (EGTA and EDTA) did not change hemolytic activity. An increase was observed when 30 mM calcium was added. Hemolysis is related to specific surface areas and the crystalline structure of the minerals. Calcium may also be a contributing factor. Images FIGURE 1. a FIGURE 1. b FIGURE 1. c FIGURE 1. d FIGURE 1. e FIGURE 1. f FIGURE 7. a FIGURE 7. b FIGURE 7. c FIGURE 7. d FIGURE 7. e FIGURE 7. f PMID:6315361

Skaug, V; Gylseth, B

1983-01-01

162

Immunotherapy Treatments of Warm Autoimmune Hemolytic Anemia  

PubMed Central

Warm autoimmune hemolytic anemia (WAIHA) is one of four clinical types of autoimmune hemolytic anemia (AIHA), with the characteristics of autoantibodies maximally active at body temperature. It produces a variable anemia—sometimes mild and sometimes severe. With respect to the absence or presence of an underlying condition, WAIHA is either idiopathic (primary) or secondary, which determines the treatment strategies in practice. Conventional treatments include immune suppression with corticosteroids and, in some cases, splenectomy. In recent years, the number of clinical studies with monoclonal antibodies and immunosuppressants in the treatment of WAIHA increased as the knowledge of autoimmunity mechanisms extended. This thread of developing new tools of treating WAIHA is well exemplified with the success in using anti-CD20 monoclonal antibody, Rituximab. Following this success, other treatment methods based on the immune mechanisms of WAIHA have emerged. We reviewed these newly developed immunotherapy treatments here in order to provide the clinicians with more options in selecting the best therapy for patients with WAIHA, hoping to stimulate researchers to find more novel immunotherapy strategies. PMID:24106518

Gu, Wangang

2013-01-01

163

Transfusion medicine : support of patients undergoing cardiac surgery.  

PubMed

There is still no alternative that is as effective or as well tolerated as blood; nevertheless, the search for ways to conserve, and even eliminate blood transfusion, continues. Based on hemoglobin levels, practice guidelines for the use of perioperative transfusion of red blood cells in patients undergoing coronary artery bypass grafting have been formulated by the National Institutes of Health and the American Society of Anesthesiologists. However, it has been argued that more physiologic indicators of adequacy of oxygen delivery should be used to assess the need for blood transfusion. Methods used for conserving blood during surgery include autologous blood donation, acute normovolemic hemodilution and intra- and postoperative blood recovery and reinfusion. The guidelines for the use of autologous blood transfusion are controversial and it does not appear to be cost effective compared with allogeneic blood transfusion in patients undergoing cardiac surgery. Similarly, the cost effectiveness of intra- and postoperative blood recovery and reinfusion need further evaluation. Treatment with recombinant human erythropoietin (rhEPO) remains unapproved in the US for patients undergoing cardiac or vascular surgery, but it is a valuable adjunct in Jehovah's Witness patients, for whom blood is unacceptable. The characterization of darbepoetin alfa, a novel erythropoiesis stimulating protein with a 3-fold greater plasma elimination half-life compared with rhEPO, is an important advance in this field. Darbepoetin alfa appears to be effective in treating the anemia in patients with renal failure or cancer and trials in patients with surgical anemia are planned. Desmopressin has been used to effectively reduce intraoperative blood loss. Topical agents to prevent blood loss, such as fibrin glue and fibrin gel, and agents that alter platelet function, such as aspirin (acetylsalicylic acid) or dipyridamole, need further evaluation in patients undergoing cardiac surgery. Aprotinin has been shown to preserve hemostasis and reduce allogeneic blood exposure to a greater extent than the antifibrinolytic agents tranexamic acid and aminocaproic acid. Controlled clinical trials comparing the costs of these agents with clinical outcomes, along with tolerability profiles in patients at risk for substantial perioperative bleeding are needed. PMID:14728016

Goodnough, L T; Despotis, G J

2001-01-01

164

Blood Donation and Transfusion: A Primer for Health Educators.  

ERIC Educational Resources Information Center

Presents a primer for health educators about blood donation and transfusion, examining the nature of human blood, the background of blood transfusion, blood donation criteria, risks related to homologous blood transfusion, directed blood donation, potential alternatives to homologous transfusion, and resources for education on the subject. (SM)

Felts, W. Michael; Glascoff, Mary A.

1991-01-01

165

Perioperative intravenous iron: an upfront therapy for treating anaemia and reducing transfusion requirements.  

PubMed

Perioperative anaemia, with iron deficiency being its leading cause, is a frequent condition among surgical patients, and has been linked to increased postoperative morbidity and mortality, and decreased quality of life. Postoperative anaemia is even more frequent and is mainly caused by perioperative blood loss, aggravated by inflammation-induced blunting of erythropoiesis. Allogenic transfusion is commonly used for treating acute perioperative anaemia, but it also increases the rate of morbidity and mortality in surgical and critically ill patients. Thus, overall concerns about adverse effects of both preoperative anaemia and allogeneic transfusion have prompted the review of transfusion practice and the search for safer and more biologically rational treatment options. In this paper, the role of intravenous iron therapy (mostly with iron sucrose and ferric carboxymaltose), as a safe and efficacious tool for treating anaemia and reducing transfusion requirements in surgical patients, as well as in other medical areas, has been reviewed. From the analysis of published data and despite the lack of high quality evidence in some areas, it seems fair to conclude that perioperative intravenous iron administration, with or without erythropoiesis stimulating agents, is safe, results in lower transfusion requirements and hastens recovery from postoperative anaemia. In addition, some studies have reported decreased rates of postoperative infection and mortality, and shorter length of hospital stay in surgical patients receiving intravenous iron. PMID:23588429

Muńoz, M; Gómez-Ramírez, S; Martín-Montańez, E; Pavía, J; Cuenca, J; García-Erce, J A

2012-01-01

166

Comparative analysis of autologous blood transfusion and allogeneic blood transfusion in surgical patients  

PubMed Central

Objective: To investigate application effects of autologous blood transfusion and allogeneic blood transfusion in surgically treated patients receiving spine surgery, abdomen surgery and ectopic pregnancy surgery. Methods: 130 patients who would undergo selective operations were divided into autologous transfusion group and allogeneic transfusion group. Both groups received the same anesthesia, and there was no significant difference in transfusion volume or fluid infusion volume. Results: The serum TNF-? level in autologous transfusion group after operation showed a clear upward trend and had significant difference compared with that before operation (P < 0.05). Meanwhile, after operation, the serum TNF-? level in autologous transfusion group was all significantly higher than that allogeneic transfusion group and the comparative difference was statistically significant (P < 0.05). IgG level in treatment group did not significantly fluctuate during perioperative period, but IgG level in allogeneic transfusion group after operation was all significantly lower than that before operation, and there was statistically significant difference between both groups (P < 0.05). At the same time, complement C3 level in treatment group after operation was significantly higher than that before operation (P < 0.05), but complement C3 level in allogeneic transfusion group did not significantly change. After operation, there was statistically significant difference in complement C3 level between both groups (P < 0.05). Conclusion: Autologous transfusion is already a widely accepted transfusion method at present, and it can increase TNF-? and complement C3 levels in the body of surgically treated patients to strengthen immune ability against infection. PMID:25356154

Long, Miao-Yun; Liu, Zhong-Han; Zhu, Jian-Guang

2014-01-01

167

Transfusion transmitted diseases in perioperative and intensive care settings  

PubMed Central

Patients in the perioperative period and intensive care unit are commonly exposed to blood transfusion (BT). They are at increased risk of transfusion transmitted bacterial, viral and protozoal diseases. The risk of viral transmission has decreased steadily, but the risk of bacterial transmission remains same. Bacterial contamination is more in platelet concentrates than in red cells and least in plasma. The chances of sepsis, morbidity and mortality depend on the number of transfusions and underlying condition of the patient. Challenges to safe BT continue due to new emerging pathogens and various management problems. Strategies to restrict BT, optimal surgical and anaesthetic techniques to reduce blood loss and efforts to develop transfusion alternatives should be made. Literature search was performed using search words/phrases blood transfusion, transfusion, transfusion transmitted diseases, transfusion transmitted bacterial diseases, transfusion transmitted viral diseases, transfusion transmitted protozoal diseases or combinations, on PubMed and Google Scholar from 1990 to 2014.

Das, Rekha; Hansda, Upendra

2014-01-01

168

Transfusion Practices in Postpartum Haemorrhage: a Population-Based Study1 Running headline: Transfusion in Postpartum Haemorrhage3  

E-print Network

-00809169,version1-8Apr2013 #12;4 Abstract1 2 Objective: To describe transfusion practices and blood loss the rate of red blood cell (RBC)8 transfusion in PPH overall and according to transfusion guidelines. Transfusion practices and9 blood loss severity were described by mode of delivery and cause of PPH in women

Paris-Sud XI, Université de

169

Twin-to-twin transfusion syndrome  

MedlinePLUS

Twin-to-twin transfusion syndrome (TTTS) is a rare condition that occurs only in identical twins while they are in the womb. ... TTTS occurs when the blood supply of one twin moves to the other the shared placenta. The ...

170

Blood transfusion practices in obstetric anaesthesia.  

PubMed

Blood transfusion is an essential component of emergency obstetric care and appropriate blood transfusion significantly reduces maternal mortality. Obstetric haemorrhage, especially postpartum haemorrhage, remains one of the major causes of massive haemorrhage and a prime cause of maternal mortality. Blood loss and assessment of its correct requirement are difficult in pregnancy due to physiological changes and comorbid conditions. Many guidelines have been used to assess the requirement and transfusion of blood and its components. Infrastructural, economic, social and religious constraints in blood banking and donation are key issues to formulate practice guidelines. Available current guidelines for transfusion are mostly from the developed world; however, they can be used by developing countries keeping available resources in perspective. PMID:25535427

Jadon, Ashok; Bagai, Rajni

2014-09-01

171

Blood Transfusions and Organ/Tissue Transplants  

MedlinePLUS

... Translate Text Size Print Blood Transfusions & Organ/Tissue Transplants Our Nation's Blood Supply In the early years ... Supply in the United States ?â?ť Organ/Tissue Transplants The risks of transplant-related HIV infection are ...

172

Blood transfusion practices in liver transplantation  

PubMed Central

Blood loss and blood transfusion have been inherently associated with liver transplantation. Bleeding has been attributed to the various factors which are associated with chronic liver dysfunction. Various surgical and anaesthetic strategies have been developed over the years to reduce bleeding and also to optimise the usage of various blood and blood products perioperatively. The present day success of liver transplantation can be attributed to these issues where transfusion practices have changed. Although several centres are successfully performing liver transplantations in large numbers, there is still a large variability in the usage of blood and blood products perioperatively among the institutions and even among different anaesthesiologists from the same institution. The present article deals with the various factors confounding this concept of blood transfusion practices and the various strategies adopted to reduce the transfusion requirements in the perioperative period.

Chidananda Swamy, MN

2014-01-01

173

Blood transfusion practices in obstetric anaesthesia  

PubMed Central

Blood transfusion is an essential component of emergency obstetric care and appropriate blood transfusion significantly reduces maternal mortality. Obstetric haemorrhage, especially postpartum haemorrhage, remains one of the major causes of massive haemorrhage and a prime cause of maternal mortality. Blood loss and assessment of its correct requirement are difficult in pregnancy due to physiological changes and comorbid conditions. Many guidelines have been used to assess the requirement and transfusion of blood and its components. Infrastructural, economic, social and religious constraints in blood banking and donation are key issues to formulate practice guidelines. Available current guidelines for transfusion are mostly from the developed world; however, they can be used by developing countries keeping available resources in perspective.

Jadon, Ashok; Bagai, Rajni

2014-01-01

174

Impact of innovations on transfusion medicine.  

PubMed

The final decade of the last century of the second millennium ad has seen dramatic changes in all aspects of science and health care. In transfusion medicine, the blood supply is the safest it has ever been. Newer refinements and innovations are continuously being researched and implemented to achieve and further enhance safety. Advances in blood conservation, pharmacologic manipulation, engineered blood derivatives, and recombinant growth factors can now provide safer and more effective alternatives to blood transfusions for many patients. This overview highlights selective innovations in transfusion medicine and emphasizes some significant advances that have occurred in blood donor screening, blood component collections and therapy, and laboratory testing. Newer technologies are anticipated that will further enhance the safety of blood and transfusions and potentially augment annually the blood supply on a worldwide basis. PMID:10420220

Sacher, R A; Sandler, S G

1999-08-01

175

Health Care–Associated Infection After Red Blood Cell Transfusion  

PubMed Central

IMPORTANCE The association between red blood cell (RBC) transfusion strategies and health care–associated infection is not fully understood. OBJECTIVE To evaluate whether RBC transfusion thresholds are associated with the risk of infection and whether risk is independent of leukocyte reduction. DATA SOURCES MEDLINE, EMBASE, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, Cochrane Database of Sytematic Reviews, ClinicalTrials.gov, International Clinical Trials Registry, and the International Standard Randomized Controlled Trial Number register were searched through January 22, 2014. STUDY SELECTION Randomized clinical trials with restrictive vs liberal RBC transfusion strategies. DATA EXTRACTION AND SYNTHESIS Twenty randomized trials with 8598 patients met eligibility criteria, of which 17 trials (n = 7456 patients) contained sufficient information for meta-analyses. DerSimonian and Laird random-effects models were used to report pooled risk ratios. Absolute risks of infection were calculated using the profile likelihood random-effects method. MAIN OUTCOMES AND MEASURES Incidence of health care–associated infection such as pneumonia, mediastinitis, wound infection, and sepsis. RESULTS The pooled risk of all serious infections was 10.6% (95% CI, 5.6%-15.9%) in the restrictive group and 12.7% (95% CI, 7.0%-18.7%) in the liberal group. The risk ratio (RR) for the association between transfusion strategies and infection (serious infections and selected infections, combined) was 0.92 (95% CI, 0.82-1.04) with little heterogeneity (I2 = 6.3%; ?2 = .0041). The RR for the association between transfusion strategies and serious infection was 0.84 (95% CI, 0.73-0.96; I2 = 0%, ?2 <.0001). The number needed to treat (NNT) with restrictive strategies to prevent serious infection was 48 (95% CI, 36-71). The risk of infection remained reduced with a restrictive strategy, even with leukocyte reduction (RR, 0.83 [95% CI, 0.69-0.99]). For trials with a restrictive hemoglobin threshold of <7.0 g/dL, the RR was 0.86 (95% CI, 0.72-1.02). With stratification by patient type, the RR for serious infection was 0.72 (95% CI, 0.53-0.97) in patients undergoing orthopedic surgery and 0.51 (95% CI, 0.28-0.95) in patients presenting with sepsis. There were no significant differences in the incidence of infection by RBC threshold for patients with cardiac disease, the critically ill, those with acute upper gastrointestinal bleeding, or for infants with low birth weight. CONCLUSIONS AND RELEVANCE Among hospitalized patients, a restrictive RBC transfusion strategy compared with a liberal transfusion strategy was not associated with a reduced risk of health care–associated infection overall, although it was associated with a reduced risk of serious infection. Implementing restrictive strategies may have the potential to lower the incidence of serious health care–associated infection. PMID:24691607

Rohde, Jeffrey M.; Dimcheff, Derek E.; Blumberg, Neil; Saint, Sanjay; Langa, Kenneth M.; Kuhn, Latoya; Hickner, Andrew; Rogers, Mary A. M.

2014-01-01

176

Transfusion and coagulation management in liver transplantation  

PubMed Central

There is wide variation in the management of coagulation and blood transfusion practice in liver transplantation. The use of blood products intraoperatively is declining and transfusion free transplantations take place ever more frequently. Allogenic blood products have been shown to increase morbidity and mortality. Primary haemostasis, coagulation and fibrinolysis are altered by liver disease. This, combined with intraoperative disturbances of coagulation, increases the risk of bleeding. Meanwhile, the rebalancing of coagulation homeostasis can put patients at risk of hypercoagulability and thrombosis. The application of the principles of patient blood management to transplantation can reduce the risk of transfusion. This includes: preoperative recognition and treatment of anaemia, reduction of perioperative blood loss and the use of restrictive haemoglobin based transfusion triggers. The use of point of care coagulation monitoring using whole blood viscoelastic testing provides a picture of the complete coagulation process by which to guide and direct coagulation management. Pharmacological methods to reduce blood loss include the use of anti-fibrinolytic drugs to reduce fibrinolysis, and rarely, the use of recombinant factor VIIa. Factor concentrates are increasingly used; fibrinogen concentrates to improve clot strength and stability, and prothrombin complex concentrates to improve thrombin generation. Non-pharmacological methods to reduce blood loss include surgical utilisation of the piggyback technique and maintenance of a low central venous pressure. The use of intraoperative cell salvage and normovolaemic haemodilution reduces allogenic blood transfusion. Further research into methods of decreasing blood loss and alternatives to blood transfusion remains necessary to continue to improve outcomes after transplantation. PMID:24876736

Clevenger, Ben; Mallett, Susan V

2014-01-01

177

In Vitro Prostacyclin Production in the Hemolytic-Uremic Syndrome  

PubMed Central

Reports from Europe suggest that the hemolytic-uremic syndrome is associated with an impaired ability to produce prostacyclin (prostaglandin [PG] I2), a potent inhibitor of platelet aggregation and thrombus formation. In comparing the production of PGI2 by cultured endothelial cells using serum obtained from 22 children with the hemolytic-uremic syndrome with values obtained using serum from 22 normal children, we found that cultured endothelial cells produced less PGF1? (the stable metabolite of PGI2) when incubated with affected serum. The relationship of this observation to the pathogenesis of the hemolytic-uremic syndrome is unclear. PMID:3754077

Siegler, Richard L.; Smith, Jean B.; Lynch, Michael B.; Mohammad, S. F.

1986-01-01

178

Postoperative Atypical Hemolytic Uremic Syndrome Associated with Complement C3 Mutation  

PubMed Central

Atypical hemolytic uremic syndrome (aHUS) can be distinguished from typical or Shiga-like toxin-induced HUS. The clinical outcome is unfavorable; up to 50% of affected patients progress to end-stage renal failure and 25% die during the acute phase. Multiple conditions have been associated with aHUS, including infections, drugs, autoimmune conditions, transplantation, pregnancy, and metabolic conditions. aHUS in the nontransplant postsurgical period, however, is rare. An 8-month-old boy underwent surgical repair of tetralogy of Fallot. Neurological disturbances, acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia developed 25 days later, and aHUS was diagnosed. Further evaluation revealed that his complement factor H (CFH) level was normal and that anti-FH antibodies were not detected in his plasma. Sequencing of his CFH, complement factor I, membrane cofactor protein, complement factor B, and thrombomodulin genes was normal. His ADAMTS-13 (a disintegrin-like and metalloprotease with thrombospondin-1 repeats 13) activity was also normal. However, he had a potentially causative mutation (R425C) in complement component C3. Restriction fragment length polymorphism analysis revealed that his father and aunt also had this mutation; however, they had no symptoms of aHUS. We herein report a case of aHUS that developed after cardiovascular surgery and was caused by a complement C3 mutation. PMID:25431709

Matsukuma, Eiji; Imamura, Atsushi; Iwata, Yusuke; Takeuchi, Takamasa; Yoshida, Yoko; Fujimura, Yoshihiro; Fan, Xinping; Miyata, Toshiyuki; Kuwahara, Takashi

2014-01-01

179

The kinetics of hematopoiesis in the light horse III. The hematological response to hemolytic anemia.  

PubMed

The hematological response to acetylphenylhydrazine hemolytic anemia was studied in three standardbred horses. The lifespan of erythrocytes produced during the most severe phase of the anemia were measured with 75-selenomethionine and found to be 144 days as compared to the 139 day lifespan in response to hemorrhagic anemia or 155 days in normal standardbred horses measured previously using the same technique. The erythrocyte counts returned to initial values in 42 days (37, 34 and 54 days) a mean erythrocyte production of 6.4 times 10-12 erythrocytes/day. The mean hemoglobin production was 0.31 gm/kg body weight/day as compared to 0.11 gm Hb/kg/day previously observed in response to hemorrhagic anemia. The mean increase in erythrocyte mean cell volume was 12 mu-3 during the acute response phase to hemolytic anemia in contrast to the absence of a significant increase in the mean cell volume as previously observed during response to hemorrhagic anemia. Free Heinz bodies separated from erythrocytes during the acute phase could not be differentiated from platelets on the hemocytometer counting chamber with standard techniques. PMID:1139414

Lumsden, H J; Valli, V E; McSherry, B J; Robinson, G A; Claxton, M J

1975-07-01

180

The kinetics of hematopoiesis in the light horse III. The hematological response to hemolytic anemia.  

PubMed Central

The hematological response to acetylphenylhydrazine hemolytic anemia was studied in three standardbred horses. The lifespan of erythrocytes produced during the most severe phase of the anemia were measured with 75-selenomethionine and found to be 144 days as compared to the 139 day lifespan in response to hemorrhagic anemia or 155 days in normal standardbred horses measured previously using the same technique. The erythrocyte counts returned to initial values in 42 days (37, 34 and 54 days) a mean erythrocyte production of 6.4 times 10-12 erythrocytes/day. The mean hemoglobin production was 0.31 gm/kg body weight/day as compared to 0.11 gm Hb/kg/day previously observed in response to hemorrhagic anemia. The mean increase in erythrocyte mean cell volume was 12 mu-3 during the acute response phase to hemolytic anemia in contrast to the absence of a significant increase in the mean cell volume as previously observed during response to hemorrhagic anemia. Free Heinz bodies separated from erythrocytes during the acute phase could not be differentiated from platelets on the hemocytometer counting chamber with standard techniques. PMID:1139414

Lumsden, H J; Valli, V E; McSherry, B J; Robinson, G A; Claxton, M J

1975-01-01

181

Cost of allogeneic and autologous blood transfusion in Canada. Canadian Cost of Transfusion Study Group.  

PubMed Central

OBJECTIVE: To determine the cost, from a societal perspective, of blood transfusion in Canada. STUDY DESIGN: Cost-structure analysis. SETTING: Data were collected from eight hospitals and from six blood centres operated by the Canadian Red Cross Society in four provinces. OUTCOME MEASURES: Costs associated with four stages of transfusion-- collection, production, distribution and delivery--in 1933 were assessed. Costs were divided into the following categories; personnel, purchases, external services, overhead, donors' time, patients' time (for autologous transfusion), wastage and infection. RESULTS: The mean overall cost of a transfusion performed on an inpatient basis was $210 per unit of red blood cells for an allogeneic transfusion and $338 per unit of blood for an autologous transfusion. The mean cost of an allogeneic transfusion performed on an outpatient basis was $280 per unit of red blood cells. CONCLUSION: The costs determined in this study can be used in future studies comparing the cost-effectiveness of allogeneic transfusion with that of alternative methods. PMID:8625000

Tretiak, R; Laupacis, A; Rivičre, M; McKerracher, K; Souętre, E

1996-01-01

182

Thrombopoietin following transfusion of platelets in preterm neonates.  

PubMed

Thrombocytopenia is common in the neonatal intensive care unit. Transfusion of platelets is often required. The purpose of our study was to determine changes in thrombopoietin (Tpo) following transfusion of platelets in preterm neonates. Preterm neonates undergoing platelet transfusion were randomized to receive a transfusion volume of either 10 or 15 ml/kg. Blood was obtained for Tpo measurement pre-transfusion, one and 24 hours post-transfusion. Platelet Factor 4 (PF4) was also measured to quantify platelet activation. Statistical analysis was performed using repeated measures ANOVA, and Mann-Whitney U test as appropriate. Ten infants were enrolled in each group. Gestational age, birth weight, etiology of thrombocytopenia, and timing of transfusion did not differ between the 10 and 15 ml/kg groups. There were no differences between the groups in platelet count prior to and/or following transfusion. Both transfusion volumes were equally well tolerated. Tpo and PF4 did not differ between groups at any of the study time points. When both groups were analysed together, Tpo dropped 43% (95% confidence 37-49%, p = 0.01) 1-hour post compared to pre-transfusion. In conclusion the observed decrease in Tpo following platelet transfusion suggests that Tpo kinetics in neonates is similar to adults following transfusion. PF4 was not affected by transfusion. There was not an increase in platelet count following transfusion volume of 15 ml/kg compared to 10 ml/kg. PMID:18925510

Kline, Alex; Mackley, Amy; Taylor, Scott M; McKenzie, Steven E; Paul, David A

2008-09-01

183

Reappraisal of the Etiology of Extracorpuscular Non-Autoimmune Acquired Hemolytic Anemia in 2657 Hospitalized Patients with Non-Neoplastic Disease  

PubMed Central

INTRODUCTION Unlike autoimmune hemolytic anemia (AIHA), literature on the etiological study of non-autoimmune hemolytic anemia (non-AIHA) is scarce. The incidence and prevalence of non-AIHA in different geographic regions are largely unknown perhaps owing to the lack of perspective investigation and different profiles of etiologies from different geographic regions. We aimed to examine the real-world etiology or mechanisms of the non-hereditary non-AIHA from a nationwide population-based administrative claim database in Taiwan. PATIENTS AND METHODS The National Health Insurance Research Database of Taiwan was adopted for this research. The studied population was total inpatient claim records including both pediatric and adult patients, contributed by a population of 23 million insured individuals in Taiwan. From 2002 to 2008, we retrieved 3,903 patients having no pre-existing malignancy discharged after inpatient management for acquired hemolytic anemia, which was defined as coding in discharge diagnoses containing ICD-9-CM code 283. By contrast, ICD-9-CM code 282 and all of the sub-codes are for hereditary hemolytic anemias. RESULTS AIHA accounted for 32% of the total cases. Among 2,657 patients with non-AIHA, mechanical or microangiopathic mechanism accounted for 19% of cases; hemolytic-uremic syndrome (HUS) 4%, hemoglobinuria because of hemolysis from external causes such as paroxysmal nocturnal hemoglobinuria (PNH) and march hemoglobinuria 7%, and chronic idiopathic hemolytic anemia or other unspecified non-AIHA 69%. We looked further for specific etiology or mechanism for this group of patients with non-hereditary extrinsic non-AIHA (n = 2,657). The explanatory disease states or conditions were splenomegaly; alcohol use disorder (spur cell hemolysis); heart-valve prosthesis; malignant hypertension; disseminated intravascular coagulation; transfusion reaction; dengue fever-induced hemolytic anemia; direct parasitization; snake, lizard, or spider bite; and Wilson’s disease with internal toxin mechanism. All these cases can explain up to 34.6% of all the non-hereditary extrinsic non-AIHA cases. Fragmentation hemolysis (HUS, heart-valve prosthesis, malignant hypertension, and disseminated intravascular coagulation) accounted for 7.4% of non-AIHA hospitalized patients with non-neoplastic disease. CONCLUSIONS This article is the first one to clearly demonstrate that the non-neoplastic-induced HUS requiring hospitalization cases in Taiwan, which has a population of over 23 million were 110 over a span of seven years, 16 cases per year. Although the etiologies of non-AIHA are well known and described in the literature, this work added the statistical percentages of the various etiologies of non-AIHA in Taiwan. PMID:24808725

Kok, Victor C; Lee, Chien-Kuan; Horng, Jorng-Tzong; Lin, Che-Chen; Sung, Fung-Chang

2014-01-01

184

Cost-effectiveness analysis of preoperative transfusion in patients with sickle cell disease using evidence from the TAPS trial  

PubMed Central

The study’s objective was to assess the cost-effectiveness of preoperative transfusion compared with no preoperative transfusion in patients with sickle cell disease undergoing low- or medium-risk surgery. Seventy patients with sickle cell disease (HbSS/Sß0thal genotypes) undergoing elective surgery participated in a multicentre randomised trial, Transfusion Alternatives Preoperatively in Sickle Cell Disease (TAPS). Here, a cost-effectiveness analysis based on evidence from that trial is presented. A decision-analytic model is used to incorporate long-term consequences of transfusions and acute chest syndrome. Costs and health benefits, expressed as quality-adjusted life years (QALYs), are reported from the ‘within-trial’ analysis and for the decision-analytic model. The probability of cost-effectiveness for each form of management is calculated taking into account the small sample size and other sources of uncertainty. In the range of scenarios considered in the analysis, preoperative transfusion was more effective, with the mean improvement in QALYs ranging from 0.018 to 0.206 per patient, and also less costly in all but one scenario, with the mean cost difference ranging from ?Ł813 to Ł26. All scenarios suggested preoperative transfusion had a probability of cost-effectiveness >0.79 at a cost-effectiveness threshold of Ł20 000 per QALY. PMID:24329965

Spackman, Eldon; Sculpher, Mark; Howard, Jo; Malfroy, Moira; Llewelyn, Charlotte; Choo, Louise; Hodge, Renate; Johnson, Tony; Rees, David C; Fijnvandraat, Karin; Kirby-Allen, Melanie; Davies, Sally; Williamson, Lorna

2014-01-01

185

Modification of sticholysin II hemolytic activity by free radicals  

Microsoft Academic Search

Sticholysin II is a highly hemolytic toxin present in the caribbean sea anemone Stichodactyla helianthus. Pre-incubation of St II with 2,2?-azobis(2-amidinopropane), a source of peroxyl radicals in air saturated solution, readily reduces its hemolytic activity. Analysis of the amino acids present in the protein after its modification shows that only tryptophan groups are significantly modified by the free radicals. According

Isabel F. Pazos; Carlos Alvarez; Maria E. Lanio; Diana Martinez; Vivian Morera; Eduardo A. Lissi; Ana M. Campos

1998-01-01

186

Blood transfusion practices in cancer surgery  

PubMed Central

Cancer patients are commonly transfused with blood products immediately before, during or after major surgery. Blood loss and haemodilution are the most common causes of red blood cells (RBCs) administration and coagulopathies are the indications for the infusion of fresh-frozen plasma (FFP), cryoprecipitates and platelets. Transfusion-related immune modulation is a complication associated with the administration of blood products. A decreased immune surveillance as a consequence of blood transfusions has been linked to cancer recurrence and progression. Moreover, soluble factors present in packed RBCs, platelets and FFP can directly stimulate tumour growth and spread. Two meta-analyses suggest that the administration of blood products is associated with shorter recurrence-free survival and overall survival after colorectal cancer surgery. More studies are needed to show such association in different cancer patient populations.

Cata, Juan P; Gottumukkala, Vijaya

2014-01-01

187

When to consider transfusion therapy for patients with non-transfusion-dependent thalassaemia.  

PubMed

Non-transfusion-dependent thalassaemia (NTDT) refers to all thalassaemia disease phenotypes that do not require regular blood transfusions for survival. Thalassaemia disorders were traditionally concentrated along the tropical belt stretching from sub-Saharan Africa through the Mediterranean region and the Middle East to South and South-East Asia, but global migration has led to increased incidence in North America and Northern Europe. Transfusionists may be familiar with ?-thalassaemia major because of the lifelong transfusions needed by these patients. Although patients with NTDT do not require regular transfusions for survival, they may require transfusions in some instances such as pregnancy, infection or growth failure. The complications associated with NTDT can be severe if not properly managed, and many are directly related to chronic anaemia. Awareness of NTDT is important, and this review will outline the factors that should be taken into consideration when deciding whether to initiate and properly plan for transfusion therapy in these patients in terms of transfusion interval and duration of treatment. PMID:25286743

Taher, A T; Radwan, A; Viprakasit, V

2015-01-01

188

When to consider transfusion therapy for patients with non-transfusion-dependent thalassaemia  

PubMed Central

Non-transfusion-dependent thalassaemia (NTDT) refers to all thalassaemia disease phenotypes that do not require regular blood transfusions for survival. Thalassaemia disorders were traditionally concentrated along the tropical belt stretching from sub-Saharan Africa through the Mediterranean region and the Middle East to South and South-East Asia, but global migration has led to increased incidence in North America and Northern Europe. Transfusionists may be familiar with ?-thalassaemia major because of the lifelong transfusions needed by these patients. Although patients with NTDT do not require regular transfusions for survival, they may require transfusions in some instances such as pregnancy, infection or growth failure. The complications associated with NTDT can be severe if not properly managed, and many are directly related to chronic anaemia. Awareness of NTDT is important, and this review will outline the factors that should be taken into consideration when deciding whether to initiate and properly plan for transfusion therapy in these patients in terms of transfusion interval and duration of treatment. PMID:25286743

Taher, A T; Radwan, A; Viprakasit, V

2015-01-01

189

STUDIES ON BACTERIOPHAGES OF HEMOLYTIC STREPTOCOCCI  

PubMed Central

The host ranges of bacteriophages for group A, types 1, 6, 12, and 25 and group C streptococci have been determined. The findings indicate that the susceptibility to these phages is primarily a group-specific phenomenon, although it is modified by several factors such as the hyaluronic acid capsule, lysogeny, and possibly the presence of surface proteins. Phage antibody studies indicate that while the group A phages are antigenically related, they are distinct from the group C phage. This is in agreement with the observation that group A phages are not specific for their homologous streptococcal types. The purified group C carbohydrate inactivates group C phage but not the group A phages, thus suggesting that the carbohydrate, a component of the cell wall, may serve as the phage receptor site. It has not been possible to inactivate the group A phages with group A carbohydrate. Phage lysis of groups A and C streptococci is accompanied by fragmentation of the cell wall since the C carbohydrate has been identified serologically and chemically in the supernate of centrifuged lysates. The immediate lysis of groups A and C hemolytic streptococci and their isolated cell walls by an accesory heat-labile lytic factor in fresh group C lysates is also described. PMID:13463248

Krause, Richard M.

1957-01-01

190

Establishment of permanent chimerism in a lactate dehydrogenase-deficient mouse mutant with hemolytic anemia  

SciTech Connect

Pluripotent hemopoietic stem cell function was investigated in the homozygous muscle type lactate dehydrogenase (LDH-A) mutant mouse using bone marrow transplantation experiments. Hemopoietic tissues of LDH-A mutants showed a marked decreased in enzyme activity that was associated with severe hemolytic anemia. This condition proved to be transplantable into wild type mice (+/+) through total body irradiation (TBI) at a lethal dose of 8.0 Gy followed by engraftment of mutant bone marrow cells. Since the mutants are extremely radiosensitive (lethal dose50/30 4.4 Gy vs 7.3 Gy in +/+ mice), 8.0-Gy TBI followed by injection of even high numbers of normal bone marrow cells did not prevent death within 5-6 days. After a nonlethal dose of 4.0 Gy and grafting of normal bone marrow cells, a transient chimerism showing peripheral blood characteristics of the wild type was produced that returned to the mutant condition within 12 weeks. The transfusion of wild type red blood cells prior to and following 8.0-Gy TBI and reconstitution with wild type bone marrow cells prevented the early death of the mutants and permanent chimerism was achieved. The chimeras showed all hematological parameters of wild type mice, and radiosensitivity returned to normal. It is concluded that the mutant pluripotent stem cells are functionally comparable to normal stem cells, emphasizing the significance of this mouse model for studies of stem cell regulation.

Datta, T.; Doermer, P.

1987-12-01

191

42 CFR 493.1103 - Standard: Requirements for transfusion services.  

Code of Federal Regulations, 2013 CFR

...a facility stores or maintains blood or blood products for transfusion outside of a monitored refrigerator, the...promptly identify, investigate, and report blood and blood product transfusion reactions to the laboratory and, as...

2013-10-01

192

42 CFR 493.1103 - Standard: Requirements for transfusion services.  

Code of Federal Regulations, 2012 CFR

...a facility stores or maintains blood or blood products for transfusion outside of a monitored refrigerator, the...promptly identify, investigate, and report blood and blood product transfusion reactions to the laboratory and, as...

2012-10-01

193

42 CFR 493.1103 - Standard: Requirements for transfusion services.  

Code of Federal Regulations, 2010 CFR

...a facility stores or maintains blood or blood products for transfusion outside of a monitored refrigerator, the...promptly identify, investigate, and report blood and blood product transfusion reactions to the laboratory and, as...

2010-10-01

194

42 CFR 493.1103 - Standard: Requirements for transfusion services.  

Code of Federal Regulations, 2011 CFR

...a facility stores or maintains blood or blood products for transfusion outside of a monitored refrigerator, the...promptly identify, investigate, and report blood and blood product transfusion reactions to the laboratory and, as...

2011-10-01

195

42 CFR 493.1103 - Standard: Requirements for transfusion services.  

...a facility stores or maintains blood or blood products for transfusion outside of a monitored refrigerator, the...promptly identify, investigate, and report blood and blood product transfusion reactions to the laboratory and, as...

2014-10-01

196

Blood Transfusions During Heart Surgery May Up Pneumonia Risk  

MedlinePLUS

... JavaScript. Blood Transfusions During Heart Surgery May Up Pneumonia Risk But study found overall rate was under ... Blood Transfusion and Donation Coronary Artery Bypass Surgery Pneumonia TUESDAY, Jan. 27, 2015 (HealthDay News) -- Receiving a ...

197

Battlefield Blood-Transfusion 'Recipe' Passes Real-Life Test  

MedlinePLUS

... reports. A blood transfusion "recipe" containing equal parts plasma, platelets and red blood cells is the most ... a blood transfusion mix that contained one part plasma and one part platelets to two parts red ...

198

The Signaling Role of CD40 Ligand in Platelet Biology and in Platelet Component Transfusion  

PubMed Central

The CD40 ligand (CD40L) is a transmembrane molecule of crucial interest in cell signaling in innate and adaptive immunity. It is expressed by a variety of cells, but mainly by activated T-lymphocytes and platelets. CD40L may be cleaved into a soluble form (sCD40L) that has a cytokine-like activity. Both forms bind to several receptors, including CD40. This interaction is necessary for the antigen specific immune response. Furthermore, CD40L and sCD40L are involved in inflammation and a panoply of immune related and vascular pathologies. Soluble CD40L is primarily produced by platelets after activation, degranulation and cleavage, which may present a problem for transfusion. Soluble CD40L is involved in adverse transfusion events including transfusion related acute lung injury (TRALI). Although platelet storage designed for transfusion occurs in sterile conditions, platelets are activated and release sCD40L without known agonists. Recently, proteomic studies identified signaling pathways activated in platelet concentrates. Soluble CD40L is a good candidate for platelet activation in an auto-amplification loop. In this review, we describe the immunomodulatory role of CD40L in physiological and pathological conditions. We will focus on the main signaling pathways activated by CD40L after binding to its different receptors. PMID:25479079

Aoui, Chaker; Prigent, Antoine; Sut, Caroline; Tariket, Sofiane; Hamzeh-Cognasse, Hind; Pozzetto, Bruno; Richard, Yolande; Cognasse, Fabrice; Laradi, Sandrine; Garraud, Olivier

2014-01-01

199

The Signaling Role of CD40 Ligand in Platelet Biology and in Platelet Component Transfusion.  

PubMed

The CD40 ligand (CD40L) is a transmembrane molecule of crucial interest in cell signaling in innate and adaptive immunity. It is expressed by a variety of cells, but mainly by activated T-lymphocytes and platelets. CD40L may be cleaved into a soluble form (sCD40L) that has a cytokine-like activity. Both forms bind to several receptors, including CD40. This interaction is necessary for the antigen specific immune response. Furthermore, CD40L and sCD40L are involved in inflammation and a panoply of immune related and vascular pathologies. Soluble CD40L is primarily produced by platelets after activation, degranulation and cleavage, which may present a problem for transfusion. Soluble CD40L is involved in adverse transfusion events including transfusion related acute lung injury (TRALI). Although platelet storage designed for transfusion occurs in sterile conditions, platelets are activated and release sCD40L without known agonists. Recently, proteomic studies identified signaling pathways activated in platelet concentrates. Soluble CD40L is a good candidate for platelet activation in an auto-amplification loop. In this review, we describe the immunomodulatory role of CD40L in physiological and pathological conditions. We will focus on the main signaling pathways activated by CD40L after binding to its different receptors. PMID:25479079

Aloui, Chaker; Prigent, Antoine; Sut, Caroline; Tariket, Sofiane; Hamzeh-Cognasse, Hind; Pozzetto, Bruno; Richard, Yolande; Cognasse, Fabrice; Laradi, Sandrine; Garraud, Olivier

2014-01-01

200

Rh Disease: Intravascular Fetal Blood Transfusion by Cordocentesis  

Microsoft Academic Search

A total of 130 cordocenteses, including 96 intravascular fetal blood transfusions, were performed in 21 pregnancies complicated by red cell isoimmunization. Transfusions were commenced at 18–34 weeks’ gestation and repeated up to 7 times, at 1- to 4-week intervals. The volumes of transfused blood were 5–150 ml, the haematocrits 62–88 % and the rate of transfusions 1–15 ml\\/min. The pretransfusion

K. H. Nicolaides; P. W. Soothill; C. H. Rodeck; W. Clewell

1986-01-01

201

Red Blood Cell Transfusions for Selected Neonatal and Pediatric Patients  

Microsoft Academic Search

\\u000a Neonatal and pediatric transfusion practice includes consideration of the neonate’s immature immunologie, renal, and hepatic\\u000a function; and it encompasses new technologies and innovative programs that limit donor exposures and infectious disease risks.\\u000a Neonatal and pediatric transfusion practice is not merely the transfusion of small volumes of blood to small people.

Elaine K. Jeter; Mary Ann Spivey

202

Department and function: Professor, Institute for Transfusion Medicine  

E-print Network

Department and function: Professor, Institute for Transfusion Medicine Education: 1988 ­ 1993, Institute for Transfusion Medicine, MHH Positions: 1996-1999 Research Group Leader at the German Red Cross Institute, Springe 1999-2003 Research Group Leader, Institute for Transfusion Medicine, MHH 2003-recent W1

Manstein, Dietmar J.

203

The Blood Transfusion Service Joel Umlas and Christopher P. Stowell  

E-print Network

319 Chapter The Blood Transfusion Service Joel Umlas and Christopher P. Stowell Transfusion in France using lamb's blood (1). A fourth patient died, apparently as a direct result of the procedure, which led to the banning of transfusions by the French Parliament (2). Blood banking, the stor- age

Mootha, Vamsi K.

204

An enzyme-linked immunoabsorbent assay for estimating red cell survival of transfused red cells-validation using CR-51 labeling  

SciTech Connect

The survival time of transfused red cells antigenically distinct from the recipient's red cells was determined using an indirect enzyme linked antiglobulin test. These results were then compared to those determined by Cr-51 labeling. Three patients with hypoproliferative anemias and one patient (2 studies) with traumatic hemolytic anemia caused by a prosthetic heart valve were studied. Survival times were performed by transfusing a 5cc aliquot of Cr-51 labeled cells along with the remaining unit. One hour post transfusion, a blood sample was drawn and used as the 100% value. Subsequent samples drawn over a 2-3 week period were then compared to the initial sample to determine percent survival for both methods. The ELISA method for measuring red cell survival in antigenically distinct cells is in close agreement with the Cr-51 method. Although CR-51 labeling is the accepted method for red cell survival determination the ELISA method can be used when radioisotopes are unavailable or contraindicated or when the decision to estimate red cell survival is made after transfusion.

Drew, H.; Kickler, T.; Smith, B.; LaFrance, N.

1984-01-01

205

Current treatment of atypical hemolytic uremic syndrome  

PubMed Central

Summary Tremendous advances have been made in understanding the pathogenesis of atypical Hemolytic Uremic Syndrome (aHUS), an extremely rare disease. Insights into the molecular biology of aHUS resulted in rapid advances in treatment with eculizumab (Soliris®, Alexion Pharmaceuticals Inc.). Historically, aHUS was associated with very high rates of mortality and morbidity. Prior therapies included plasma therapy and/or liver transplantation. Although often life saving, these were imperfect and had many complications. We review the conditions included under the rubric of aHUS: S. pneumoniae HUS (SpHUS), inborn errors of metabolism, and disorders of complement regulation, emphasizing their differences and similarities. We focus on the clinical features, diagnosis, and pathogenesis, and treatment of aHUS that results from mutations in genes encoding alternative complement regulators, SpHUS and HUS associated with inborn errors of metabolism. Mutations in complement genes, or antibodies to their protein products, result in unregulated activity of the alternate complement pathway, endothelial injury, and thrombotic microangiopathy (TMA). Eculizumab is a humanized monoclonal antibody that inhibits the production of the terminal complement components C5a and the membrane attack complex (C5b-9) by binding to complement protein C5a. This blocks the proinflammatory and cytolytic effects of terminal complement activation. Eculizumab use has been reported in many case reports, and retrospective and prospective clinical trials in aHUS. There have been few serious side effects and no reports of tachphylaxis or drug resistance. The results are very encouraging and eculizumab is now recognized as the treatment of choice for aHUS. PMID:25343125

Kaplan, Bernard S.; Ruebner, Rebecca L.; Spinale, Joann M.; Copelovitch, Lawrence

2014-01-01

206

Hemolytic-uremic syndrome in Switzerland: a nationwide surveillance 1997-2003.  

PubMed

Hemolytic-uremic syndrome (HUS) is a leading cause of acute renal failure in childhood. In its typical presentation, it is preceded by an episode of diarrhea mostly due to Shiga-toxin-producing Escherichia coli. There is important geographical variation of many aspects of this syndrome. Nationwide data on childhood HUS in Switzerland have not been available so far. In a prospective national study through the Swiss Pediatric Surveillance Unit 114 cases (median age 21 months, 50% boys) were reported between April 1997 and March 2003 by 38 pediatric units (annual incidence 1.42 per 10(5) children < or =16 years). Shiga-toxin-producing E. coli were isolated in 32 (60%) of tested stool samples, serotype O157:H7 in eight. Sixteen children presented with only minimal renal involvement, including three with underlying urinary tract infection. Six patients presented with atypical hemolytic-uremic syndrome, and six with HUS due to invasive Streptococcus pneumoniae infection. Mortality was 5.3%, including two out of six children with S. pneumoniae infection. The severity of thrombocytopenia and the presence of central nervous system involvement significantly correlated with mortality. In conclusion, childhood HUS is not rare in Switzerland. Contrasting other countries, E. coli O157:H7 play only a minor role in the etiology. Incomplete manifestation is not uncommon. PMID:19830454

Schifferli, Alexandra; von Vigier, Rodo O; Fontana, Matteo; Spartŕ, Giuseppina; Schmid, Hans; Bianchetti, Mario G; Rudin, Christoph

2010-05-01

207

Familial Atypical Hemolytic Uremic Syndrome: A Review of Its Genetic and Clinical Aspects  

PubMed Central

Atypical hemolytic uremic syndrome (aHUS) is a rare renal disease (two per one million in the USA) characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. Both sporadic (80% of cases) and familial (20% of cases) forms are recognized. The study of familial aHUS has implicated genetic variation in multiple genes in the complement system in disease pathogenesis, helping to define the mechanism whereby complement dysregulation at the cell surface level leads to both sporadic and familial disease. This understanding has culminated in the use of Eculizumab as first-line therapy in disease treatment, significantly changing the care and prognosis of affected patients. However, even with this bright outlook, major challenges remain to understand the complexity of aHUS at the genetic level. It is possible that a more detailed picture of aHUS can be translated to an improved understanding of disease penetrance, which is highly variable, and response to therapy, both in the short and long terms. PMID:23251215

Bu, Fengxiao; Borsa, Nicolo; Gianluigi, Ardissino; Smith, Richard J. H.

2012-01-01

208

Anemia and transfusion after subarachnoid hemorrhage.  

PubMed

Delayed cerebral ischemia after subarachnoid hemorrhage (SAH) may be affected by a number of factors, including cerebral blood flow and oxygen delivery. Anemia affects about half of patients with SAH and is associated with worse outcome. Anemia also may contribute to the development of or exacerbate delayed cerebral ischemia. This review was designed to examine the prevalence and impact of anemia in patients with SAH and to evaluate the effects of transfusion. A literature search was made to identify original research on anemia and transfusion in SAH patients. A total of 27 articles were identified that addressed the effects of red blood cell transfusion (RBCT) on brain physiology, anemia in SAH, and clinical management with RBCT or erythropoietin. Most studies provided retrospectively analyzed data of very low-quality according to the GRADE criteria. While RBCT can have beneficial effects on brain physiology, RBCT may be associated with medical complications, infection, vasospasm, and poor outcome after SAH. The effects may vary with disease severity or the presence of vasospasm, but it remains unclear whether RBCTs are a marker of disease severity or a cause of worse outcome. Erythropoietin data are limited. The literature review further suggests that the results of the Transfusion Requirements in Critical Care Trial and subsequent observational studies on RBCT in general critical care do not apply to SAH patients and that randomized trials to address the role of RBCT in SAH are required. PMID:21769459

Le Roux, Peter D

2011-09-01

209

Patient blood management to reduce transfusion need.  

PubMed

Patient blood management is a multidisciplinary, patient-centered approach aimed at improving patient outcomes, preserving the blood supply, and reducing costs. By identifying patients at risk for transfusion and taking steps to maintain hemoglobin concentration, manage anemia, optimize hemostasis, and minimize blood loss, clinicians can improve patient outcomes. PMID:25621967

Lynn, Shannon

2015-02-01

210

Twin-to-twin transfusion syndrome  

MedlinePLUS Videos and Cool Tools

Twin to Twin Transfusion Syndrome, or TTTS, is a disease of the placenta. This condition affects twins or other multiples that share a single placenta containing blood vessels going from one baby to the other. Blood from the smaller "donor" twin is transferred to the larger " ...

211

Utilization management in the blood transfusion service.  

PubMed

The scope of activity of the Blood Transfusion Service (BTS) makes it unique among the clinical laboratories. The combination of therapeutic and diagnostic roles necessitates a multi-faceted approach to utilization management in the BTS. We present our experience in utilization management in large academic medical center. PMID:24080431

Peńa, Jeremy Ryan Andrew; Dzik, Walter Sunny

2014-01-01

212

Alloimmunization among transfusion-dependent thalassemia patients  

PubMed Central

Background: Thalassemia is a common hemoglobin disorder in Iran and one of the major public health problems. Although blood transfusions are lifesavers for thalassemia patients, they may be associated with some complications especially erythrocyte alloimmunization. The purpose of this study was to investigate the prevalence of red blood cell alloantibodies and to determine types of these antibodies among multiple-transfused thalassemic patients. Materials and Methods: A total of 313 thalassemia patients in the northeast of Iran, who received regular blood transfusion, were included in this study. Screening of antibodies was performed on fresh serum of all patients and then antibodies were identified in patients’ serum that had positive antibody screening test using a panel of recognized blood group antigens. Results: We identified 12 alloantibodies in 9 patients (2.87%) that all were against Rhesus (Rh) blood group antigens (D, C, E). Three patients developed 2 antibodies, and others had one antibody. The most common alloantibodies were Anti-D (88.88%) and followed by Anti-C and Anti-E. Higher frequency of alloimmunization was observed in female, Rh negative and splenectomized patients. Conclusion: This study showed that evaluation of the packed cells for Rh (C, E) from the start of transfusion can be helpful in decreasing the rate of alloantibody synthesis. PMID:20808654

Sadeghian, Mohammad Hadi; Keramati, Mohammad Reza; Badiei, Zahra; Ravarian, Mehrangiz; Ayatollahi, Hossein; Rafatpanah, Houshang; Daluei, Mohammad Khajeh

2009-01-01

213

Transmission of prion diseases by blood transfusion  

Microsoft Academic Search

Attempts to detect infectivity in the blood of humans and animals affected with transmissible spongiform encephalopathies (TSEs or prion diseases) have often been inconclusive because of the limitations of cross-species bioassays and the small volumes of blood that can be injected by the intracerebral route. A model has been developed for the experimental study of TSE transmission by blood transfusion

Nora Hunter; James Foster; Angela Chong; Sandra McCutcheon; David Parnham; Samantha Eaton; Calum MacKenzie; Fiona Houston

2002-01-01

214

Alloantibodies to a paternally derived RBC KEL antigen lead to hemolytic disease of the fetus/newborn in a murine model  

PubMed Central

Exposure to nonself red blood cell (RBC) antigens, either from transfusion or pregnancy, may result in alloimmunization and incompatible RBC clearance. First described as a pregnancy complication 80 years ago, hemolytic disease of the fetus and newborn (HDFN) is caused by alloimmunization to paternally derived RBC antigens. Despite the morbidity/mortality of HDFN, women at risk for RBC alloimmunization have few therapeutic options. Given that alloantibodies to antigens in the KEL family are among the most clinically significant, we developed a murine model with RBC-specific expression of the human KEL antigen to evaluate the impact of maternal/fetal KEL incompatibility. After exposure to fetal KEL RBCs during successive pregnancies with KEL-positive males, 21 of 21 wild-type female mice developed anti-KEL alloantibodies; intrauterine fetal anemia and/or demise occurred in a subset of KEL-positive pups born to wild type, but not agammaglobulinemic mothers. Similar to previous observations in humans, pregnancy-associated alloantibodies were detrimental in a transfusion setting, and transfusion-associated alloantibodies were detrimental in a pregnancy setting. This is the first pregnancy-associated HDFN model described to date, which will serve as a platform to develop targeted therapies to prevent and/or mitigate the dangers of RBC alloantibodies to fetuses and newborns. PMID:23801629

Stowell, Sean R.; Henry, Kate L.; Smith, Nicole H.; Hudson, Krystalyn E.; Halverson, Greg R.; Park, Jaekeun C.; Bennett, Ashley M.; Girard-Pierce, Kathryn R.; Arthur, C. Maridith; Bunting, Silvia T.; Zimring, James C.

2013-01-01

215

Economic Impact of Blood Transfusions: Balancing Cost and Benefits  

PubMed Central

Blood transfusions may be lifesaving, but they inherit their own risks. Risk of transfusion to benefit is a delicate balance. In addition, blood product transfusions purchases are one of the largest line items among the hospital and laboratory charges. In this review, we aimed to discuss the transfusion strategies and share our transfusion protocol as well as the steps for hospitals to build-up a blood management program while all these factors weight in. Moreover, we evaluate the financial burden to the health care system. PMID:25610294

Oge, Tufan; Kilic, Cemil Hakan; Kilic, Gokhan Sami

2014-01-01

216

Unique risks of red blood cell transfusions in very-low-birth-weight neonates: associations between early transfusion and intraventricular hemorrhage and between late transfusion and necrotizing enterocolitis.  

PubMed

Red blood cell transfusions can be life-saving for neonates with severe anemia or active hemorrhage. However, risks of transfusions exist and should always be weighed against potential benefits. At least two transfusion risks are unique to very low birth weight neonates. The first is an association between transfusions given in the first days after birth and the subsequent occurrence of a grade 3 or 4 intraventricular hemorrhage. The second is an association between "late" RBC transfusions and the subsequent occurrence of necrotizing enterocolitis. Much remains to be discovered about the pathogenesis of these two outcomes. Moreover, work is needed to clearly establish whether transfusions are causatively-associated with these outcomes or are co-variables. This review will provide basic data establishing these associations and propose mechanistic explanations. PMID:24059555

Christensen, Robert D; Baer, Vickie L; Del Vecchio, Antonio; Henry, Erick

2013-10-01

217

Correlation between red blood cell transfusion volume and mortality in patients with massive blood transfusion: A large multicenter retrospective study.  

PubMed

This study aimed to explore the correlation between red blood cell (RBC) transfusion volume and patient mortality in massive blood transfusion. A multicenter retrospective study was carried out on 1,601 surgical inpatients who received massive blood transfusion in 20 large comprehensive hospitals in China. According to RBC transfusion volume and duration, the patients were divided into groups as follows: 0-4, 5-9, 10-14, 15-19, 20-24, 25-29, 30-39 and ?40 units within 24 or 72 h. Mortality in patients with different RBC transfusion volumes was analyzed. It was found that patient mortality increased with the increase in the volume of RBC transfusion when the total RBC transfusion volume was ?10 units within 24 or 72 h. Survival analysis revealed significant differences in mortality according to the RBC transfusion volume (?(2)=72.857, P<0.001). Logistic regression analysis revealed that RBC transfusion volume is an independent risk factor [odds ratio (OR) = 0.52; confidence interval (CI): 0.43-0.64; P<0.01] for the mortality of patients undergoing a massive blood transfusion. When RBCs were transfused at a volume of 5-9 units within 24 and 72 h, the mortality rate was the lowest, at 3.7 and 2.3% respectively. It is concluded that during massive blood transfusion in surgical inpatients, there is a correlation between RBC transfusion volume within 24 or 72 h and the mortality of the patients. Patient mortality increases with the increase in the volume of RBC transfusion. RBC transfusion volume, the length of stay at hospital and intensive care unit stay constitute the independent risk factors for patient mortality. PMID:25452789

Yang, Jiang-Cun; Sun, Yang; Xu, Cui-Xiang; Dang, Qian-Li; Li, Ling; Xu, Yong-Gang; Song, Yao-Jun; Yan, Hong

2015-01-01

218

Correlation between red blood cell transfusion volume and mortality in patients with massive blood transfusion: A large multicenter retrospective study  

PubMed Central

This study aimed to explore the correlation between red blood cell (RBC) transfusion volume and patient mortality in massive blood transfusion. A multicenter retrospective study was carried out on 1,601 surgical inpatients who received massive blood transfusion in 20 large comprehensive hospitals in China. According to RBC transfusion volume and duration, the patients were divided into groups as follows: 0–4, 5–9, 10–14, 15–19, 20–24, 25–29, 30–39 and ?40 units within 24 or 72 h. Mortality in patients with different RBC transfusion volumes was analyzed. It was found that patient mortality increased with the increase in the volume of RBC transfusion when the total RBC transfusion volume was ?10 units within 24 or 72 h. Survival analysis revealed significant differences in mortality according to the RBC transfusion volume (?2=72.857, P<0.001). Logistic regression analysis revealed that RBC transfusion volume is an independent risk factor [odds ratio (OR) = 0.52; confidence interval (CI): 0.43–0.64; P<0.01] for the mortality of patients undergoing a massive blood transfusion. When RBCs were transfused at a volume of 5–9 units within 24 and 72 h, the mortality rate was the lowest, at 3.7 and 2.3% respectively. It is concluded that during massive blood transfusion in surgical inpatients, there is a correlation between RBC transfusion volume within 24 or 72 h and the mortality of the patients. Patient mortality increases with the increase in the volume of RBC transfusion. RBC transfusion volume, the length of stay at hospital and intensive care unit stay constitute the independent risk factors for patient mortality. PMID:25452789

YANG, JIANG-CUN; SUN, YANG; XU, CUI-XIANG; DANG, QIAN-LI; LI, LING; XU, YONG-GANG; SONG, YAO-JUN; YAN, HONG

2015-01-01

219

Effect of blood transfusions on canine renal allograft survival  

SciTech Connect

In this study significantly prolonged canine renal allograft survival has been demonstrated after transfusion of 100 ml of third-party whole blood given peroperatively. Peroperative transfusions of third-party leukocyte-free blood or pure lymphocyte cell suspensions did not influence graft survival. Furthermore, no improvement in graft survival has been found after a peroperative transfusion of irradiated whole blood (2500 rad). These data suggest that delayed graft rejection after blood transfusions can only be expected after the administration of whole blood. The role of competent lymphocytes in whole blood is questionable, since a transfusion or irradiated whole blood in combination with nonirradiated lymphocytes did not lead to prolonged graft survival. Immunosuppression of the recipient directly after transfusion seems to be essential to induce the beneficial effect of blood transfusions. This has been demonstrated for a transfusion of whole blood 14 days before transplantation. A single transfusion of 100 ml of whole blood 14 days before transplantation could effectively prolong graft survival if immunosuppression with azathioprine and prednisone was started on the day of transfusion. No improvement in graft survival has been found with such a transfusion if preoperative immunosuppression has been omitted.

van der Linden, C.J.; Buurman, W.A.; Vegt, P.A.; Greep, J.M.; Jeekel, J.

1982-04-01

220

78 FR 79469 - Strategies To Address Hemolytic Complications of Immune Globulin Infusions; Public Workshop  

Federal Register 2010, 2011, 2012, 2013

...Hemolytic Complications of Immune Globulin Infusions; Public Workshop AGENCY: Food and Drug...Hemolytic Complications of Immune Globulin Infusions.'' The purpose of the public workshop...Globulin Intravenous (IGIV) (Human) infusion. Complications of hemolysis...

2013-12-30

221

Bar code technology improves positive patient identification and transfusion safety.  

PubMed

As a result of human error, an estimated 1 in 12,000 blood transfusions is given to the wrong patient. The cause of nearly all of these errors is failure of hospital personnel to identify positively intended transfusion recipients, their blood samples for cross-matching, or their correct blood components. We describe our experience using a point-of-care bar code transfusion safety system that links patients' bar-coded wristbands, with bar-coded labels on blood sample tubes, blood component bags, and nurses' identification badges. The result was 100 % accuracy of matching patients, their blood samples, and components for transfusions. For verifying information before starting blood transfusions, nurses preferred bar code "double checks" to conventional visual "double checks" by a second nurse. Methods are needed to reinforce nurses' proficiency with technological approaches to transfusion safety, such as software-driven bar code scanning, in situations where transfusions are administered infrequently. PMID:16050151

Sandler, S G; Langeberg, A; Dohnalek, L

2005-01-01

222

Hemolytic Activities of the Candida Species in Liquid Medium  

PubMed Central

Objective The aim of this study was to evaluate the in vitro hemolytic activities of 107 Candida strains isolated from different clinical samples in liquid medium, and to examine the impact of glucose on this activity. Materials and Methods A total of 107 Candida isolates representing seven species (C. albicans, n=28; C. glabrata, n=23; C. tropicalis, n=17; C. parapsilosis, n=16; C. kefyr, n=14; C. krusei, n=5; C. guilliermondii, n=4) were included in the study. The hemolytic activities of the strains were tested on two different Sabouraud dextrose liquid media (SDB) containing 7% defibrinated human blood, one of which is supplemented with 3% glucose and the other without glucose. Cultures were evaluated at the end of a 48-hour incubation. The hemolysis in the media was detected spectrophotometrically by measuring the amount of released hemoglobin and compared with a standard hemolysate which was prepared prior to testing. The degree of hemolysis (percentage value) by an individual strain was calculated according to the following formula below: (Absorbance of supernatant media at 540 nm / Absorbance of standard hemolysate at 540 nm X 100). Results In the liquid medium without glucose, strains generally produced hemolysis at low levels. The degree of hemolysis produced by all species increased noticeably in the liquid medium with glucose. Strains of C. albicans and C.kefyr had demonstrated significant hemolytic activity, whereas others had lower activity. C. parapsilosis exerted very little hemolytic activity in the medium with glucose and showed no activity in the medium without glucose. Conclusion The hemolytic activities of most Candida species was found to be higher in the human blood-enriched SDB medium containing 3% additive glucose than in the one free from additives. This result indicates that increased blood glucose concentration may contribute to increased hemolytic activity in Candida species, and it suggests a parallel with possible pathogenesis of Candida in patients with diabetes mellitus.

Malcok, Hilal Kuzucu; Aktas, Esin; Ayyildiz, Ahmet; Yigit, Nimet; Yazgi, Halil

2009-01-01

223

Splenic infarction in a patient with autoimmune hemolytic anemia and protein C deficiency  

PubMed Central

Splenic infarction is most commonly caused by cardiovascular thromboembolism; however, splenic infarction can also occur in hematologic diseases, including sickle cell disease, hereditary spherocytosis, chronic myeloproliferative disease, leukemia, and lymphoma. Although 10% of splenic infarction is caused by hematologic diseases, it seldom accompanies autoimmune hemolytic anemia (AIHA). We report a case of a 47-year-old woman with iron deficiency anemia who presented with pain in the left upper abdominal quadrant, and was diagnosed with AIHA and splenic infarction. Protein C activity and antigen decreased to 44.0% (60-140%) and 42.0% (65-140%), respectively. Laboratory testing confirmed no clinical cause for protein C deficiency, such as disseminated intravascular coagulation, sepsis, hepatic dysfunction, or acute respiratory distress syndrome. Protein C deficiency with splenic infarction has been reported in patients with viral infection, hereditary spherocytosis, and leukemia. This is a rare case of splenic infarction and transient protein C deficiency in a patient with AIHA. PMID:22259634

Park, Min Yong; Kim, Jung A; Yi, Seong Yoon; Chang, Sun Hee; Um, Tae Hyun

2011-01-01

224

Heinz body hemolytic anemia in newborns and failure of laboratory studies to implicate a phenolic disinfectant.  

PubMed

Two unrelated, white, female, premature infants in the same hospital nursery contemporaneously exhibited features of an acute, Heinz body hemolytic anemia: decreased levels of hemoglobin and hematocrit, anisocytosis, fragmented cells, hyperbilirubinemia, reticulocytosis, and red cell inclusion bodies. Physical examination and laboratory studies failed to reveal the etiology of this process. Epidemiologic studies indicated a possible association between the reaction and the improper use and inappropriately high concentration of a phenolic disinfectant. Such an association has been suggested previously between similar products and epidemics of hyperbilirubinemia. Despite extensive experimental efforts (four species, six routes of administration, newborn rats, splenectomized rats, direct incubation with age-matched human cord blood), the reaction could not be produced in the laboratory. It may be highly specific for the intact, human, premature infant. Perhaps the hyperbilirubinemia reported previously had an erythrocytic rather than hepatic origin. PMID:6828342

Vitkun, S A; Smith, R P; French, E E; Edwards, W H; Watkins, N

1983-03-01

225

Coomb’s Positive Hemolytic Anemia Due To Insect Bite  

PubMed Central

Hemolytic anemia has occasionally been described in association with insect bites. The venom of certain spiders, bees and wasps, and some snakes can rarely cause intravascular hemolysis. We report here a case of Coombs positive hemolytic anemia due to an insect bite. These bites often pose diagnostic challenges and when associated with systemic manifestations necessitate early intervention. This communication reviews the clinico- hematologic spectrum in these cases and also emphasizes the need to capture the insect as identification would help in early diagnosis and management. PMID:22400097

2007-01-01

226

Heinz-body hemolytic anemia associated with phenazopyridine and sulfonamide.  

PubMed

A 27-year-old white woman developed Heinz-body hemolytic anemia following multiple courses of oral phenazopyridine and trimethoprim-sulfamethoxazole. Her diagnosis was supported by the finding of bite cells on peripheral blood smear. The patient's rapid recovery and reversal of abnormal laboratory parameters were consistent with an acquired hemolytic disorder. This case should sensitize the clinician to the development of drug-induced oxidative hemolysis, its clinical features, and its reversibility. It is also important that the clinician recognize those drugs capable of causing this disorder and appreciate the methods available to establish the diagnosis. PMID:2786291

Ponte, C D; Lewis, M J; Rogers, J S

1989-02-01

227

Idiopathic Heinz body hemolytic anemia in newborn infants.  

PubMed

Heinz body hemolytic anemia developed in six full-term infants while at home during the first 2 weeks of life. The disorder first manifested as hyperbilirubinemia. However, in all cases, severe anemia (hemoglobin concentration 49-73 g/L) developed during the 4-12 days of hospitalization. The infants had not been exposed to known oxidants, and their erythrocytes were not glucose-6-phosphate dehydrogenase (G6PD) deficient and contained no unstable hemoglobin. It is hypothesized that in these newborn infants, Heinz body hemolytic anemia developed as a result of ingestion of an oxidant contained in feedings. The nature of this agent is as yet unknown. PMID:2712239

Ballin, A; Brown, E J; Zipursky, A

1989-01-01

228

Association between perioperative blood transfusion and early postoperative cognitive dysfunction in aged patients following total hip replacement surgery  

PubMed Central

Introduction Accumulating evidence suggests that enhanced inflammatory responses contribute to the pathogenesis of postoperative cognitive dysfunction (POCD). Blood transfusion can trigger an enhancement of acute inflammatory responses. Therefore, we hypothesized that perioperative blood transfusion is associated with a higher risk of POCD in aged patients following total hip replacement surgery. Material and methods Patients older than 65 years undergoing elective total hip replacement surgery were enrolled from October 2011 to December 2012. Neurocognitive tests were evaluated at baseline and at 7 d after surgery by a Mini-Mental State Test. Multivariate logistic regression analysis was used to determine risk factors associated with POCD. Results Fifty-six patients (27.3%) developed POCD 7 d postoperatively. Patients who developed POCD were older, had a lower education level and preoperative hemoglobin concentration, had more blood loss, and had a lower body weight (p < 0.05). Patients with POCD were more likely to receive red blood cells (RBCs) transfusion (51.8% versus 31.5%; p < 0.05). A multivariable logistic regression model identified older age, lower education level, and perioperative blood transfusion of more than 3 units as independent risk factors for POCD 7 d postoperatively. Conclusion Our data suggested that perioperative blood transfusion of more than 3 units of RBCs is an independent risk factor for POCD in aged patients following total hip replacement surgery. PMID:24345210

Zhu, Si-Hai; Ji, Mu-Huo; Gao, Da-Peng; Yang, Jian-Jun

2014-01-01

229

Neonatal hemolytic anemia due to inherited harderoporphyria: clinical characteristics and molecular basis.  

PubMed

Porphyrias, a group of inborn errors of heme synthesis, are classified as hepatic or erythropoietic according to clinical data and the main site of expression of the specific enzymatic defect. Hereditary coproporphyria (HC) is an acute hepatic porphyria with autosomal dominant inheritance caused by deficient activity of coproporphyrinogen III oxidase (COX). Typical clinical manifestations of the disease are acute attacks of neurological dysfunction; skin photosensitivity may also be present. We report a variant form of HC characterized by a unifying syndrome in which hematologic disorders predominate: harderoporphyria. Harderoporphyric patients exhibit jaundice, severe chronic hemolytic anemia of early onset associated with hepatosplenomegaly, and skin photosensitivity. Neither abdominal pain nor neuropsychiatric symptoms are observed. COX activity is markedly decreased. In a first harderoporphyric family, with three affected siblings, a homozygous K404E mutation has been previously characterized. In the present study, molecular investigations in a second family with neonatal hemolytic anemia and harderoporphyria revealed two heterozygous point mutations in the COX gene. One allele bore the missense mutation K404E previously described. The second allele bore an A-->G transition at the third position of the donor splice site in intron 6. This new COX gene mutation resulted in exon 6 skipping and the absence of functional protein production. In contrast with other COX gene defects that produce the classical hepatic porphyria presentation, our data suggest that the K404E substitution (either in the homozygous or compound heterozygous state associated with a mutation leading to the absence of functional mRNA or protein) is responsible for the specific hematologic clinical manifestations of harderoporphyria. PMID:9454777

Lamoril, J; Puy, H; Gouya, L; Rosipal, R; Da Silva, V; Grandchamp, B; Foint, T; Bader-Meunier, B; Dommergues, J P; Deybach, J C; Nordmann, Y

1998-02-15

230

Patients with sickle cell anemia on simple chronic transfusion protocol show gender differences for hemodynamic and hematologic responses to transfusion  

PubMed Central

Background Chronic transfusion therapy (CTT) is a mainstay for stroke prophylaxis in sickle cell anemia, but its effects on hemodynamics are poorly characterized. Transfusion improves oxygen carrying capacity, reducing demands for high cardiac output, while decreasing hemoglobin S%, reticulocyte count, and hemolysis. We hypothesized that transfusion would improve oxygen carrying capacity, but that would be counteracted by a decrease in cardiac output due to increased hematocrit and vascular resistance, leaving oxygen delivery unchanged. Study Design and Methods To test this hypothesis, we examined patients on CTT immediately pre transfusion and again 12–120 hours post transfusion, using echocardiography and near infrared spectroscopy. Results Comparable increases in hemoglobin and hematocrit, and decreases in reticulocyte count and hemoglobin S with transfusion were observed in all patients; but males had a larger rebound of hemoglobin S%, reticulocyte count, and free hemoglobin levels between transfusions. In males, transfusion decreased heart rate by 12%, stroke volume by 15%, and cardiac index by 24% while estimates for pulmonary and systemic vascular resistance rose, culminating in 6% decrease in oxygen delivery. In contrast, stroke volume and cardiac index, systemic and pulmonary vascular resistance did not change in women following transfusion, such that oxygen delivery improved 17%. Conclusion In our sample population, males exhibit a paradoxical reduction in oxygen delivery in response to transfusion because the rise in vascular resistance is larger than the increase in oxygen capacity. This may result from an inability to adequately suppress their hemoglobin S% between transfusion cycles. PMID:23176402

Detterich, Jon A.; Sangkatumvong, Suvimol; Kato, Roberta; Dongelyan, Ani; Bush, Adam; Khoo, Michael; Meiselman, Herbert J.; Coates, Thomas D.; Wood, John C.

2012-01-01

231

Pathology Case Study: Post Transfusion Hemolysis  

NSDL National Science Digital Library

This is a case study presented by the University of Pittsburgh Department of Pathology, which describes a 56-year-old female with a 20 year history of systemic lupus erythematosis with a history of deep venous thrombosis and a recent myocardial infarct. Visitors are given patient history and admission data along with data results from the resulting transfusion reaction investigation. A "Final Diagnosis" section provides a discussion of the findings as well as references. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in pathology and transfusion medicine.

Hari, Raj

2009-03-24

232

Management of patients who refuse blood transfusion  

PubMed Central

A small group of people belonging to a certain religion, called Jehovah's witness do not accept blood transfusion or blood products, based on biblical readings. When such group of people are in need of health care, their faith and belief is an obstacle for their proper treatment, and poses legal, ethical and medical challenges for attending health care provider. Due to the rapid growth in the membership of this group worldwide, physicians attending hospitals should be prepared to manage such patients. Appropriate management of such patients entails understanding of ethical and legal issues involved, providing meticulous medical management, use of prohaemostatic agents, essential interventions and techniques to reduce blood loss and hence, reduce the risk of subsequent need for blood transfusion. An extensive literature search was performed using search engines such as Google scholar, PubMed, MEDLINE, science journals and textbooks using keywords like ‘Jehovah's witness’, ‘blood haemodilution’, ‘blood salvage’ and ‘blood substitutes’.

Chand, N Kiran; Subramanya, H Bala; Rao, G Venkateswara

2014-01-01

233

Staging of Twin-Twin Transfusion Syndrome  

Microsoft Academic Search

OBJECTIVE:The purpose of this study was to evaluate the prognostic value of sonographic and clinical parameters to develop a staging classification of twin-twin transfusion syndrome (TTTS).STUDY DESIGN:Severe TTTS was defined as the presence of polyhydramnios (maximum vertical pocket of ?8 cm) and oligohydramnios (maximum vertical pocket of ?2 cm). Nonvisualization of the bladder in the donor twin (?BDT) and absence

Rubén A Quintero; Walter J Morales; Mary H Allen; Patricia W Bornick; Patricia K Johnson; Michael Kruger

1999-01-01

234

Blood transfusion before radiation for malignancies  

SciTech Connect

This editorial discusses the situation of administering blood to patients prior to radiotherapy in an attempt to increase tissue/tumor oxygen tension. The author believes that since the rate at which tumor cells consume oxygen is highly variable, the aim of achieving high cellular oxygen tension may be met better by maintaining a high blood perfusion rate. Blood volume can be maintained without relying on transfusion, and safer alternatives are available.

Hunt, T.K. (Univ. of California, San Francisco (USA))

1989-10-27

235

Effect of blood transfusions on canine renal allograft survival  

SciTech Connect

In this study significantly prolonged canine renal allograft survival has been demonstrated after transfusion of 100 ml of third-party whole blood given peroperatively. Peroperative transfusions of third-party leukocyte-free blood or pure lymphocyte cell suspensions did not influence graft survival. Futhermore, no improvement in graft survival has been found after a peroperative transfuson of irradiated whole blood (2500 rad). These data suggest that delayed graft rejection after blood transfusions can only be expected after the administration of whole blood. The role of competent lymphocytes in whole blood is questionable, since a transfusion of irradiated whole blood in combination with nonirradiated lymphocytes did not lead to prolonged graft survival. Immunosuppression of the recipient directly after transfusion seems to be essential to induce the beneficial effect of blood transfusions. This has been demonstrated for a transfusion of whole blood 14 days before transplantation. A single transfusion of 100 ml of whole blood 14 days before transplantation could effectively prolong graft survival if immunosuppression with azathioprine and prednisone was started on the day of transfusion. No improvement in graft survival has been found with such a transfusion if preoperative immunosuppression has been omitted.

Van Der Linden, C.J.; Buurman, W.A.; Vegt, P.A.; Greep, J.M.; Jeekel, J.

1982-04-01

236

Cationic amphiphilic non-hemolytic polyacrylates with superior antibacterial activity.  

PubMed

Acrylic copolymers with appropriate compositions of counits having cationic charge with 2-carbon and 6-carbon spacer arms can show superior antibacterial activities with concomitant very low hemolytic effect. These amphiphilic copolymers represent one of the most promising synthetic polymer antibacterial systems reported. PMID:24854366

Punia, Ashish; He, Edward; Lee, Kevin; Banerjee, Probal; Yang, Nan-Loh

2014-07-01

237

Identification of a hemolytic activity elaborated by Haemophilus ducreyi.  

PubMed Central

Haemophilus ducreyi is the causative agent of the sexually transmitted disease chancroid. We have identified a hemolytic activity expressed by H. ducreyi. This activity is most readily detected when horse erythrocytes are used as a target; however, low levels of activity can be detected with sheep, human, or rabbit erythrocyte targets. The activity is heat labile and protease sensitive. PMID:8005696

Palmer, K L; Grass, S; Munson, R S

1994-01-01

238

Hemolytic anemia associated with heterograft replacement of the mitral valve.  

PubMed

The first case of overt hemolytic anemia following mitral valve replacement with a porcine heterograft is reported. Cardiac catheterization failed to reveal a paravalvular leak or valvular incompetence to account for the hemolysis. Red cell traumatization by the Dacron-covered Stellite ring and stent is suggested as the cause of hemolysis with the porcine heterograft. PMID:567264

Myers, T J; Hild, D H; Rinaldi, M J

1978-08-01

239

Experimental haemorrhage and blood component transfusion in humans: no change in plasma concentration of thrombin-antithrombin complex and plasmin-antiplasmin complex.  

PubMed

The influence of haemorrhage and blood transfusion on primary haemostasis, coagulation and fibrinolysis was investigated in ten healthy male volunteers. Acute loss of 10% of the blood volume did not give any significant alteration in thrombin- antithrombin III (TAT) complex and plasmin-alpha 2-antiplasmin (PAP) complex levels compared with a control series. The skin bleeding time with the Simplate II device was not altered after the 10% blood loss. Acute loss of 10% of blood volume followed by transfusion of packed red cells or stored plasma did not resulted in any significant change in bleeding time, TAT and PAP complex levels. It could be concluded that a controlled haemorrhage does not give any detectable changes of the platelet dependent primary haemostasis, blood coagulation and fibrinolysis. Transfusion of one unit of packed red cells or stored plasma does not seem to adversely affect the haemostasis. PMID:8771701

Henriksson, A E; Nilsson, T K; Jansson, U; Bergqvist, D

1996-06-01

240

Red blood cell vesiculation in hereditary hemolytic anemia  

PubMed Central

Hereditary hemolytic anemia encompasses a heterogeneous group of anemias characterized by decreased red blood cell survival because of inherited membrane, enzyme, or hemoglobin disorders. Affected red blood cells are more fragile, less deformable, and more susceptible to shear stress and oxidative damage, and show increased vesiculation. Red blood cells, as essentially all cells, constitutively release phospholipid extracellular vesicles in vivo and in vitro in a process known as vesiculation. These extracellular vesicles comprise a heterogeneous group of vesicles of different sizes and intracellular origins. They are described in literature as exosomes if they originate from multi-vesicular bodies, or as microvesicles when formed by a one-step budding process directly from the plasma membrane. Extracellular vesicles contain a multitude of bioactive molecules that are implicated in intercellular communication and in different biological and pathophysiological processes. Mature red blood cells release in principle only microvesicles. In hereditary hemolytic anemias, the underlying molecular defect affects and determines red blood cell vesiculation, resulting in shedding microvesicles of different compositions and concentrations. Despite extensive research into red blood cell biochemistry and physiology, little is known about red cell deformability and vesiculation in hereditary hemolytic anemias, and the associated pathophysiological role is incompletely assessed. In this review, we discuss recent progress in understanding extracellular vesicles biology, with focus on red blood cell vesiculation. Also, we review recent scientific findings on the molecular defects of hereditary hemolytic anemias, and their correlation with red blood cell deformability and vesiculation. Integrating bio-analytical findings on abnormalities of red blood cells and their microvesicles will be critical for a better understanding of the pathophysiology of hereditary hemolytic anemias. PMID:24379786

Alaarg, Amr; Schiffelers, Raymond M.; van Solinge, Wouter W.; van Wijk, Richard

2013-01-01

241

Impairment of Bone Health in Pediatric Patients with Hemolytic Anemia  

PubMed Central

Introduction Sickle cell anemia and thalassemia result in impaired bone health in both adults and youths. Children with other types of chronic hemolytic anemia may also display impaired bone health. Study Design To assess bone health in pediatric patients with chronic hemolytic anemia, a cross-sectional study was conducted involving 45 patients with different forms of hemolytic anemia (i.e., 17 homozygous sickle cell disease and 14 hereditary spherocytosis patients). Biochemical, radiographic and anamnestic parameters of bone health were assessed. Results Vitamin D deficiency with 25 OH-vitamin D serum levels below 20 ng/ml was a common finding (80.5%) in this cohort. Bone pain was present in 31% of patients. Analysis of RANKL, osteoprotegerin (OPG) and osteocalcin levels indicated an alteration in bone modeling with significantly elevated RANKL/OPG ratios (control: 0.08+0.07; patients: 0.26+0.2, P?=?0.0007). Osteocalcin levels were found to be lower in patients compared with healthy controls (68.5+39.0 ng/ml vs. 118.0+36.6 ng/ml, P?=?0.0001). Multiple stepwise regression analysis revealed a significant (P<0.025) influence of LDH (partial r2?=?0.29), diagnosis of hemolytic anemia (partial r2?=?0.05) and age (partial r2?=?0.03) on osteocalcin levels. Patients with homozygous sickle cell anemia were more frequently and more severely affected by impaired bone health than patients with hereditary spherocytosis. Conclusion Bone health is impaired in pediatric patients with hemolytic anemia. In addition to endocrine alterations, an imbalance in the RANKL/OPG system and low levels of osteocalcin may contribute to this impairment. PMID:25299063

Schündeln, Michael M.; Goretzki, Sarah C.; Hauffa, Pia K.; Wieland, Regina; Bauer, Jens; Baeder, Lena; Eggert, Angelika; Hauffa, Berthold P.; Grasemann, Corinna

2014-01-01

242

Blood Transfusions and the Subsequent Risk of Hematologic Malignancies  

PubMed Central

Background Blood transfusions are associated with viral transmission and immunomodulation, perhaps increasing subsequent risk of hematologic malignancies (HMs). Prior studies of transfusion recipients have lacked details on specific HM subtypes. Study Design and Methods Risk of HM risk following blood transfusion was evaluated in a U.S. population-based case-control study (77,488 elderly HM cases identified through cancer registries, 154,509 controls). Transfusions were identified using linked Medicare hospitalization claims. Polytomous logistic regression was used to calculate odds ratios (ORs) associating transfusion and HM subtypes by features suggestive of a causal relationship. Results A history of transfusion was present in 7.9% of HM cases vs. 5.9% of controls. Associations for most HM subtypes suggested reverse causality: ORs were elevated only during the shortest latency periods; ORs for unspecified anemia and gastrointestinal bleeding, which may be related to undiagnosed HM, were stronger than for surgeries, which are unlikely to be related to HM; and/or there was no dose-response. In contrast, risk for lymphoplasmacytic lymphoma (1,397 cases) was elevated at long latency (OR=1.56 at 10+ years following transfusion), following transfusions for surgeries (ORs 1.22–1.47), and in a dose-response relationship with number of transfusion-related hospitalizations (OR=1.53 with 1 hospitalization; OR=1.80 with 2+ hospitalizations, p-trend<0.0001). Risk for marginal zone lymphoma (1,915 cases) was also elevated at 10+ years following transfusion (OR=1.80). Conclusion Consistent with prior studies, blood transfusions did not increase risk of most HM subtypes. Patterns of elevated risk for lymphoplasmacytic and marginal zone lymphomas suggest an etiologic role for transfusion. PMID:20497517

Chang, Cindy M.; Quinlan, Scott C.; Warren, Joan. L.; Engels, Eric A.

2010-01-01

243

What factors contribute to hospital variation in obstetric transfusion rates?  

PubMed Central

Background and Objectives To explore variation in red blood cell transfusion rates between hospitals, and the extent to which this can be explained. A secondary objective was to assess whether hospital transfusion rates are associated with maternal morbidity. Materials and Methods Linked hospital discharge and birth data were used to identify births (n = 279 145) in hospitals with at least 10 deliveries per annum between 2008 and 2010 in New South Wales, Australia. To investigate transfusion rates, a series of random-effects multilevel logistic regression models were fitted, progressively adjusting for maternal, obstetric and hospital factors. Correlations between hospital transfusion and maternal, neonatal morbidity and readmission rates were assessed. Results Overall, the transfusion rate was 1·4% (hospital range 0·6–2·9) across 89 hospitals. Adjusting for maternal casemix reduced the variation between hospitals by 26%. Adjustment for obstetric interventions further reduced variation by 8% and a further 39% after adjustment for hospital type (range 1·1–2·0%). At a hospital level, high transfusion rates were moderately correlated with maternal morbidity (0·59, P = 0·01), but not with low Apgar scores (0·39, P = 0·08), or readmission rates (0·18, P = 0·29). Conclusion Both casemix and practice differences contributed to the variation in transfusion rates between hospitals. The relationship between outcomes and transfusion rates was variable; however, low transfusion rates were not associated with worse outcomes. PMID:25092527

Patterson, J A; Roberts, C L; Isbister, J P; Irving, D O; Nicholl, M C; Morris, J M; Ford, J B

2015-01-01

244

Blood transfusion requirements for endoscopic sinonasal inverted papilloma resections  

PubMed Central

Background Endoscopic resection of sinonasal Inverted Papilloma (SNIP) tumors has been shown to reduce intra-operative blood loss and recovery time compared to open approaches. The purpose of this study is to investigate the incidence and requirements of blood transfusion for endoscopic SNIP surgeries. Methods An individual retrospective cohort study of endoscopic SNIP surgeries over a 10-year period was performed. Age, sex, pre-existing co-morbidity, use of anti-coagulants, tumor type and stage, time of surgery, estimated blood loss and the requirement for blood transfusion were recorded. Results 82 patients were included (57 males, 25 females). 4 (5%) Stage 1, 7 (8.5%) Stage 2, 62 (75.5%) Stage 3 and 9 (11%) Stage 4 SNIP tumors were identified according to the Krouse staging system. 3 (4%) patients required blood transfusion. 3 of the 9 (33%) Stage 4 tumors required blood transfusion. Stage 4 tumors were significantly associated with blood transfusion (p?transfusion and no other pre-operative variable was associated with requirement for blood transfusion. Conclusion Endoscopic SNIP resections rarely require blood transfusions. No pre-operative factor other than tumor stage is associated with the requirement for blood transfusion. We would therefore suggest that only Stage 4 SNIP tumors require pre-operative type and screen. PMID:23866296

2013-01-01

245

An association of ABO non-identical platelet and cryoprecipitate transfusions with altered red cell transfusion needs in surgical patients  

PubMed Central

Background Transfusion of ABO non-identical plasma, platelets and cryoprecipitate is routine practice even though adverse effects can occur. Methods and Materials Our hospital changed transfusion practice in 2005 and adopted a policy of providing ABO identical blood components to all patients when feasible. We retrospectively compared the transfusion requirements, length of stay, and in-hospital mortality in relation to ABO blood group in surgical patients who received platelet transfusions before and after this change to determine if it resulted in any benefit. Results Prior to the change in practice both group B and AB patients received more ABO non-identical platelet transfusion (p = 0.0004), required significantly greater numbers of red cell transfusions (p = 0.04), and had 50% longer hospital stays (p = 0.039) than group O and A patients. Following the policy change, there was a trend for fewer red cell transfusions (p = 0.17) and length of stay in group B and AB patients than group O or A patients. Overall, the mortality rate per red cell transfusion decreased from 15.2 per 1000 to 11.0 per 1000 (p = 0.013). Conclusions These results, in the context of previous findings, suggest that providing ABO identical platelets and cryoprecipitate might be associated with reduction in transfusion requirements and improve outcomes in surgical patients. PMID:21414009

Refaai, Majed A.; Fialkow, Lawrence B.; Heal, Joanna M.; Henrichs, Kelly F.; Spinelli, Sherry L.; Phipps, Richard P.; Masel, Edward; Smith, Brian H.; Corsetti, James P.; Francis, Charles W.; Bankey, Paul E.; Blumberg, Neil

2010-01-01

246

Internet-based transfusion audit system  

NASA Astrophysics Data System (ADS)

This project is aimed at developing a cost-effective working environment for the transfusion medicine specialists of American Red Cross (ARC). In this project we are developing a multimedia-based consultation environment that uses Internet and teleconferencing to increase the quality of services and to replace currently used 800 telephone lines. Through the use of Internet/LAN/ISDN the physicians can share information and references while they discuss patient cases. A multimedia interface allows the physician to access data from the office and from the house. This paper discusses the approach, current status of the project and future plans to extend the approach to other areas of medicine.

Maitan, Jacek; Haley, Rebecca

1995-03-01

247

Model mice for Presbyterian hemoglobinopathy (Asn(beta108)-->Lys) confer hemolytic anemia with altered oxygen affinity and instability of Hb.  

PubMed

Hb Presbyterian is a variant hemoglobin that carries Lys at Asn-108 of beta-globin. This variant Lys(beta108) residue enhances the stability of Hb in the deoxy-state, conferring the low affinity for oxygen-binding in vitro. In the present study, we generated mutant mice carrying the Presbyterian mutation (Asn(beta108)-->Lys) at the beta-globin locus by a targeted knock-in strategy. Heterozygous mice showed the expression of Hb Presbyterian in 27.7% of total peripheral blood without any hematological abnormalities, which well mimicked human cases. On the other hand, homozygous mice exclusively expressed Hb Presbyterian in 100% of peripheral blood associated with hemolytic anemia, Heinz body formation, and splenomegaly. Hb Presbyterian showed instability in an in vitro precipitation assay. Erythrocytes from homozygous mice showed a shortened life span when transfused into wild-type mice, confirming that the knocked-in mutation of Lys(beta108) caused hemolysis in homozygous mice. This is the first report on the hemolytic anemia of unstable hemoglobin in an animal model. These results confirm the notion that the higher ratio of an unstable variant beta-globin chain in erythrocytes triggers the pathological precipitation and induces hemolysis in abnormal hemoglobinopathies. PMID:12127975

Suzuki, Yo-ichi; Shimizu, Takahiko; Sakai, Hiromi; Tamaki, Masakatsu; Koizumi, Ken ichi; Kuriyama, Takayuki; Tsuchida, Eishun; Koseki, Haruhiko; Shirasawa, Takuji

2002-07-26

248

Balanced massive transfusion ratios in multiple injury patients with traumatic brain injury  

PubMed Central

Introduction Retrospective studies have demonstrated a potential survival benefit from transfusion strategies using an early and more balanced ratio between fresh frozen plasma (FFP) concentration and packed red blood cell (pRBC) transfusions in patients with acute traumatic coagulopathy requiring massive transfusions. These results have mostly been derived from non-head-injured patients. The aim of the present study was to analyze whether a regime using a high FFP:pRBC transfusion ratio (FFP:pRBC ratio >1:2) would be associated with a similar survival benefit in severely injured patients with traumatic brain injury (TBI) (Abbreviated Injury Scale (AIS) score, head ?3) as demonstrated for patients without TBI requiring massive transfusion (?10 U of pRBCs). Methods A retrospective analysis of severely injured patients from the Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie (TR-DGU) was conducted. Inclusion criteria were primary admission, age ?16 years, severe injury (Injury Severity Score (ISS) ?16) and massive transfusion (?10 U of pRBCs) from emergency room to intensive care unit (ICU). Patients were subdivided into patients with TBI (AIS score, head ?3) and patients without TBI (AIS score, head <3), as well as according to the transfusion ratio they had received: high FFP:pRBC ratio (FFP:pRBC ratio >1:2) and low FFP:pRBC ratio (FFP:pRBC ratio ?1:2). In addition, morbidity and mortality between the two groups were compared. Results A total of 1,250 data sets of severely injured patients from the TR-DGU between 2002 and 2008 were analyzed. The mean patient age was 42 years, the majority of patients were male (72.3%), the mean ISS was 41.7 points (±15.4 SD) and the principal mechanism of injury was blunt force trauma (90%). Mortality was statistically lower in the high FFP:pRBC ratio groups versus the low FFP:pRBC ratio groups, regardless of the presence or absence of TBI and across all time points studied (P < 0.001). The frequency of sepsis and multiple organ failure did not differ among groups, except for sepsis in patients with TBI who received a high FFP:pRBC ratio transfusion. Other secondary end points such as ventilator-free days, length of stay in the ICU and overall in-hospital length of stay differed significantly between the two study groups, but not when only data for survivors were analyzed. Conclusions These results add more detailed knowledge to the concept of a high FFP:pRBC ratio during early aggressive resuscitation, including massive transfusion, to decrease mortality in severely injured patients both with and without accompanying TBI. Future research should be conducted with a larger number of patients to prove these results in a prospective study. PMID:21342499

2011-01-01

249

History of blood transfusion in sub-saharan Africa.  

PubMed

The adequacy and safety of blood transfusion in sub-Saharan Africa is the subject of much concern, yet there have been very few studies of its history. An overview of that record finds that transfusions were first reported in Africa (sub-Saharan and excluding South Africa) in the early 1920s, and organized transfusion practices were established before the Second World War. Blood transfusion grew rapidly after 1945, along with the construction of new hospitals and expanded health services in Africa. Significant differences existed between colonial powers in the organization of transfusion services, but these converged after independence as their use continued to grow and decentralized and hospital-based practices were adopted. It was only after the oil crisis in the mid-1970s that health spending declined and the collection, testing, and transfusion of blood began to level off. Thus, when the AIDS crisis hit transfusion services, they were already struggling to meet the needs of patients. At this time, foreign assistance as well as the World Health Organization and the League of Red Cross Societies helped respond to both the immediate problem of testing blood, and for some countries, support existed for the broader reorganization of transfusion. Overall, the history shows that transfusion was adopted widely and quickly, limited mainly by the availability of knowledgeable doctors and hospital facilities. There was less resistance than expected by Africans to receive transfusions, and the record shows a remarkable flexibility in obtaining blood. The dangers of disease transmission were recognized from an early date but were balanced against the potential lifesaving benefits of transfusion. PMID:22981696

Schneider, William H

2013-01-01

250

Effect of toluene on the hemolytic resistance of rat erythrocytes.  

PubMed

The effect of toluene on rat erythrocyte hemolytic resistance was studied both in vitro and in vivo. In vitro, toluene at concentrations up to 1000 ppm showed a marked antihemolytic effect, the maximum being at 300 ppm. Above 1000 ppm, an increase in the hypotonic hemolysis was seen. The antihemolytic effect of toluene was temperature-dependent. Elevation of temperature diminished the ability of toluene to protect erythrocytes. In the in vivo experiments, when the rats breathed 2000 ppm of toluene in an inhalation chamber for 7 days and for 21 days (6 h/day), the antihemolytic effect of toluene was evident. Our results demonstrate that toluene, at moderate concentrations, increases the hemolytic resistance of rat erythrocytes in hypotonic media both in vitro and in inhalation exposures in vivo. PMID:6623518

Korpela, M; Vapaatalo, H; Tähti, H

1983-07-01

251

Heinz body hemolytic anemia associated with high plasma zinc concentration in a dog.  

PubMed

Acute zinc toxicosis from the ingestion of pennies was diagnosed in a dog with Heinz body hemolytic anemia (PCV = 14%), leukocytosis (51,000 cells/ml) with a left shift (3,060 band neutrophils; 37,740 segmented neutrophils) and monocytosis (4,080 cells/ml), azotemia (BUN = 60 mg/dl), bilirubinemia (total bilirubin = 5.3 mg/dl), hypokalemia (3.0 mEq/L), high serum alkaline phosphatase activity (691 U/L), high total plasma solids (8.1 g/dl), hemoglobinuria, and proteinuria. Despite aggressive medical treatment, renal failure ensued, and the dog died of cardiac arrest. The clinical signs, clinical course, and laboratory findings in this dog were similar to what has been reported in other cases of acute zinc toxicosis in dogs, with the exception of a history of generalized seizures and the findings of Heinz bodies. Although a causative relationship between plasma zinc values and Heinz body formation cannot be proven, their association suggests that oxidative damage to erythrocyte hemoglobin and cell membrane proteins may be involved in the pathogenesis of zinc-induced hemolysis. PMID:2266050

Luttgen, P J; Whitney, M S; Wolf, A M; Scruggs, D W

1990-11-15

252

Increased bacterial infections after transfusion of leukoreduced non-irradiated blood products in recipients of allogeneic stem cell transplants after reduced-intensity conditioning.  

PubMed

Blood components transfused to hematopoietic stem cell transplant (HSCT) recipients are irradiated to prevent transfusion-associated graft-versus-host disease (TA-GVHD). The effect of transfusing non-irradiated blood products in HSCT outcome, including incidence of transplant complications, bacterial infections, acute and chronic GVHD presentation, and characteristics, has not been documented. Clinical records as well as blood bank and electronic databases of HSCT patients grafted after reduced-intensity conditioning who received irradiated versus non-irradiated blood products, after blood irradiation became unavailable at our center, were scrutinized for transplant outcome, clinical evolution, engraftment characteristics including days to neutrophil and platelet recovery, acute and chronic GVHD, rate and type of infections, and additional transplant-related comorbidities. All transfused blood products were leukoreduced. A total of 156 HSCT recipients was studied, 73 received irradiated and 83 non-irradiated blood components. Bacterial infections were significantly more frequent in patients transfused with non-irradiated blood products, P = .04. Clinically relevant increased rates of fever and neutropenia and mucositis were also documented in these patients. No cases of TA-GVHD occurred. Classical GVHD developed in 37 patients (50.7%) who received irradiated blood products and 36 (43.9%) who received non-irradiated blood products, P = .42. Acute GVHD developed in 28 patients (38.4%) in the blood-irradiated and 33 patients (39.8%) in the non-irradiation group, P = .87. The 2-year GVHD-free survival rate was 40% in the irradiated versus 40.6% in the non-irradiation group, P = .071. Increased bacterial infections were found in HSCT recipients transfused with non-irradiated blood products, which ideally must always be irradiated. PMID:25498924

Jaime-Pérez, José C; Villarreal-Villarreal, César D; Salazar-Riojas, Rosario; Méndez-Ramírez, Nereida; Vázquez-Garza, Eduardo; Gómez-Almaguer, David

2015-03-01

253

[Hepatitis E virus: Blood transfusion implications].  

PubMed

Hepatitis E virus (HEV) is a non-enveloped RNA virus transmitted by the fecal-oral route. Autochthonous hepatitis E occurring in developed countries is caused by genotypes 3 and 4 and is a zoonotic infection. Humans are infected mostly after ingestion of undercooked meat from infected animals. Most HEV 3 and 4 infections are clinically inapparent. However, genotype 3 (HEV 3) can lead to chronic hepatitis in immuno-compromised patients such as organ-transplant recipients and patients with haematological malignancies. In Europe, HEV 3 is implicated in transfusion-transmitted HEV infection. In France, as observed in several European countries, prevalence of HEV RNA and specific IgG antibodies are high indicating that viral circulation is important. The systematic HEV NAT screening of blood donations used for preparation of solvent detergent plasma indicate that 1 to 2218 donation is infected by HEV RNA. The need or implementation's impacts of safety measures to prevent HEV transmission by blood transfusion are under reflexion by French's health authorities. The HEV NAT screening is the only available tool of prevention. Alternative strategies are under investigation including individual or mini pool NAT testing all or part of blood donations. PMID:25267201

Gallian, P; Piquet, Y; Assal, A; Djoudi, R; Chiaroni, J; Izopet, J; Tiberghien, P

2014-11-01

254

Contemporary issues in transfusion medicine informatics.  

PubMed

The Transfusion Medicine Service (TMS) covers diverse clinical and laboratory-based services that must be delivered with accuracy, efficiency and reliability. TMS oversight is shared by multiple regulatory agencies that cover product manufacturing and validation standards geared toward patient safety. These demands present significant informatics challenges. Over the past few decades, TMS information systems have improved to better handle blood product manufacturing, inventory, delivery, tracking and documentation. Audit trails and access to electronic databases have greatly facilitated product traceability and biovigilance efforts. Modern blood bank computing has enabled novel applications such as the electronic crossmatch, kiosk-based blood product delivery systems, and self-administered computerized blood donor interview and eligibility determination. With increasing use of barcoding technology, there has been a marked improvement in patient and specimen identification. Moreover, the emergence of national and international labeling standards such as ISBT 128 have facilitated the availability, movement and tracking of blood products across national and international boundaries. TMS has only recently begun to leverage the electronic medical record to address quality issues in transfusion practice and promote standardized documentation within institutions. With improved technology, future growth is expected in blood bank automation and product labeling with applications such as radio frequency identification devices. This article reviews several of these key informatics issues relevant to the contemporary practice of TMS. PMID:21383927

Sharma, Gaurav; Parwani, Anil V; Raval, Jay S; Triulzi, Darrell J; Benjamin, Richard J; Pantanowitz, Liron

2011-01-01

255

Hemolytic venoms from marine cnidarian jellyfish - an overview.  

PubMed

Cnidarian jellyfish are viewed as an emergent problem in several coastal zones throughout the world. Recurrent outbreaks pose a serious threat to tourists and bathers, as well as to sea-workers, involving health and economical aspects. As a rule, cnidarian stinging as a consequence of nematocyst firing induces merely local symptoms but cardiovascular or neurological complications can also occur. Hemolysis is a frequent effect of cnidarian stinging; this dangerous condition is known to be caused by several venoms and can sometimes be lethal. At present, the bulk of data concerning hemolytic cnidarian venoms comes from the study of benthic species, such as sea anemones and soft corals, but hemolytic factors were found in venoms of several siphonophore, cubozoan and scyphozoan jellyfish, which are mainly involved in the envenomation of bathers and sea-workers. Therefore, the aim of this paper is to review the scientific literature concerning the hemolytic venoms from cnidarian jellyfish taking into consideration their importance in human pathology as well as health implications and possible therapeutic measures. PMID:25386336

Mariottini, Gian Luigi

2014-01-01

256

Cloning and characterization of hemolytic genes from Helicobacter pylori.  

PubMed Central

Strains of Helicobacter pylori, the bacterium associated with gastritis, peptic ulcer disease, and gastric cancer in humans, express different degrees of hemolysis on agar containing erythrocytes (RBC). Here we report the isolation and characterization of six recombinant clones from a genomic library of H. pylori ATCC 49503 that confer on Escherichia coli the ability to lyse sheep RBC. DNA hybridizations indicated no sequence homology among these hemolytic clones. Hybridization mapping of them to an ordered H. pylori cosmid library identified their separate chromosomal locations. One clone hybridized to two regions separated by approximately 200 kb. The specificities of the hemolytic activities of these clones were tested with RBC from humans, monkeys, cattle, horses, guinea pigs, rabbits, and chickens as well as with RBC from sheep. One clone conferred the ability to lyse RBC from five species, a second clone allowed the lysis of RBC from four of these species, three other clones allowed the lysis of RBC from three of these species, and the sixth clone allowed the lysis of RBC from just two species. We propose that some or all of the genes that confer these various hemolytic activities contribute to pathogen-host tissue interactions and that the different specificities seen here are important for H. pylori infections of humans of different genotypes or disease states. PMID:7591069

Drazek, E S; Dubois, A; Holmes, R K; Kersulyte, D; Akopyants, N S; Berg, D E; Warren, R L

1995-01-01

257

Candida Species Exhibit Differential In Vitro Hemolytic Activities  

PubMed Central

A total of 80 Candida isolates representing 14 species were examined for their respective responses to an in vitro hemolytic test. A modification of a previously described plate assay system where the yeasts are incubated on glucose (3%)-enriched sheep blood agar in a carbon dioxide (5%)-rich environment for 48 h was used to evaluate the hemolytic activity. A group of eight Candida species which included Candida albicans (15 isolates), C. dubliniensis (2), C. kefyr (2), C. krusei (4), C. zeylanoides (1), C. glabrata (34), C. tropicalis (5), and C. lusitaniae (2) demonstrated both alpha and beta hemolysis at 48 h postinoculation. Only alpha hemolysis was detectable in four Candida species, viz., C. famata (3), C. guilliermondii (4), C. rugosa (1), and C. utilis (1), while C. parapsilosis (5) and C. pelliculosa (1) failed to demonstrate any hemolytic activity after incubation for 48 h or longer. This is the first study to demonstrate the variable expression profiles of hemolysins by different Candida species. PMID:11474025

Luo, Gang; Samaranayake, Lakshman P.; Yau, Joyce Y. Y.

2001-01-01

258

[Out-of-hospital blood transfusion by emergency medical services].  

PubMed

The indications for out-of-hospital blood transfusion by emergency medical services (EMS) are relatively rare (0.2 to 1% of interventions). The guidelines and the law about transfusion seem to be a hindrance for out-of-hospital blood transfusion. In prehospital settings, the main concern is the quick supply of blood products, while for interhospital transports the priority is to ensure haemovigilance, thanks to transfusion records. Blood transfusion into mobile intensive care units have to be conform with rules of good practice and guidelines, but it is necessary to consider the specific sanitary conditions in prehospital emergency medicine, which often cause a delay to perform it and this delay must be known by emergency physicians. The writing of a blood transfusion protocol, established in partnership with EMS and haemovigilance centres, should facilitate the set-up of this treatment. This protocol is the guarantor of a safe and effective use of this procedure. The first treatment of hemorrhagic shock is to stop the bleeding. The interest of out-of-hospital blood transfusion is to facilitate and to secure the arrival of patients in operating rooms for an etiological treatment. Thus it is justified when there are significant delays for extraction and/or for transport of patients, or in interhospital transport when transfusion cannot be delayed or interrupted during transfer. It is an exceptional procedure that requires a regular updating of protocols and a regular training of staffs in order to remain safe and effective. PMID:21051259

Fournier, M; Chenaitia, I

2010-12-01

259

Preventive transfusion in dengue shock syndrome–is it necessary?  

Microsoft Academic Search

We compared 53 patients with dengue shock syndrome (DSS) who received preventive transfusions with 53 who did not. Significant differences in the development of pulmonary edema and length of hospitalization (P<.05) and none in hemorrhage (P=.136) were observed. Preventive transfusions did not produce sustained improvements in the coagulation status in DSS.

Lucy Chai See Lum; Mohammad El-Amin Abdel-Latif; Adrian Yu Teik Goh; Patrick Wai Keong Chan; Sai Kit Lam

2003-01-01

260

Prognostic impact of pre-transplantation transfusion history and secondary iron overload in patients with myelodysplastic syndrome undergoing allogeneic stem cell transplantation: a GITMO study  

PubMed Central

Background Transfusion-dependency affects the natural history of myelodysplastic syndromes. Secondary iron overload may concur to this effect. The relative impact of these factors on the outcome of patients with myelodysplastic syndrome receiving allogeneic stem-cell transplantation remains to be clarified. Design and Methods We retrospectively evaluated the prognostic effect of transfusion history and iron overload on the post-transplantation outcome of 357 patients with myelodysplastic syndrome reported to the Gruppo Italiano Trapianto di Midollo Osseo (GITMO) registry between 1997 and 2007. Results Transfusion-dependency was independently associated with reduced overall survival (hazard ratio=1.48, P=0.017) and increased non-relapse mortality (hazard ratio=1.68, P=0.024). The impact of transfusion-dependency was noted only in patients receiving myeloablative conditioning (overall survival: hazard ratio=1.76, P=0.003; non-relapse mortality: hazard ratio=1.70, P=0.02). There was an inverse relationship between transfusion burden and overall survival after transplantation (P=0.022); the outcome was significantly worse in subjects receiving more than 20 red cell units. In multivariate analysis, transfusion-dependency was found to be a risk factor for acute graft-versus-host disease (P=0.04). Among transfusion-dependent patients undergoing myeloablative allogeneic stem cell transplantation, pre-transplantation serum ferritin level had a significant effect on overall survival (P=0.01) and non-relapse mortality (P=0.03). This effect was maintained after adjusting for transfusion burden and duration, suggesting that the negative effect of transfusion history on outcome might be determined at least in part by iron overload. Conclusions Pre-transplantation transfusion history and serum ferritin have significant prognostic value in patients with myelodysplastic syndrome undergoing myeloablative allogeneic stem cell transplantation, inducing a significant increase of non-relapse mortality. These results indicate that transfusion history should be considered in transplantation decision-making in patients with myelodysplastic syndrome. PMID:19903678

Alessandrino, Emilio Paolo; Porta, Matteo Giovanni Della; Bacigalupo, Andrea; Malcovati, Luca; Angelucci, Emanuele; Van Lint, Maria Teresa; Falda, Michele; Onida, Francesco; Bernardi, Massimo; Guidi, Stefano; Lucarelli, Barbarella; Rambaldi, Alessandro; Cerretti, Raffaella; Marenco, Paola; Pioltelli, Pietro; Pascutto, Cristiana; Oneto, Rosi; Pirolini, Laura; Fanin, Renato; Bosi, Alberto

2010-01-01

261

[Assessment of transfusion practice: Assessing nurses' knowledge in transfusion medicine at Mohamed VI Hematology and Oncology Center of Marrakesh, Morocco.  

PubMed

Blood transfusion is a complex activity, involving many actors. It is a high-risk activity which could not be controlled without the use of specific methods. Health care workers beliefs and organizational factors are two major issues for the blood transfusion safety. PMID:25458986

Lahlimi, F Z; Tazi, I; Sifsalam, M; Bouchtia, M; Mahmal, L

2014-10-30

262

Severe neonatal hyperbilirubinemia leading to exchange transfusion  

PubMed Central

Background: Severe neonatal hyperbilirubinemia is associated with significant morbidity and mortality. This study was conducted to investigate the causes of severe hyperbilirubinemia leading to Exchange Transfusion (ET) from March 2009 to March 2011 in Bahrami children hospital, Tehran, Iran in order to establish guidelines to prevent profound jaundice & ET. Methods: 94 neonates underwent ET for severe hyperbilirubinemia data for demographic data, and onset of jaundice, history of severe hyperbilirubinemia in siblings, blood group of both mother and neonate, G6PD activity, hemoglobin, hematocrite, reticulocyte count, peripheral blood smear, total and direct bilirubin before and after ET, direct and indirect Coombs, times of transfusion and the cause of hyperbilirubinemia were all recorded for analysis. Results: Ninety four neonates (56.4% boys and 43.6% girls) underwent ET with a mean birth weight of 1950±40 g and a mean gestational age of 35.2±1.4 weeks. Premature labor, breastfeeding jaundice, ABO incompatibility and G6PDD with the frequency of 59(63%), 33(35%), 25(24/5%) and 12(12.8%) were of major causes of ET. Conclusions: Predisposing factors for severe hyperbilirubinemia in this study were premature labor, breastfeeding jaundice, ABO incompatibility and G6PDD. The authors recommend prevention of premature labor, reevaluation of successful breastfeeding education for mothers and screening infants for blood group and G6PD In the first of life. Arranging earlier and continuous visits in neonates with these risk factors during the first four days of life is also recommended. PMID:25405129

Alizadeh Taheri, Peymaneh; Sadeghi, Mandana; Sajjadian, Negar

2014-01-01

263

Stroke With Transfusions Changing to Hydroxyurea (SWiTCH).  

PubMed

Stroke is a devastating complication of sickle cell anemia (SCA) with high recurrence if untreated. Chronic transfusions reduce recurrent strokes but have associated morbidities including iron overload. Stroke With Transfusions Changing to Hydroxyurea (SWiTCH) was a multicenter phase 3 randomized trial comparing standard treatment (transfusions/chelation) to alternative treatment (hydroxyurea/phlebotomy) for children with SCA, stroke, and iron overload. SWiTCH was a noninferiority trial with a composite primary end point, allowing an increased stroke risk but requiring superiority for removing iron. Subjects on standard treatment received monthly transfusions plus daily deferasirox iron chelation. Subjects on alternative treatment received hydroxyurea plus overlap transfusions during dose escalation to maximum tolerated dose (MTD), followed by monthly phlebotomy. Subjects on standard treatment (N = 66) maintained 30% sickle hemoglobin (HbS) and tolerated deferasirox at 28.2 ± 6.0 mg/kg/d. Subjects on alternative treatment (N = 67) initiated hydroxyurea and 60 (90%) reached MTD at 26.2 ± 4.9 mg/kg/d with 29.1% ± 6.7% fetal hemoglobin (HbF). Adjudication documented no strokes on transfusions/chelation but 7 (10%) on hydroxyurea/phlebotomy, still within the noninferiority stroke margin. The National Heart, Lung, and Blood Institute closed SWiTCH after interim analysis revealed equivalent liver iron content, indicating futility for the composite primary end point. Transfusions and chelation remain a better way to manage children with SCA, stroke, and iron overload. PMID:22318199

Ware, Russell E; Helms, Ronald W

2012-04-26

264

Tranexamic Acid Reduces Allogenic Transfusion in Revision Hip Arthroplasty  

Microsoft Academic Search

Background  Revision THA is associated with high blood loss and a high probability of blood transfusion in the perioperative period. In\\u000a November 2003, government legislation established the Blood Utilization Program at our center to reduce the rate and risks\\u000a associated with allogenic transfusion.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes  The purposes of this study were to (1) determine whether the allogenic transfusion rate in patients undergoing revision

Shahryar Noordin; Terrence S. Waters; Donald S. Garbuz; Clive P. Duncan; Bassam A. Masri

2011-01-01

265

Transfusion-associated graft-versus-host disease  

SciTech Connect

The clinical pathologic syndrome of graft-versus-host disease (GVHD) is usually a sequela of bone marrow transplantation. This disorder occurs as a result of recognition by engrafted donor-derived lymphocytes of foreign recipient transplantation antigens. GVHD may also result from engraftment of lymphocytes from other sources, including (1) transfusion of lymphocytes containing blood components, (2) transplacental maternal fetal transfusion, and (3) passive transfer of lymphocytes in solid organ transplantation. The recipients are usually severely immunodeficient and thus incapable of rejecting the transfused lymphocytes. This syndrome may, however, also develop in immunologically competent patients receiving blood products from individuals with histocompatibility antigens not recognized as foreign. 58 refs.

Rappeport, J.M. (Yale Univ. School of Medicine, New Haven, CT (USA))

1990-09-01

266

Transfusion-associated graft-versus-host disease.  

PubMed Central

The clinical pathologic syndrome of graft-versus-host disease (GVHD) is usually a sequela of bone marrow transplantation. This disorder occurs as a result of recognition by engrafted donor-derived lymphocytes of "foreign" recipient transplantation antigens. GVHD may also result from engraftment of lymphocytes from other sources, including (1) transfusion of lymphocytes containing blood components, (2) transplacental maternal fetal transfusion, and (3) passive transfer of lymphocytes in solid organ transplantation. The recipients are usually severely immunodeficient and thus incapable of rejecting the transfused lymphocytes. This syndrome may, however, also develop in immunologically competent patients receiving blood products from individuals with histocompatibility antigens not recognized as foreign. PMID:2293503

Rappeport, J. M.

1990-01-01

267

Abstract. Objective and Design: Post transfusion infectious complications associated with allogeneic blood components  

E-print Network

-40 accumulation during storage of erythrocyte compo- nents. Key words: Blood transfusion ­ YKL-40 to blood transfusion are still not known in details, but transfusion-induced impaired immune competence morbidity and mortality in relation to blood transfusion may be related to storage time of the trans- fused

Price, Paul A.

268

Randomized trial comparing packed red cell blood transfusion with and without leukocyte depletion for gastrointestinal surgery  

Microsoft Academic Search

BACKGROUND: Allogeneic transfusion is associated with postoperative infections that significantly prolong hospital stays and increase costs. Recent studies suggest that filtering leukocytes from blood prior to transfusion reduces the risk of postoperative infection associated with blood transfusion. We compared the incidence of postoperative infections, hospital stays, and hospital charges of gastrointestinal surgery patients transfused with packed red cells or leukocyte-depleted

Paul Ian Tartter; Kala Mohandas; Penny Azar; Jill Endres; Jess Kaplan; Morton Spivack

1998-01-01

269

Hemolytic anemia in wild seaducks caused by marine oil pollution.  

PubMed

Clinico-pathological examinations were conducted on wild white-winged scoters (Melanitta fusca) contaminated with fuel oil (Bunker C oil) from a capsized cargo ship in February 1993 in Japan. The erythrocyte count, hemoglobin concentration and hematocrit value in the oiled seaducks all were decreased and numerous immature erythrocytes were observed in blood smears. In addition, hemosiderosis was observed in the liver, kidney, and lung of some birds. We propose that the sea-ducks suffered from hemolytic anemia induced by ingestion of oil, which occurs when the birds preen their oiled plumage. PMID:8722285

Yamato, O; Goto, I; Maede, Y

1996-04-01

270

Pleural solitary fibrous tumor complicated with autoimmune hemolytic anemia.  

PubMed

We herein report a 74-year-old woman who presented with autoimmune hemolytic anemia (AIHA) associated with pleural solitary fibrous tumor (SFT). Her AIHA was initially treated with 1 mg/kg daily of oral prednisolone (PSL) for 2 months, which had a limited effect. However, after surgical tumor resection, the patient showed remarkable improvement of AIHA with normalizations of serum lactate dehydrogenase and bilirubin levels, and we were able to rapidly reduce the PSL dosage. This is the first description of a case of AIHA caused by SFT. PMID:25030571

Takahashi, Hiroshi; Ohkawara, Hiroshi; Ikeda, Kazuhiko; Harada-Shirado, Kayo; Furukawa, Miki; Sukegawa, Masumi; Shichishima-Nakamura, Akiko; Noji, Hideyoshi; Wakamatsu, Saho; Tasaki, Kazuhiro; Suzuki, Hiroyuki; Ogawa, Kazuei; Takeishi, Yasuchika

2014-01-01

271

Geographical variations in current clinical practice on transfusions and iron chelation therapy across various transfusion-dependent anaemias  

PubMed Central

Background and objectives Many patients with chronic anaemia require blood transfusions as part of their treatment regimen. As a result, iron overload will inevitably develop if not adequately managed by iron chelation therapy. There are many guidelines relating to transfusion and chelation practices for patients with transfusion-dependent anaemia; however, there is a lack of information on how treatment practices differ around the world. The objective of this manuscript is to highlight key features of current transfusion and chelation management, including similarities and differences across various anaemias and between geographical regions worldwide. Materials and methods Data collected at study entry to the multicentre Evaluation of Patients’ Iron Chelation with Exjade (EPIC) study, which recruited 1,744 patients with a variety of transfusion-dependent anaemias across 23 countries from three geographic regions, were assessed. These analyses compared transfusion and chelation treatment prior to the start of study treatment, together with iron burden assessed at study entry by serum ferritin, liver iron concentration and labile plasma iron levels. Results and conclusions Data show that transfusion and iron chelation practices differ between anaemias and between geographical regions; this may be linked to availability and accessibility of transfusion and chelation therapy, patients’ compliance, physicians’ attitudes, costs and use of treatment guidelines. Approximately 60% of these transfusion-dependent patients were severely iron overloaded with a serum ferritin level over 2,500 ng/mL, indicating that the risks of iron burden may have been underestimated and current iron chelation therapy, if considered, may not have been adequate to control iron burden. PMID:22871821

Viprakasit, Vip; Gattermann, Norbert; Lee, Jong Wook; Porter, John B.; Taher, Ali T.; Habr, Dany; Martin, Nicolas; Domokos, Gabor; Cappellini, Maria Domenica

2013-01-01

272

Does blood transfusion affect pituitary gonadal axis and sperm parameters in young males with sickle cell disease?  

PubMed Central

Objective: We evaluated the effect of packed red cell transfusion (PCTx) on serum concentrations of gonadotropins luteinizing hormone and follicle-stimulating hormone (LH and FSH) and testosterone (T) levels and measured sperm parameters in young adults with sickle cell disease (SCD) on top-up transfusion (TTx) and those on exchange transfusion (ETx) regimen. Materials and Methods: Basal serum concentrations of FSH, LH, and T and semen parameters were evaluated before and 7 days after PCTx in 18 young adults with transfusion-dependent SCD, aged 20.7 ± 2.88 years. They had full pubertal development (Tanner's stage 5), and capacity to ejaculate. They were regularly transfused since early childhood. Chelation therapy was started early during the first 2 years of life using desferrioxamine and was replaced by deferasirox for the last 4-5 years. Ten patients were on TTx and eight were on ETx regimen. Results: PCTx significantly increased hemoglobin (Hb) from 8.5 ± 1.17 g/dl to 10.5 ± 0.4 g/dl, T from 12.3 ± 1.24 nmol/L to 14.23 ± 1.22 nmol/L and gonadotropins’ concentrations. Sperm parameters improved significantly after PCTx including: total sperm count from 87.4 ± 24.6 million/ml to 146.2 ± 51.25 million/ml, total progressive sperm motility (TPM) from 40.8 ± 11.1 million/ml to 93.4 ± 38.3 million/ml, rapid progressive sperm motility (RPM) progressive motility from 29.26 ± 8.75 million/ml to 67.4 ± 29 million/ml. After PCTx the total sperm count, TPM and RPM were significantly better in the ETx group versus the TTx group. Before and after PCTx, T concentrations were correlated significantly with sperm total count, volume, TPM and RPM (r = 0.53, 0.55, 0.42, and 0.38, respectively, P < 0.01). Hb concentrations were correlated significantly with sperm count, TPM, RPM, and % of sperms with normal morphology (r = 0.60, 0.69, 0.66, and 0.86, respectively, P < 0.001). Conclusion: Our study suggests that in males with SCD blood transfusion is associated with significant acute enhancement of sperm parameters and with increased concentrations of serum T, LH, and FSH. Improvement of sperm parameters were significantly better in the ETx group verses the TTx group. These “acute” effects on spermiogenesis are reached with an unknown mechanism/s and suggest a number of pathways that need further human and/or experimental studies. PMID:24381868

Soliman, Ashraf T.; Yasin, Mohamed; El-Awwa, Ahmed; Abdelrahman, Mohamed O.; De Sanctis, Vincenzo

2013-01-01

273

Enzyme-Linked Immunosorbent Assay for Detection of Shiga Toxin-Producing Escherichia coli Infection by Antibodies to Escherichia coli Secreted Protein B in Children with Hemolytic Uremic Syndrome  

Microsoft Academic Search

In order to detect immunoglobulin (Ig)A and IgG antibodies to Escherichia coli-secreted protein B in sera of children infected with Shiga toxin-producing Escherichia coli, an enzyme-linked immunosorbent assay was developed. The assay was tested using acute sera from 40 children with diarrhea-associated hemolytic uremic syndrome compared with 238 sera obtained from pediatric controls. Two cut-off values were used for children

A.-C. Sjögren; J. B. Kaper; A. Caprioli; D. Karpman

2004-01-01

274

Hemolytic activity of venom from crown-of-thorns starfish Acanthaster planci spines  

PubMed Central

Background The crown-of-thorns starfish Acanthaster planci is a venomous species from Taiwan whose venom provokes strong hemolytic activity. To understand the hemolytic properties of A. planci venom, samples were collected from A. planci spines in the Penghu Islands, dialyzed with distilled water, and lyophilized into A. planci spine venom (ASV) powder. Results Both crude venom and ASV cause 50% hemolysis at a concentration of 20 ?g/mL. The highest hemolytic activity of ASV was measured at pH 7.0-7.4; ASV-dependent hemolysis was sharply reduced when the pH was lower than 3 or greater than 8. There was almost no hemolytic activity when the Cu2+ concentration was increased to 10 mM. Furthermore, incubation at 100°C for 30 to 60 minutes sharply decreased the hemolytic activity of ASV. After treatment with the protease ?-chymotrypsin, the glycoside hydrolase cellulase, and the membrane component cholesterin, the hemolytic activity of ASV was significantly inhibited. Conclusions The results of this study provide fundamental information about A. planci spine venom. The hemolytic activity was affected by pH, temperature, metal ions, EDTA, cholesterin, proteases, and glycoside hydrolases. ASV hemolysis was inhibited by Cu2+, cholesterin, ?-chymotrypsin, and cellulose, factors that might prevent the hemolytic activity of venom and provide the medical treatment for sting. PMID:24063308

2013-01-01

275

Blood Transfusion and Donation - Multiple Languages: MedlinePlus  

MedlinePLUS

... please enable JavaScript. Blood Transfusion and Donation - Multiple Languages Arabic (???????) Bosnian (Bosanski) Chinese - Simplified (????) Chinese - ... Characters not displaying correctly on this page? See language display issues . Return to the MedlinePlus Health Information ...

276

Bone marrow transfusions in previously irradiated, hematologically normal syngeneic mice  

SciTech Connect

Transfusion of syngeneic marrow into normal, nonirradiated recipients results only in minimal proliferation of donor cells. However, irradiated recipients, restored to hematologic normalcy by an initial marrow transfusion, subsequently sustain proliferation which replaces approximately 10% of endogenous marrow after a single transfusion of 4 x 10/sup 7/ marrow cells of the same strain as the host. Cells from histoincompatible donors proliferate only rarely or minimally in the marrows of these irradiated, but hematologically normal recipients without reirradiation. Syngeneic male donor cells proliferate in irradiated and restored female mice, while female donor cells fail to proliferate in the marrow of syngeneic male recipients. A possible explanation is that transfused female cells respond immunologically to the abundant H-Y antigen in the male environment and are eliminated as a result.

Brecher, G. (Univ. of California, Berkeley); Lawce, H.; Tjio, J.H.

1981-03-01

277

Stage-based treatment of twin-twin transfusion syndrome  

Microsoft Academic Search

Objective: The purpose of this study was to compare the outcomes of patients with twin-twin transfusion syndrome who were treated with either serial amniocentesis or selective laser photocoagulation of communicating vessels according to disease severity (stage). Study Design: Centers that were experienced in the treatment of twin-twin transfusion syndrome were invited to share stage-based perinatal outcome data. All patients met

Rubén A. Quintero; Jan E. Dickinson; Walter J. Morales; Patricia W. Bornick; Carlos Bermúdez; Robert Cincotta; Fung Yee Chan; Mary H. Allen

2003-01-01

278

Placental types and twin-twin transfusion syndrome  

Microsoft Academic Search

Objective: The purpose of this study was to assess the value of a proposed classification of monochorionic placenta in reference to twin-twin transfusion syndrome. Study Design: The placentas from laser-treated patients with twin-twin transfusion syndrome and from uncomplicated monochorionic pregnancies that were delivered between January 1997 and December 2000 were included in the study. Placentas were classified as type A

Carlos Bermúdez; Carlos H. Becerra; Patricia W. Bornick; Mary H. Allen; Jorge Arroyo; Rubén A. Quintero

2002-01-01

279

Concerns of patients, MDs are transforming transfusion medicine.  

PubMed Central

Fear of HIV and AIDS has been the driving force in reducing physicians' use of blood and blood products. Nancy Robb interviewed doctors across the country to determine steps they are taking to lower the number of transfusions and discovered that transfusion medicine in Canada has undergone a sea change. Images p392-a p393-a p394-a p395-a p396-a PMID:8564912

Robb, N

1996-01-01

280

Isolation of a Variant of Subtilosin A with Hemolytic Activity?  

PubMed Central

Bacillus subtilis produces an anionic bacteriocin called subtilosin A that possesses antibacterial activity against certain gram-positive bacteria. In this study, we uncovered a hemolytic mutant of B. subtilis that produces an altered form of subtilosin A. The mutant bacteriocin, named subtilosin A1, has a replacement of threonine at position 6 with isoleucine. In addition to the hemolytic activity, subtilosin A1 was found to exhibit enhanced antimicrobial activity against specific bacterial strains. The B. subtilis albB mutant that does not produce a putative immunity peptide was more sensitive to both subtilosin A and subtilosin A1. A spontaneous suppressor mutation of albB that restored resistance to subtilosin A and subtilosin A1 was obtained. The sbr (subtilosin resistance) mutation conferring the resistance is not linked to the sboA-alb locus. The sbr mutation does not increase the resistance of B. subtilis to other cell envelope-targeted antimicrobial agents, indicating that the mutation specifically confers the resistance to subtilosins. The findings suggest possible bioengineering approaches for obtaining anionic bacteriocins with enhanced and/or altered bactericidal activity. Furthermore, future identification of the subtilosin-resistant mutation could provide insights into the mechanism of subtilosin A activity. PMID:19633086

Huang, Tai; Geng, Hao; Miyyapuram, Venugopal R.; Sit, Clarissa S.; Vederas, John C.; Nakano, Michiko M.

2009-01-01

281

Current approaches for the treatment of autoimmune hemolytic anemia.  

PubMed

Autoimmune hemolytic anemia (AIHA) is an infrequent group of diseases defined by autoantibody mediated red blood cell destruction. Correct diagnosis and classification of this condition are essential to provide appropriate treatment. AIHA is divided into warm and cold types according to the characteristics of the autoantibody involved and by the presence of an underlying or associated disorder into primary and secondary AIHA. Due to its low frequency, treatment for AIHA is largely based on small prospective trials, case series, and empirical observations. This review describes in detail the different treatment approaches for autoimmune hemolytic anemia. Warm antibody type AIHA should be treated with steroids, to which most patients respond, although relapse can occur and maintenance doses are frequently required. Splenectomy is an effective second line treatment and can provide long-term remission without medication. Rituximab is a useful alternative for steroid refractory patients, those requiring high maintenance doses and unfavorable candidates for surgery. Promising therapeutic modifications with this monoclonal antibody are emerging including drug combinations, lower doses, and long-term use. Primary cold agglutinin disease has been recognized as having a lymphoproliferative monoclonal origin. It is unresponsive to both steroids and splenectomy. Rituximab is currently the best therapeutic alternative for this condition, and several treatment regimens are available with variable responses. PMID:23689532

Jaime-Pérez, José Carlos; Rodríguez-Martínez, Marisol; Gómez-de-León, Andrés; Tarín-Arzaga, Luz; Gómez-Almaguer, David

2013-10-01

282

Hydroxyurea Treatment in Transfusion-Dependent ?-Thalassemia Patients  

PubMed Central

Background: ?-Thalassemia is an inherited hemoglobin disorder caused by defective synthesis of ß-globin chains. Hemoglobin (Hb) F induction is a possible therapeutic approach which can partially compensate for ? and non-? globin chains imbalance. Objectives: We aimed to investigate the efficacy and safety of Hydroxyurea (HU) in diminishing transfusion requirements of patients with ?-thalassemia major in Southern Iran. Patients and Methods: In this single-arm clinical trial, all transfusion-dependent ?-thalassemia patients older than two years old (n = 97) who had inclusion criteria of the study and had been registered for at least six months in Dastgheib thalassemia outpatient clinic (a referral center affiliated to Shiraz University of Medical Sciences) were evaluated from October 2010 to December 2011. The patients were treated with HU with a mean dose of 10.5 mg/kg for a mean duration of 8 months (range 3-14 months). Transfusion needs and Hb levels were compared before and after HU treatment. Results: The mean volume of blood transfusion decreased significantly following HU treatment (0.71 mL/kg/day vs. 0.43 mL/kg/day, P < 0.001). Two-thirds of the patients showed good and partial response. No serious adverse reaction was observed except persistent neutropenia in two patients. Conclusions: Hydroxyurea can be safely used in some transfusion-dependent ?-thalassemia patients to decrease their transfusion needs. PMID:25068055

Bordbar, Mohammad Reza; Silavizadeh, Samir; Haghpanah, Sezaneh; Kamfiroozi, Roza; Bardestani, Marzieh; Karimi, Mehran

2014-01-01

283

Blood transfusion in Europe: basic principles for initial and continuous training in transfusion medicine: an approach to an European harmonisation  

Microsoft Academic Search

Over the past few decades, transfusion medicine and haemotherapy have evolved into complex medical disciplines comprising a broad field of subspecialties such as immunohaematology, blood component production, haemapheresis and haemostaseology. Transfusion medicine is thus an important qualification at the interfaces of analytical laboratory medicine, pharmaceutical production and clinical disciplines such as internal medicine, anaesthesiology or surgery. Physicians specialising in transfusion

M. M. Mueller; E. Seifried

2006-01-01

284

[Responsibility for prescribing and monitoring an act transfusion and safety blood transfusion].  

PubMed

The act to transfuse is a prescription following basic rules similar to drug prescriptions. If harm happens, potentially linked with this prescription, the harm's responsibility is borne by the physician, the paramedics, the care organization but by the supplier laboratory too. The setting of good practice rules consistent with science data at the time when the act is performed, the respect of the patient's rights and the quality of supplied products will be assessed during the expertise. Under restorative responsibility, it is necessary to previously establish a direct and certain causation between the litigious act and the harm to enforce the vicarious liability. Nowadays, legal precedents grant a larger protection to more and more numerous victims, enhancing the field of the fault with the appeal to assumption of fault. At the same time, the lawmaker himself promulgated objective conditions of compensation for many categories of victims of medical risk from which transfused people are part. The law of March the 4th of 2002 went one step closer devoting a new foundation of compensation: national solidarity. PMID:25282487

Piercecchi-Marti, M D; Tuchtan-Torrents, L; Lassale, B; Leonetti, G; Bartoli, C

2014-11-01

285

Reversal of liver function without exchange transfusion in sickle cell intrahepatic cholestasis  

PubMed Central

Sickle cell intrahepatic cholestasis (SCIC) is a rare but fatal complication of sickle cell disease. It is found mainly in homozygous sickle cell disease. To date, there are no standard diagnostic criteria or well-established therapeutic approaches to this condition. Herein, we report this case of a 48-year-old man with sickle cell anemia and a total bilirubin of 78.5 mg/dL without evidence of extrahepatic biliary obstruction or viral hepatitis. The patient had a hemoglobin S level of 87.9%, acute renal failure, and mild coagulopathy. Despite the disease severity, he refused exchange transfusion (ET) with packed red blood cells. He was transfused with 2 units of blood and treated mainly with supportive measures. His total bilirubin levels trended down to normal days after discharge. Multiple studies have shown a significant decrease in the mortality rate in SCIC after ET. To date, only two reported adult cases have survived SCIC without aggressive treatment. Our case is the third case that demonstrates recovery of severe SCIC without ET. PMID:25484513

Rassameehiran, Supannee; Argueta, Erwin; Tijani, Lukman

2014-01-01

286

Immune-mediated hemolytic anemia and thrombocytopenia in a foal.  

PubMed

A one-month-old Quarter Horse filly had unilateral epistaxis, hyphema, icterus, petechial hemorrhages in the oral, nasal, conjunctival, and vulvar mucous membranes, anemia, thrombocytopenia, negative antinuclear test result, and a positive direct Coombs' test result. Megakaryocytes or cell-associated IgG (fluorescent antibody and immunoperoxidase stains) were not found in bone marrow biopsy specimens. Treatment consisted of glucocorticoids, antibiotics, and a single whole blood transfusion. The foal responded well to treatment, did not develop relapses of the disease, and was clinically normal one year after treatment. PMID:3558071

Sockett, D C; Traub-Dargatz, J; Weiser, M G

1987-02-01

287

Anemia and red blood cell transfusion in neurocritical care  

PubMed Central

Introduction Anemia is one of the most common medical complications to be encountered in critically ill patients. Based on the results of clinical trials, transfusion practices across the world have generally become more restrictive. However, because reduced oxygen delivery contributes to 'secondary' cerebral injury, anemia may not be as well tolerated among neurocritical care patients. Methods The first portion of this paper is a narrative review of the physiologic implications of anemia, hemodilution, and transfusion in the setting of brain-injury and stroke. The second portion is a systematic review to identify studies assessing the association between anemia or the use of red blood cell transfusions and relevant clinical outcomes in various neurocritical care populations. Results There have been no randomized controlled trials that have adequately assessed optimal transfusion thresholds specifically among brain-injured patients. The importance of ischemia and the implications of anemia are not necessarily the same for all neurocritical care conditions. Nevertheless, there exists an extensive body of experimental work, as well as human observational and physiologic studies, which have advanced knowledge in this area and provide some guidance to clinicians. Lower hemoglobin concentrations are consistently associated with worse physiologic parameters and clinical outcomes; however, this relationship may not be altered by more aggressive use of red blood cell transfusions. Conclusions Although hemoglobin concentrations as low as 7 g/dl are well tolerated in most critical care patients, such a severe degree of anemia could be harmful in brain-injured patients. Randomized controlled trials of different transfusion thresholds, specifically in neurocritical care settings, are required. The impact of the duration of blood storage on the neurologic implications of transfusion also requires further investigation. PMID:19519893

Kramer, Andreas H; Zygun, David A

2009-01-01

288

Neutropenia, inflammation, and the kinetics of transfused neutrophils in rabbits.  

PubMed

A rabbit model was used to study the effects of neutropenia and inflammation on the intravascular distribution, survival, and tissue accumulation of transfused neutrophils. Donor blood labeled with [(3)H]thymidine was infused into normal or neutropenic (vinblastine treated) animals. Inflammation was created by subcutaneous implantation of polyvinyl sponges, some with added endotoxin. Initial circulating neutrophil pool recovery, survival, and inflammatory site accumulation of labeled neutrophils were measured. Neutropenia was associated with a relative increase in the marginal pool size, manifested by a diminished initial circulating pool (CNP) recovery of transfused cells. The CNP recovery was directly proportional to recipient neutrophil count. Neutropenia had no effect on the intravascular survival of transfused cells and was accompanied by only a modest decrease in the inflammatory site recovery of the transfused neutrophils (10.4+/-5.4 vs. 14.4+/-4.0% in normals). Inflammation in the form of subcutaneous polyvinyl sponges was accompanied by an increase in margination with initial CNP recoveries of 24.3+/-4.7 and 27.6+/-8.8% at zero and 4 h after implantation respectively (normal, 38.2+/-9.9%). Transit through the CNP was hastened by inflammation with a t((1/2)) of 2.02+/-0.72 h (normal, 3.2+/-1.0 h). Addition of endotoxin to the sponges further perturbed cell kinetics. CNP recoveries were considerably lower and half-lifes were initially shorter and subsequently uninterpretable in studies done after endotoxin sponge insertion. Inflammatory site accumulation was markedly diminished to 7.4+/-1.9% of injected neutrophil label in the endotoxin sponge animals, suggesting that many of the transfused cells were functionally unavailable rather than marginated. These studies demonstrate that neutropenia and inflammation with or without endotoxin markedly alter the kinetics of transfused neutrophils and that CNP recovery of transfused cells is not necessarily predictive of their inflammatory site accumulation. PMID:457870

Rosenshein, M S; Price, T H; Dale, D C

1979-08-01

289

Neutropenia, Inflammation, and the Kinetics of Transfused Neutrophils in Rabbits  

PubMed Central

A rabbit model was used to study the effects of neutropenia and inflammation on the intravascular distribution, survival, and tissue accumulation of transfused neutrophils. Donor blood labeled with [3H]thymidine was infused into normal or neutropenic (vinblastine treated) animals. Inflammation was created by subcutaneous implantation of polyvinyl sponges, some with added endotoxin. Initial circulating neutrophil pool recovery, survival, and inflammatory site accumulation of labeled neutrophils were measured. Neutropenia was associated with a relative increase in the marginal pool size, manifested by a diminished initial circulating pool (CNP) recovery of transfused cells. The CNP recovery was directly proportional to recipient neutrophil count. Neutropenia had no effect on the intravascular survival of transfused cells and was accompanied by only a modest decrease in the inflammatory site recovery of the transfused neutrophils (10.4±5.4 vs. 14.4±4.0% in normals). Inflammation in the form of subcutaneous polyvinyl sponges was accompanied by an increase in margination with initial CNP recoveries of 24.3±4.7 and 27.6±8.8% at zero and 4 h after implantation respectively (normal, 38.2±9.9%). Transit through the CNP was hastened by inflammation with a t˝ of 2.02±0.72 h (normal, 3.2±1.0 h). Addition of endotoxin to the sponges further perturbed cell kinetics. CNP recoveries were considerably lower and half-lifes were initially shorter and subsequently uninterpretable in studies done after endotoxin sponge insertion. Inflammatory site accumulation was markedly diminished to 7.4±1.9% of injected neutrophil label in the endotoxin sponge animals, suggesting that many of the transfused cells were functionally unavailable rather than marginated. These studies demonstrate that neutropenia and inflammation with or without endotoxin markedly alter the kinetics of transfused neutrophils and that CNP recovery of transfused cells is not necessarily predictive of their inflammatory site accumulation. PMID:457870

Rosenshein, Marc S.; Price, Thomas H.; Dale, David C.

1979-01-01

290

Survival of red blood cells after transfusion: processes and consequences  

PubMed Central

The currently available data suggest that efforts toward improving the quality of red blood cell (RBC) blood bank products should concentrate on: (1) preventing the removal of a considerable fraction of the transfused RBCs that takes place within the first hours after transfusion; (2) minimizing the interaction of the transfused RBCs with the patient's immune system. These issues are important in reducing the number and extent of the damaging side effects of transfusions, such as generation of alloantibodies and autoantibodies and iron accumulation, especially in transfusion-dependent patients. Thus, it becomes important for blood bank research not only to assess the classical RBC parameters for quality control during storage, but even more so to identify the parameters that predict RBC survival, function and behavior in the patient after transfusion. These parameters are likely to result from elucidation of the mechanisms that underly physiological RBC aging in vivo, and that lead to the generation of senescent cell antigens and the accumulation of damaged molecules in vesicles. Also, study of RBC pathology-related mechanisms, such as encountered in various hemoglobinopathies and membranopathies, may help to elucidate the mechanisms underlying a storage-associated increase in susceptibility to physiological stress conditions. Recent data indicate that a combination of new approaches in vitro to mimick RBC behavior in vivo, the growing knowledge of the signaling networks that regulate RBC structure and function, and the rapidly expanding set of proteomic and metabolomic data, will be instrumental to identify the storage-associated processes that control RBC survival after transfusion. PMID:24391593

Bosman, Giel J. C. G. M.

2013-01-01

291

Twin-to-Twin Transfusion Syndrome  

PubMed Central

The twin-to-twin transfusion syndrome (TTS) results from an unbalanced blood supply through placental anastomoses in monochorionic twins. It induces growth restriction, renal tubular dysgenesis, and oliguria in the donor and visceromegaly and polyuria in the recipient. A better understanding of its pathophysiology could contribute to improving the management of TTS, which still carries a high perinatal mortality in both twins. As well as several other candidates, the renin-angiotensin system might be involved in TTS. To evaluate its role in the pathogenesis of the syndrome, we studied the kidneys of 21 twin pairs who died from TTS at 19 to 30 weeks, compared with 39 individuals in a control group, using light microscopy, immunohistochemistry, and in situ hybridization. The overexpression of the renin protein and transcript with frequent evidence of renin synthesis by mesangial cells was observed in the donor kidneys, presumably as a consequence of chronic renal hypoperfusion. This upregulation of renin synthesis might be beneficial to restore euvolemia. In severe cases of TTS, however, angiotensin-II-induced vasoconstriction acts as an additional deleterious factor by further reducing the renal blood flow in donors. In recipients, renin expression was virtually absent, possibly because it was down-regulated by hypervolemia. However, in addition to congestion and hemorrhagic infarction, there were severe glomerular and arterial lesions resembling those observed in polycythemia- or hypertension-induced microangiopathy. We speculate that fetal hypertension in the recipient might be partly mediated by the transfer of circulating renin produced by the donor, through the placental vascular shunts. PMID:10666392

Mahieu-Caputo, Dominique; Dommergues, Marc; Delezoide, Anne-Lise; Lacoste, Mireille; Cai, Yi; Narcy, Françoise; Jolly, Dominique; Gonzales, Marie; Dumez, Yves; Gubler, Marie-Claire

2000-01-01

292

Randomized Trial of Liberal Versus Restrictive Guidelines for Red Blood Cell Transfusion in Preterm Infants  

PubMed Central

Objective Although many centers have introduced more restrictive transfusion policies for preterm infants in recent years, the benefits and adverse consequences of allowing lower hematocrit levels have not been systematically evaluated. The objective of this study was to determine if restrictive guidelines for red blood cell (RBC) transfusions for preterm infants can reduce the number of transfusions without adverse consequences. Design, Setting, and Patients We enrolled 100 hospitalized preterm infants with birth weights of 500 to 1300 g into a randomized clinical trial comparing 2 levels of hematocrit threshold for RBC transfusion. Intervention The infants were assigned randomly to either the liberal- or the restrictive-transfusion group. For each group, transfusions were given only when the hematocrit level fell below the assigned value. In each group, the transfusion threshold levels decreased with improving clinical status. Main Outcome Measures We recorded the number of transfusions, the number of donor exposures, and various clinical and physiologic outcomes. Results Infants in the liberal-transfusion group received more RBC transfusions (5.2 ± 4.5 [mean ± SD] vs 3.3 ± 2.9 in the restrictive-transfusion group). However, the number of donors to whom the infants were exposed was not significantly different (2.8 ± 2.5 vs 2.2 ± 2.0). There was no difference between the groups in the percentage of infants who avoided transfusions altogether (12% in the liberal-transfusion group versus 10% in the restrictive-transfusion group). Infants in the restrictive-transfusion group were more likely to have intraparenchymal brain hemorrhage or periventricular leukomalacia, and they had more frequent episodes of apnea, including both mild and severe episodes. Conclusions Although both transfusion programs were well tolerated, our finding of more frequent major adverse neurologic events in the restrictive RBC-transfusion group suggests that the practice of restrictive transfusions may be harmful to preterm infants. PMID:15930233

Bell, Edward F.; Strauss, Ronald G.; Widness, John A.; Mahoney, Larry T.; Mock, Donald M.; Seward, Victoria J.; Cress, Gretchen A.; Johnson, Karen J.; Kromer, Irma J.; Zimmerman, M. Bridget

2010-01-01

293

REACTIONS OF RABBITS TO NON-HEMOLYTIC STREPTOCOCCI  

PubMed Central

1. Accompanying and following the evolution of a secondary reaction in the skin of rabbits after inoculation with suitable doses of certain non-hemolytic streptococci there quickly develops a general state of hypersensitiveness or allergy towards these streptococci. 2. This state is made evident by ophthalmic reactions following corneal inoculations, by much increased reactivity of the skin following intracutaneous reinoculations, and by lethal reactions, resembling tuberculin shock, following intravenous inoculations. 3. In a given hypersensitive rabbit there is a rough parallelism in the intensities of these different kinds of reactions. 4. This type of hypersensitiveness or bacterial allergy does not follow primary intravenous inoculation of rabbits with comparable doses of the streptococci employed. 5. As the development of this type of hypersensitiveness or bacterial allergy seems to accompany the production of focal lesions of a certain intensity, it is probable that in these foci are produced the substances or conditions which lead to this type of bacterial allergy. PMID:19869568

Derick, C. L.; Swift, Homer F.

1929-01-01

294

A Fetal Hemolytic Anemia in a Child with Cytomegalovirus Infection  

PubMed Central

Background Autoimmune hemolytic anemia is a hematologic disorder that is rarely observed in infants and young children. Most of the cases are associated with viral or bacterial infections. In some cases, AIHA can be characterized by a chronic course and an unsatisfactory control of hemolysis, thus requiring prolonged immunosuppressive therapy. Case report Especially in children younger than 2 years of age, the clinical course of the disease may show either resistance to steroids or dependence on high-dose steroids. We report here an infant fatal autoimmune Conclusion This case suggests that investigation for the presence of CMV infection in infantile AIHA should be considered. Severe hemolysis is rare but could be a potentially life-threatening complication of CMV infection described mostly in immune compromised adults and children. PMID:25002930

Hosseeini, S; Ansari, Sh; Kalantar, E; Sabzechian, M; Alibeik, A; Dorgalaleh, A

2014-01-01

295

Green light phototherapy in newborn infants with ABO hemolytic disease.  

PubMed

The efficacy of fluorescent green light phototherapy was compared with that of blue light phototherapy in the treatment of full-term infants with hemolytic disease and jaundice caused by ABO incompatibility. The efficacy of the treatment was expressed as actual (milligrams per hour) and quantum (milligrams per hour per square centimeter per megawatt) efficiency, taking into account the differential emission of energy from the green versus the blue fluorescent tubes. No statistically significant difference in the rate of serum bilirubin photodegradation was found between the two groups after treatment for 84.6 +/- 14.1 hours versus 81.5 +/- 14.2 hours with the green and the blue phototherapy, respectively. These results, coupled with the known effects of the blue light on the genetic apparatus of mammalian cells, support the application of the green light phototherapy for the treatment of neonatal hyperbilirubinemia caused by ABO incompatibility. PMID:3681556

Ayyash, H; Hadjigeorgiou, E; Sofatzis, J; Chatziioannou, A; Nicolopoulos, D; Sideris, E

1987-12-01

296

Blood transfusion in Europe: basic principles for initial and continuous training in transfusion medicine: an approach to an European harmonisation.  

PubMed

Over the past few decades, transfusion medicine and haemotherapy have evolved into complex medical disciplines comprising a broad field of subspecialties such as immunohaematology, blood component production, haemapheresis and haemostaseology. Transfusion medicine is thus an important qualification at the interfaces of analytical laboratory medicine, pharmaceutical production and clinical disciplines such as internal medicine, anaesthesiology or surgery. Physicians specialising in transfusion medicine are valuable and competent partners for these related disciplines when it comes to safe, effective and tailored haemotherapy. Why has transfusion medicine become so complex? On the one hand, one can discern problems such as infectious diseases like the HIV disaster in the past century, resulting in guidelines, directives and laws such as the transfusion law in Germany. Thereby, we now enjoy the highest level of blood product safety ever regarding viral transmission thanks to the broad implementation of PCR testing. On the other hand, there are numerous positive reasons for the increasing complexity of transfusion medicine: Modern medical therapies like stem cell transplantation, cellular therapy, transplantation of solid organs, regenerative medicine and surgery cannot exist without a safe supply of blood products and high quality standard as well as special blood products and laboratory services provided by blood banks and transfusion medicine specialists. Good laboratory practice (GLP), good manufacturing practice (GMP), quality management systems and quality control on the pharmaceutical manufacturer's level are only few examples of the standards in today's blood banking. European directives in the field of blood products, stem cell preparations and tissue have led to higher uniform quality standards for biological preparations in a unified Europe, which is the desired outcome, but which also increases the complexity of this field. In contrast, directives 93/16/EEC and 2001/19/EC, the directives of the European Parliament and of the Council on the mutual recognition of professional qualifications of European doctors currently in force, as well as the impending directive 2005/36/EC, which has to be translated into national law until October 2007, do not include transfusion medicine, blood transfusion or immunohaematology at all. Other medical specialities, which like our field, are not common to all member states of the European Union, are listed in the above mentioned directives with the minimum length of training and minimal requirements for the qualifications. Examples include clinical biology, biological haematology, microbiology-bacteriology, biological chemistry, immunology, thoracic, paediatric or vascular surgery as well as physiotherapy, stomatology, neuro-psychiatry, dermato-venerology, occupational medicine, allergology, geriatrics, gastro-enterological surgery, community medicine, nuclear medicine, pharmacology, accident and emergency medicine or tropical medicine. Most of the above are medical specialities in some member states, but not in all. A concerted initiative inaugurated by the European Network of Transfusion Medicine Societies (EuroNet-TMS) and the European Blood Alliance (EBA) aims to compile the situation of the transfusion medicine speciality throughout Europe. A preliminary summary of the current situation in 15 European states was prepared in 2005 after a first set of questions, which was sent out by us via the EBA platform. The authors appreciate Clair Watts' compilation of the answers provided by the 15 European colleagues. A summary of these answers is depicted in Table 1. However, the initiative aims at a more complex analysis of the different requirements and constituent parts of the qualification in transfusion medicine in different countries. A long-term objective of this initiative might be to introduce the transfusion medicine specialisation into the above mentioned EC directives in order to facilitate mutual recognition of transfusion medicine qualifications throughout Europe. PMID:171

Mueller, M M; Seifried, E

2006-11-01

297

Dose of Prophylactic Platelet Transfusions and Prevention of Hemorrhage  

PubMed Central

BACKGROUND We conducted a trial of prophylactic platelet transfusions to evaluate the effect of platelet dose on bleeding in patients with hypoproliferative thrombocytopenia. METHODS We randomly assigned hospitalized patients undergoing hematopoietic stem-cell transplantation or chemotherapy for hematologic cancers or solid tumors to receive prophylactic platelet transfusions at a low dose, a medium dose, or a high dose (1.1×1011, 2.2×1011, or 4.4×1011 platelets per square meter of body-surface area, respectively), when morning platelet counts were 10,000 per cubic millimeter or lower. Clinical signs of bleeding were assessed daily. The primary end point was bleeding of grade 2 or higher (as defined on the basis of World Health Organization criteria). RESULTS In the 1272 patients who received at least one platelet transfusion, the primary end point was observed in 71%, 69%, and 70% of the patients in the low-dose group, the medium-dose group, and the high-dose group, respectively (differences were not significant). The incidences of higher grades of bleeding, and other adverse events, were similar among the three groups. The median number of platelets transfused was significantly lower in the low-dose group (9.25×1011) than in the medium-dose group (11.25×1011) or the high-dose group (19.63×1011) (P = 0.002 for low vs. medium, P<0.001 for high vs. low and high vs. medium), but the median number of platelet transfusions given was significantly higher in the low-dose group (five, vs. three in the medium-dose and three in the high-dose group; P<0.001 for low vs. medium and low vs. high). Bleeding occurred on 25% of the study days on which morning platelet counts were 5000 per cubic millimeter or lower, as compared with 17% of study days on which platelet counts were 6000 to 80,000 per cubic millimeter (P<0.001). CONCLUSIONS Low doses of platelets administered as a prophylactic transfusion led to a decreased number of platelets transfused per patient but an increased number of transfusions given. At doses between 1.1×1011 and 4.4×1011 platelets per square meter, the number of platelets in the prophylactic transfusion had no effect on the incidence of bleeding. (ClinicalTrials.gov number, NCT00128713.) PMID:20164484

Slichter, Sherrill J.; Kaufman, Richard M.; Assmann, Susan F.; McCullough, Jeffrey; Triulzi, Darrell J.; Strauss, Ronald G.; Gernsheimer, Terry B.; Ness, Paul M.; Brecher, Mark E.; Josephson, Cassandra D.; Konkle, Barbara A.; Woodson, Robert D.; Ortel, Thomas L.; Hillyer, Christopher D.; Skerrett, Donna L.; McCrae, Keith R.; Sloan, Steven R.; Uhl, Lynne; George, James N.; Aquino, Victor M.; Manno, Catherine S.; McFarland, Janice G.; Hess, John R.; Leissinger, Cindy; Granger, Suzanne

2010-01-01

298

Autologous versus allogeneic transfusion: patients' perceptions and experiences  

PubMed Central

BACKGROUND: Preoperative autologous donation is one way to decrease a patient's exposure to allogeneic blood transfusion. This study was designed to determine patients' perceptions about the autologous blood donation process and their experiences with transfusion. METHODS: To assess patient perception, a questionnaire was administered a few days before surgery to patients undergoing elective cardiac and orthopedic surgery in a Canadian teaching hospital. All patients attending the preoperative autologous donation clinic during a 10-month period were eligible. A convenience sample of patients undergoing the same types of surgery who had not predonated blood were selected from preadmission clinics. Patient charts were reviewed retrospectively to assess actual transfusion practice in all cases. RESULTS: A total of 80 patients underwent cardiac surgery (40 autologous donors, 40 nondonors) and 73 underwent orthopedic surgery (38 autologous donors, 35 nondonors). Of the autologous donors, 75 (96%) attended all scheduled donation appointments, 73 (93%) said that they were "very likely" or "likely" to predonate again, and 75 (96%) said that they would recommend autologous donation to others. There was little difference in preoperative symptoms between the autologous donors and the nondonors, although the former were more likely than the latter to report that their overall health had remained the same during the month before surgery (30 [75%] v. 21 [52%] for the cardiac surgery patients and 30 [79%] v. 18 [51%] for the orthopedic surgery patients). When the autologous donors were asked what they felt their chances would have been of receiving at least one allogeneic blood transfusion had they not predonated, the median response was 80%. When they were asked what their chances were after predonating their own blood, the median response was 0%. The autologous donors were significantly less likely to receive allogeneic blood transfusions (6 [15%] for cardiac surgery and 3 [8%] for orthopedic surgery) than were the nondonors (14 [35%] for cardiac surgery and 16 [46%] for orthopaedic surgery). They were, however, more likely to receive any transfusion (autologous or allogeneic) than were the nondonors (25 [63%] v. 14 [35%] for cardiac surgery and 31 [81%] v. 16 [46%] for orthopedic surgery). INTERPRETATION: Patients who underwent preoperative autologous blood donation were positive about the experience and did not report more symptoms than patients who did not donate blood preoperatively. Autologous donors overestimated their chances of receiving allogeneic blood transfusions had they not predonated and underestimated their chances after they had predonated. They were less likely to receive allogeneic transfusions, but more likely to receive any type of transfusion, than were patients who did not predonate. PMID:10207337

Graham, I D; Fergusson, D; Dokainish, H; Biggs, J; McAuley, L; Laupacis, A

1999-01-01

299

[What are the rules and regulations for blood product transfusion in France?].  

PubMed

In France, there are many rules and regulations for blood product transfusion. The clinician who prescribes a blood transfusion must go step by step, except for a vital emergency (must be procedured). He must have: informed consent, immunohaematologic results, specific prescription with quantity and quality of products, realisation of blood transfusion with many administrative and technical necessary controls, and prevent adverse events. A nurse or a midwife can realise the blood transfusion if there is a clinician able to intervene quickly. The blood transfusion must be noted in a medical file which is kept for thirty years. Absolute respect of these rules is the guarantee of transfusion security. PMID:19253890

Pélissier, Elisabeth; Bierling, Philippe

2009-01-20

300

Plasma in the PICU: why and when should we transfuse?  

PubMed

Whereas red blood cell transfusions have been used since the 19th century, plasma has only been available since 1941. It was originally mainly used as volume replacement, mostly during World War II and the Korean War. Over the years, its indication has shifted to correct coagulation factors deficiencies or to prevent bleeding. Currently, it remains a frequent treatment in the intensive care unit, both for critically ill adults and children. However, observational studies have shown that plasma transfusion fail to correct mildly abnormal coagulation tests. Furthermore, recent epidemiological studies have shown that plasma transfusions are associated with an increased morbidity and mortality in critically ill patients. Therefore, plasma, as any other treatment, has to be used when the benefits outweigh the risks. Based on observational data, most experts suggest limiting its use either to massively bleeding patients or bleeding patients who have documented abnormal coagulation tests, and refraining for transfusing plasma to nonbleeding patients whatever their coagulation tests. In this paper, we will review current evidence on plasma transfusions and discuss its indications. PMID:23725411

Labarinas, Sonia; Arni, Delphine; Karam, Oliver

2013-01-01

301

Resources and responsibility for professional education in blood transfusion therapy.  

PubMed

Two current problems in blood transfusion services are the widespread lack of information on this subject among practicing physicians, house staff, and medical students, and the dearth of broadly trained, full-time professionals in the field. Our most important and urgent responsibility is to train physicians who seek full-time careers in any aspect of blood transfusion services, blood center management, hospital transfusion services, research, or combination thereof. Successful training programs require sufficient space, personnel, and funds. In addition, blood centers have a responsibility to educate practicing physicians and house staff by formal teaching sessions, or informally when problems arise. Medical school curricula usually contain little on blood banking; exposure to some basic immunohematology or a visit to a blood center will help sensitize students to the availability of blood. Hospital administrators, regional medical society officers, and corporate medical directors, informed of the blood centers' activities, can help improve relationships between center, hospital, and community. PMID:7466901

Hirsch, R L

1981-01-01

302

Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions  

PubMed Central

Summary Debate on appropriate triggers for transfusion of allogeneic blood products and their effects on short- and long-term survival in surgical and critically ill patients continue with no definitive evidence or decisive resolution. Although transfusion-related immune modulation (TRIM) is well established, its influence on immune competence in the recipient and its effects on cancer recurrence after a curative resection remains controversial. An association between perioperative transfusion of allogeneic blood products and risk for recurrence has been shown in colorectal cancer in randomized trials; whether the same is true for other types of cancer remains to be determined. This article focuses on the laboratory, animal, and clinical evidence to date on the mechanistic understanding of inflammatory and immune-modulatory effects of blood products and their significance for recurrence in the cancer surgical patient. PMID:23599512

Cata, J. P.; Wang, H.; Gottumukkala, V.; Reuben, J.; Sessler, D. I.

2013-01-01

303

Transfusion-transmitted hepatitis E: is screening warranted?  

PubMed

Hepatitis E virus (HEV) is an emerging infectious threat to blood safety. In recent years, there have been a number of publications delineating this threat by providing evidence of the transmissibility of this virus through transfusions. The extent of transmission and its clinical relevance are issues under debate at present. HEV usually causes a self-limiting illness which subsides in a few weeks barring a few cases where fulminant hepatic failure occurs. The virus poses a risk of higher morbidity and mortality in pregnant females, patients with pre-existing liver disease and solid organ transplant recipients. As these categories of patient often require repeated transfusions or massive transfusions, they are exposed to a greater risk of transmission of HEV. At present, there is little evidence to advocate universal screening for this virus but considering that there is no definitive treatment for HEV induced hepatitis, selective screening should be advocated in blood products for high risk recipients in endemic areas. PMID:22120793

Bajpai, M; Gupta, E

2011-01-01

304

Blood transfusion at the time of the First World War - practice and promise at the birth of transfusion medicine.  

PubMed

The centenary of the start of the First World War has stirred considerable interest in the political, social, military and human factors of the time and how they interacted to produce and sustain the material and human destruction in the 4?years of the war and beyond. Medical practice may appear distant and static and perhaps seems to have been somewhat ineffectual in the face of so much trauma and in the light of the enormous advances in medicine and surgery over the last century. However, this is an illusion of time and of course medical, surgical and psychiatric knowledge and procedures were developing rapidly at the time and the war years accelerated implementation of many important advances. Transfusion practice lay at the heart of resuscitation, and although direct transfusion from donor to recipient was still used, Geoffrey Keynes from Britain, Oswald Robertson from America and his namesake Lawrence Bruce Robertson from Canada, developed methods for indirect transfusion from donor to recipient by storing blood in bottles and also blood-banking that laid the foundation of modern transfusion medicine. This review explores the historical setting behind the development of blood transfusion up to the start of the First World War and on how they progressed during the war and afterwards. A fresh look may renew interest in how a novel medical speciality responded to the needs of war and of post-war society. PMID:25586955

Boulton, F; Roberts, D J

2014-12-01

305

Resuscitation and transfusion principles for traumatic hemorrhagic shock  

PubMed Central

SUMMARY The transfusion approach to massive hemorrhage has continually evolved since it began in the early 1900s. It started with fresh whole blood and currently consists of virtually exclusive use of component and crystalloid therapy. Recent US military experience has reinvigorated the debate on what the most optimal transfusion strategy is for patients with traumatic hemorrhagic shock. In this review we discuss recently described mechanisms that contribute to traumatic coagulopathy, which include increased anticoagulation factors and hyperfibrinolysis. We also describe the concept of damage control resuscitation (DCR), an early and aggressive prevention and treatment of hemorrhagic shock for patients with severe life-threatening traumatic injuries. The central tenants of DCR include hypotensive resuscitation, rapid surgical control, prevention and treatment of acidosis, hypothermia, and hypocalcemia, avoidance of hemodilution, and hemostatic resuscitation with transfusion of red blood cells, plasma, and platelets in a 1:1:1 unit ratio and the appropriate use of coagulation factors such as rFVIIa and fibrinogen-containing products (fibrinogen concentrates, cryoprecipitate). Fresh whole blood is also part of DCR in locations where it is available. Additional concepts to DCR since its original description that can be considered are the preferential use of “fresh” RBCs, and when available thromboelastography to direct blood product and hemostatic adjunct (anti-fibrinolytics and coagulation factor) administration. Lastly we discuss the importance of an established massive transfusion protocol to rapidly employ DCR and hemostatic resuscitation principles. While the majority of recent trauma transfusion papers are supportive of these general concepts, there is no Level 1 or 2 data available. Taken together, the preponderance of data suggests that these concepts may significantly decrease mortality in massively transfused trauma patients. PMID:19695750

Spinella, Philip C.; Holcomb, John B.

2011-01-01

306

Antibody screening in multitransfused patients: A prerequisite before each transfusion.  

PubMed

Life-long red blood cell (RBC) transfusions remain the main treatment for severe thalassemia. We hereby report a case of anti S and anti Lu(a) in a ?-thalassemia major patient detected incidentally on antibody screening. The patient was a known case of ?-thalassemia major and was on regular blood transfusion every 3 weeks from the institute from the age of 6 months. Subsequently, on one occasion, patient's crossmatch was compatible despite positive antibody screen using microcolumn gel technique. Autocontrol and direct antiglobulin test were negative on microcolumn gel. Anti S and anti Lu(a) antibodies were identified. Blood unit found compatible was negative for S and Lu(a) antigens. Antibody titers were 1:1 for both anti S and anti Lu(a) in AHG phase using tube technique and antibodies were of IgG type. Blood unit was transfused uneventfully to the patient. Donors were traced back (last three donations) and called for repeat blood sample testing for S and Lu(a) antigen. Two out of three donors were found to be S antigen positive and one out of these two was Lu(a) antigen positive. Anti S and anti Lu(a) antibodies were again identified on patient's subsequent visit for transfusion. The present case re-emphasize the importance of antibody screening at each visit in earlier detection of antibodies in multi transfused patients. Encouraging patients to receive transfusion from one center and dedicating donors could reduce alloimmunization rate but larger studies are required. PMID:25294114

Lamba, Divjot S; Mittal, Kshitija; Sood, Tanvi; Bedi, Ravneet Kaur; Kaur, Paramjit; Kaur, Gagandeep

2014-10-01

307

Limiting excessive postoperative blood transfusion after cardiac procedures. A review.  

PubMed Central

Analysis of blood product use after cardiac operations reveals that a few patients (< or = 20%) consume the majority of blood products (> 80%). The risk factors that predispose a minority of patients to excessive blood use include patient-related factors, transfusion practices, drug-related causes, and procedure-related factors. Multivariate studies suggest that patient age and red blood cell volume are independent patient-related variables that predict excessive blood product transfusion after cardiac procedures. Other factors include preoperative aspirin ingestion, type of operation, over- or underutilization of heparin during cardiopulmonary bypass, failure to correct hypothermia after cardiopulmonary bypass, and physician overtransfusion. A survey of the currently available blood conservation techniques reveals 5 that stand out as reliable methods: 1) high-dose aprotinin therapy, 2) preoperative erythropoietin therapy when time permits adequate dosage before operation, 3) hemodilution by harvest of whole blood immediately before cardiopulmonary bypass, 4) autologous predonation of blood, and 5) salvage of oxygenator blood after cardiopulmonary bypass. Other methods, such as the use of epsilon-aminocaproic acid or desmopressin, cell saving devices, reinfusion of shed mediastinal blood, and hemofiltration have been reported to be less reliable and may even be harmful in some high-risk patients. Consideration of the available data allows formulation of a 4-pronged plan for limiting excessive blood transfusion after surgery: 1) recognize the causes of excessive transfusion, including the importance of red blood cell volume, type of procedure being performed, preoperative aspirin ingestion, etc.; 2) establish a quality management program, including a survey of transfusion practices that emphasizes physician education and availability of real-time laboratory testing to guide transfusion therapy; 3) adopt a multimodal approach using institution-proven techniques; and 4) continually reassess blood product use and analyze the cost-benefits of blood conservation interventions. PMID:7580359

Ferraris, V A; Ferraris, S P

1995-01-01

308

Characterization of the hemolytic activity of Staphylococcus aureus strains associated with toxic shock syndrome.  

PubMed Central

The hemolytic activity of 32 vaginal isolates of Staphylococcus aureus from patients with typical toxic shock syndrome (TSS) was contrasted with that of 50 vaginal isolates from patients without TSS, using a standardized inoculum (10(5) CFU) on 5% sheep blood agar after 48 h of incubation under 30% CO2. Additionally, 7 nongenital isolates from patients with nonmenstrual TSS and 57 strains of nongenital control isolates were included for comparison. Vaginal TSS strains were significantly less hemolytic than non-TSS S. aureus strains of either genital (P less than 0.001) or nongenital (P less than 0.01) origin. Vaginal TSS S. aureus strains were also less hemolytic than were nongenital TSS S. aureus strains (P less than 0.02). This reduced hemolytic activity of genital TSS S. aureus strains may provide a useful marker for screening and further delineation of toxigenic S. aureus associated with menstrually related TSS. PMID:6841587

Chow, A W; Gribble, M J; Bartlett, K H

1983-01-01

309

Pathology Case Study: Drop in Hemoglobin Following Platelet Transfusion  

NSDL National Science Digital Library

This is a case study presented by the University of Pittsburgh Department of Pathology in which a 55-year-old man experienced a drop in hemoglobin four months after a allogeneic peripheral blood stem cell transplant. Visitors are given the patient history, transfusion reaction workup, and the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in pathology and transfusion medicine.

Arida, Muammar; Puca, Kathleen

2009-02-23

310

Detection of alloimmunization to ensure safer transfusion practice  

PubMed Central

Background: Serological safety is an integral part of overall safety for blood banks. Emphasis is on the use of routinue Red Blood Cell (RBC) antibody screen test, at set time intervals, to reduce risks related to alloantibodies. Also emphasis is on importance of issuing antigen negative blood to alloantibody positive patients. Effect of using leucodepleted blood on the rate of alloimmunization is highlighted. The concept of provision of phenotypically matched blood is suggested. Materials and Methods: Antibody screen test is important to select appropriate blood for transfusion. Repeat antibody screen testing, except if time interval between the earlier and subsequent transfusion was less than 72 hours, followed by antibody identification, if required, was performed in patients being treated with repeat multiple blood transfusions. Between February 2008 and June 2009, repeat samples of 306 multi-transfused patients were analyzed. Search for irregular antibodies and reading of results was conducted using RBC panels (three-cell panel of Column Agglutination Technology (CAT) and two cell panel of the Solid Phase Red Cell Adherence Technology (SPRCAT). Specificities of antibodies were investigated using appropriate panels, 11 cell panel of CAT and 16 cell panel of SPRCA. These technologies, detecting agglutination in columns and reactions in solid phase, evaluate the attachment of irregular incomplete antibody to antigen in the first phase of immunological reaction more directly and hence improve the reading of agglutination. Three to four log leuco reduced red blood cells were transfused to patients in the study using blood collection bags with integral filters. Results: Alloimmunization rate of 4.24% was detected from 306 multiply transfused patients tested and followed up. The Transfusion therapy may become significantly complicated. Conclusion: Red cell antibody screening and identification and subsequent issue of antigen negative blood have a significant role in improving blood safety. Centers that have incorporated antibody screen test and identification have ensured safe transfusion. Identified patients should be flagged in a database and information shared. Such patients can be given carry-on cards and educated about the names of the identified antibodies. Full red cell phenotyping of individuals, patients and donors, can be feasibility. PMID:24014944

Sood, Rashmi; Makroo, R. N.; Riana, Vimarsh; Rosamma, N. L.

2013-01-01

311

Intratubular hemoglobin casts in hemolysis-associated acute kidney injury.  

PubMed

Kidney injury is a complication of intravascular hemolysis associated with many forms of hemolytic disease. Reports of kidney biopsy findings in patients with hemolysis-related kidney injury have focused primarily on the accumulation of hemosiderin pigment within proximal tubular epithelial cells (hemosiderosis), a feature of chronic hemolysis. The nephrotoxic effects of hemoglobin include direct cytotoxicity to tubular cells, but hemoglobin also can precipitate in distal nephron segments, forming obstructive casts. We present a case of hemolysis-associated tubular injury, characterized by acute onset of intravascular hemolysis followed by acute kidney injury with acute tubular injury and abundant intratubular casts containing hemoglobin. PMID:25441434

Khalighi, Mazdak A; Henriksen, Kammi J; Chang, Anthony; Meehan, Shane M

2015-02-01

312

Increasing Patient Safety and Efficiency in Transfusion Therapy Using Formal Process Definitions  

E-print Network

), errors and adverse events in transfusion medicine are a significant concern, and many problems may transfusion medicine profes- sionals were one of the first groups to design and implement methodologies

Massachusetts at Amherst, University of

313

Original Paper INCIDENCE OF COMMON TRANSFUSION TRANSMITTED DISEASES AMONG BLOOD DONORS  

E-print Network

Transfusion transmitted diseases are one of the major health problem in Bangladesh. This study was carried out among 12,270 voluntary and directed donors in the transfusion medicine department of Khulna

Ahmed Mu; Begum Ha; Hossain T; Chakraborty P

314

The evolution of hemolytic saponin content in wild and cultivated Alfalfa ( Medicago sativa , Fabaceae)  

Microsoft Academic Search

Hemolytic saponin content was determined of the leaves of 1213 plants of different variants ofMedicago sativa s.l. (including wild and cultivated alfalfa), and a close ally,M. papillosa. The latter species had a much higher content than any of the groups ofM. sativa. Medicago sativa ssp. caerulea, the most important ancestor of alfalfa, had a very low content of hemolytic saponins.

Ernest Small; Marian Jurzysta; Constance Nozzolillo

1990-01-01

315

Beta-Hemolytic Streptococcal Erythroderma Syndrome: A Clinical and Pathogenic Analysis  

PubMed Central

The syndrome of erythroderma due to beta-hemolytic streptococci is rarely seen and should be distinguished from cellulitis and toxic shock-like syndrome. We describe a novel syndrome of non-group A, beta-hemolytic streptococcal infection truncal erythroderma. The characteristics of this syndrome suggest that local factors were likely operative in the cutaneous manifestations of an exotoxin-associated erythroderma. PMID:21841465

Tyner, Harmony L; Schlievert, M; Baddour

2011-01-01

316

Effects of co-existing microalgae and grazers on the production of hemolytic toxins in Karenia mikimotoi  

NASA Astrophysics Data System (ADS)

Karenia mikimotoi (Miyake & Kominami ex Oda) Hansen & Moestrup is associated with harmful algal blooms in temperate and subtropical zones of the world. The hemolytic substances produced by K. mikimotoi are thought to cause mortality in fishes and invertebrates. We evaluated the composition of the hemolytic toxin produced by K. mikimotoi cultured in the laboratory using thin-layer chromatography. In addition, we evaluated the effect of co-occuring algae ( Prorocentrum donghaiense and Alexandrium tamarense) and the cladoceran grazer Moina mongolica on hemolytic toxin production in K. mikimotoi. The hemolytic toxins from K. mikimotoi were a mixture of 2 liposaccharides and 1 lipid. Waterborne clues from P. donghaiense and A. tamarense inhibited the growth of K. mikimotoi but increased the production of hemolytic toxins. Conversely, K. mikimotoi strongly inhibited the growth of caged P. donghaiense and A. tamarense. In addition, the ingestion of K. mikimotoi by M. mongolica induced the production of hemolytic toxins in K. mikimotoi. Taken together, our results suggest that the presence of other microalgae and grazers may be as important as environmental factors for controlling the production of hemolytic substances. K. mikimotoi secreted allelochemicals other than unstable fatty acids with hemolytic activity. The production of hemolytic toxins in dinoflagellates was not only dependent on resource availability, but also on the risk of predation. Hemolytic toxins likely play an important role as chemical deterrents secreted by K. mikimotoi.

Yang, Weidong; Zhang, Naisheng; Cui, Weimin; Xu, Yanyan; Li, Hongye; Liu, Jiesheng

2011-11-01

317

Red blood cell transfusion-dependence and outcome after allogeneic peripheral blood stem cell transplantation in patients with de novo myelodysplastic syndromes (MDS)  

PubMed Central

The prognosis of patients with de novo myelodysplastic syndromes (MDS), who are red blood cell transfusion-dependent (TD) and receive supportive care is inferior to that of patients not requiring transfusions. It is unknown, whether TD also affects outcome after allogeneic transplantation. We therefore analyzed in 172 de novo MDS patients, median age 51 years, the impact of TD on outcome after high-dose conditioning and allogeneic peripheral blood stem cell transplantation (PBSCT). With a median follow-up of 37 months the probability of 3-year overall survival (OS) did not differ significantly between patients who were or were not TD before PBSCT (p=0.1). However, transfusion burden, as reflected by ferritin levels, correlated with a higher probability of severe acute graft versus host disease (p=0.03) and a higher comorbidity index (p=0.01), and OS was inferior among patients with ferritin levels >1000µg/l before PBSCT (p=0.03). In multivariate analysis only marrow myeloblast count (p=0.01) and comorbidity index (p=0.001) had a significant impact on OS. Thus, these data did not identify TD as an independent negative prognostic factor for outcome after allogeneic PBSCT. However, iron overload, presumably transfusion-related, may contribute to inferior transplant success by adding to the overall comorbidities. Whether clinical intervention in the form of iron chelation would improve results of allogeneic PBSCT in TD patients with MDS remains to be determined. PMID:18940675

Platzbecker, Uwe; Bornhäuser, Martin; Germing, Ulrich; Stumpf, Julian; Scott, Bart L.; Kröger, Nicolaus; Schwerdtfeger, Rainer; Böhm, Alexandra; Kobbe, Guido; Theuser, Catrin; Rabitsch, Werner; Valent, Peter; Sorror, Mohamed L.; Ehninger, Gerhard; Deeg, H.Joachim

2009-01-01

318

Atypical Hemolytic Uremic Syndrome: Differential Diagnosis from TTP/HUS and Management  

PubMed Central

Atypical hemolytic uremic syndrome (aHUS) is a rare form of thrombotic microangiopathy (TMA). It has an unfavorable outcome with death rates as high as 25% during the acute phase and up to 50% of cases progressing to end-stage renal failure. Uncontrolled complement activation through the alternative pathway is thought to be the main underlying pathopysiology of aHUS and corresponds to all the deleterious findings of the disease. Thrombotic thrombocytopenic purpura (TTP) and Shiga toxin-associated HUS are the 2 other important TMA diseases. Although differentiating HUS from TTP is relatively easy in children with a preceding diarrheal illness or invasive S. pneumoniae, differentiating aHUS from TTP or other microangiopathic disorders can present a major diagnostic challenge in adults. ADAMTS13 analysis is currently the most informative diagnostic test for differentiating TTP, congenital TTP, and aHUS. Today empiric plasma therapy still is recommended by expert opinion to be used as early as possible in any patient with symptoms of aHUS. The overall treatment goal remains restoration of a physiological balance between activation and control of the alternative complement pathway. So it is a reasonable approach to block the terminal complement complex with eculizumab in order to prevent further organ injury and increase the likelihood organ recovery. Persistence of hemolysis or lack of improvement of renal function after 3-5 daily plasmaphereses have to be regarded as the major criteria for uncontrolled TMA even if platelet count has normalized and as an indication to switch the treatment to eculizumab. Eculizumab has changed the future perspectives of patients with aHUS and both the FDA and the EMA have approved it as life-long treatment. However, there are still some unresolved issues about the follow-up such as the optimal duration of eculizumab treatment and whether it can be stopped or how to stop the therapy. PMID:25319590

Yenerel, Mustafa N.

2014-01-01

319

Atypical Hemolytic Uremic Syndrome Post-Kidney Transplantation: Two Case Reports and Review of the Literature  

PubMed Central

Atypical hemolytic uremic syndrome (aHUS) is a rare disorder characterized by over-activation and dysregulation of the alternative complement pathway. Its estimated prevalence is 1–2 per million. The disease is characterized by thrombotic microangiopathy, which causes anemia, thrombocytopenia, and acute renal failure. aHUS has more severe course compared to typical (infection-induced) HUS and is frequently characterized by relapses that leads to end stage renal disease. For a long time, kidney transplantation for these patients was contraindicated because of high rate of recurrence and subsequent renal graft loss. The post-kidney transplantation recurrence rate largely depends on the pathogenetic mechanisms involved. However, over the past several years, advancements in the understanding and therapeutics of aHUS have allowed successful kidney transplantation in these patients. Eculizumab, which is a complement C5 antibody that inhibits complement factor 5a and subsequent formation of the membrane-attack complex, has been used in prevention and treatment of post-transplant aHUS recurrence. In this paper, we present two new cases of aHUS patients who underwent successful kidney transplantation in our center with the use of prophylactic and maintenance eculizumab therapy that have not been published before. The purpose of reporting these two cases is to emphasize the importance of using eculizumab as a prophylactic therapy to prevent aHUS recurrence post-transplant in high-risk patients. We will also review the current understanding of the genetics of aHUS, the pathogenesis of its recurrence after kidney transplantation, and strategies for prevention and treatment of post-transplant aHUS recurrence. PMID:25593925

Alasfar, Sami; Alachkar, Nada

2014-01-01

320

Angioarchitecture of monochorionic placentas in relation to the twin-twin transfusion syndrome  

Microsoft Academic Search

OBJECTIVE: Twin-twin transfusion syndrome in the midtrimester is associated with a perinatal mortality rate exceeding 80%. Although attributed to intertwin transfusion along vascular anastomoses, these occur in all monochorial placentas, not just the 10% with twin-twin transfusion syndrome. We compared fetoplacental angioarchitecture in monochorionic twin placentas with and without twin-twin transfusion syndrome.STUDY DESIGN: The fetoplacental circulations of both twins in

Rekha Bajoria; Jonathan Wigglesworth; Nicholas M. Fisk

1995-01-01

321

Uses and sources of data on long-term survival after blood transfusion  

Microsoft Academic Search

Several public policy decisions in transfusion medicine require information on the long-term (?10-year) survival of transfused patients. This information is needed (1) to estimate the number of surviving transfusion recipients who have contracted a particular infection through transfusion, (2) to assess the cost-effectiveness of measures introduced to further improve the safety of the allogeneic blood supply, (3) to estimate the

Eleftherios C Vamvakas

2003-01-01

322

FIELD EVALUATION OF AN INTELLIGENT TUTORING SYSTEM FOR TEACHING PROBLEM-SOLVING SKILLS IN TRANSFUSION MEDICINE  

E-print Network

IN TRANSFUSION MEDICINE Jodi Heinz Obradovich*, Philip 3. Smith*, Stephanie A. Cuerlain**, Sally Rudman*, Jack W tool to assist with tutoring in a class laboratory setting, useof the Transfusion Medicine Tutor (TMT-system, the Transfusion Medicine Tutor (TMT), by medical technology studentsto learn an important problem-solving task

Virginia, University of

323

Anonymizing Healthcare Data: A Case Study on the Blood Transfusion Service  

E-print Network

Anonymizing Healthcare Data: A Case Study on the Blood Transfusion Service Noman Mohammed Benjamin University of Ontario Institute of Technology, Oshawa, ON, Canada Hong Kong Red Cross Blood Transfusion the privacy concerns of the blood transfusion information-sharing system between the Hong Kong Red Cross Blood

Mohammed, Noman

324

Effect of Blood Transfusion on Long-Term Survival After Cardiac Operation  

Microsoft Academic Search

Background. Blood transfusions have been linked to increased morbidity and mortality. Bleeding during and after cardiac operations and the hemodilution effects of cardiopulmonary bypass commonly result in blood transfusions. Because we could not find any studies evaluating the effects of transfusion on long-term sur- vival after cardiac operation, we sought to determine these effects. Methods. We studied 1,915 patients who

Milo C. Engoren; Robert H. Habib; Anoar Zacharias; Thomas A. Schwann; Christopher J. Riordan; Samuel J. Durham

2010-01-01

325

Antibodies to Leptospira among blood donors in higher-risk areas of Australia: possible implications for transfusion safety  

PubMed Central

Background Leptospirosis is one of the most common bacterial zoonoses worldwide, and clinical manifestations range from asymptomatic infection to acute febrile illness, multi-organ failure and death. Asymptomatic, acute bacteraemia in a blood donor provides a potential for transfusion-transmission, although only a single such case from India has been recorded. Human leptospirosis is uncommon in developed countries; however, the state of Queensland in Australia has one of the highest rates among developed countries, especially after increased rainfall. This study examined the prevalence of antibodies to Leptospira spp. in blood donors residing in higher-risk areas of Australia, to evaluate the appropriateness of current blood safety guidelines. Materials and methods Plasma samples collected from blood donors residing in higher-risk areas of Australia during 2009 and 2011 were included in the study. All samples were tested for the presence of antibodies to 22 leptospiral serovars using the microscopic agglutination test. Result No sample had antibody titres suggestive of a current or recent infection, however, seven samples (1.44%, 95% CI: 0.38–2.50%) had titres suggestive of a past infection. Discussion This study provides data that may support the appropriateness of current relevant donor selection policies in Australia. Given that the risk profile for leptospirosis is expanding and that the infection is likely to become more prevalent with climate change, this disease may become more of a concern for transfusion safety in the future. PMID:24960651

Faddy, Helen; Seed, Clive; Lau, Colleen; Racloz, Vanessa; Flower, Robert; Smythe, Lee; Burns, Mary-Anne; Dohnt, Michael; Craig, Scott; Harley, Robert; Weinstein, Philip

2015-01-01

326

Detection of Autologous Blood Transfusions in Athletes: A Historical Perspective  

Microsoft Academic Search

Autologous Blood Transfusions (ABT) has been used by athletes for approximately four decades to enhance their performance. Although the method was prohibited by the International Olympic Committee (IOC) in the mid-1980s, no direct detection method has yet been developed and implemented by the World Anti-Doping Agency (WADA). Several indirect methods have been proposed with the majority relying on changes in

Jakob Mřrkeberg

327

Deferasirox for Transfusion-Related Iron Overload: A Clinical Review  

Microsoft Academic Search

Background: Iron is an essential element involved in energy production, mitochondrial respiration, and DNA synthesis in the body. Excess iron forms insoluble complexes that are deposited in, and cause damage to, internal organs. Diseases such as ?-thalassemia and myelodysplastic syndrome that require frequent blood transfusions can result in excess iron in the body. The traditional therapy for iron overload is

Wesley T. Lindsey; Bernie R. Olin

2007-01-01

328

Effects of a CME Program on Physicians' Transfusion Practices.  

ERIC Educational Resources Information Center

The hospital charts of 44 patients who were autologous blood donors undergoing elective orthopedic surgery and a matched group of 44 patients who were not autologous blood donors were analyzed to determine their physicians' transfusion practices. A continuing medical education program was developed. (Author/MLW)

Hull, Alan L.; And Others

1989-01-01

329

Partial ADAMTS13 deficiency in atypical hemolytic uremic syndrome.  

PubMed

Complement dysregulation leads to atypical hemolytic uremic syndrome (aHUS), while ADAMTS13 deficiency causes thrombotic thrombocytopenic purpura. We investigated whether genetic variations in the ADAMTS13 gene partially explain the reduced activity known to occur in some patients with aHUS. We measured complement activity and ADAMTS13 function, and completed mutation screening of multiple complement genes and ADAMTS13 in a large cohort of aHUS patients. In over 50% of patients we identified complement gene mutations. Surprisingly, 80% of patients also carried at least 1 nonsynonymous change in ADAMTS13, and in 38% of patients, multiple ADAMTS13 variations were found. Six of the 9 amino acid substitutions in ADAMTS13 were common single nucleotide polymorphisms; however, 3 variants-A747V, V832M, and R1096H- were rare, with minor allele frequencies of 0.0094%, 0.5%, and 0.32%, respectively. Reduced complement and ADAMTS13 activity (<60% of normal activity) were found in over 60% and 50% of patients, respectively. We concluded that partial ADAMTS13 deficiency is a common finding in aHUS patients and that genetic screening and functional tests of ADAMTS13 should be considered in these patients. PMID:23847193

Feng, Shuju; Eyler, Stephen J; Zhang, Yuzhou; Maga, Tara; Nester, Carla M; Kroll, Michael H; Smith, Richard J; Afshar-Kharghan, Vahid

2013-08-22

330

Incidence of congenital hemolytic anemias in young cholelithiasis patients  

PubMed Central

AIM: To clarify the incidence of congenital hemolytic anemias (CHA) in young cholelithiasis patients and to determine a possible screening test based on the results. METHODS: Young cholelithiasis patients (< 35 years) were invited to our outpatient clinic. Participants were asked for comorbidities and family history. The number of gallstones were recorded. Blood samples were obtained to perform a complete blood count, standard Wright-Giemsa staining, reticulocyte count, hemoglobin (Hb) electrophoresis, serum lactate dehydrogenase and bilirubin levels, and lipid profile. RESULTS: Of 3226 cholecystectomy patients, 199 were under 35 years, and 190 with no diagnosis of CHA were invited to take part in the study. Fifty three patients consented to the study. The median age was 29 years (range, 17-35 years), 5 were male and 48 were female. Twelve patients (22.6%) were diagnosed as thalassemia trait and/or ?ron-deficiency anemia. Hb levels were significantly lower (P = 0.046), and mean corpuscular volume (MCV) and hematocrit levels were slightly lower (P = 0.072 and 0.082, respectively) than normal. There was also a significantly lower number of gallstones with the diagnosis (P = 0.007). CONCLUSION: In endemic regions, for young cholelithiasis patients (age under 35) with 2-5 gallstones, the clinician/surgeon should pay attention to MCV and Hb levels as indicative of CHA. PMID:21086564

Ezer, Ali; Torer, Nurkan; Nursal, Tarik Zafer; Kizilkilic, Ebru; Caliskan, Kenan; Colakoglu, Tamer; Moray, Gokhan

2010-01-01

331

Specific macrothrombocytopenia/hemolytic anemia associated with sitosterolemia.  

PubMed

Sitosterolemia (phytosterolemia) is a rare inherited sterol storage disorder, characterized by significantly elevated plasma levels of plant sterols. The clinical features of sitosterolemia are xanthomas, premature atherosclerosis, arthritis, and, occasionally, liver function impair and hematologic abnormalities. This disorder is caused by mutations of ABCG5/ABCG8 genes. We report here the clinical, laboratory, and molecular genetic features of 13 patients with sitosterolemia from eight unrelated families who had specific hematologic problems of macrothrombocytopenia, hemolytic anemia, and splenomegaly besides the major clinical manifestations. The peripheral blood films showed some unique features: large platelets surrounded by a circle of vacuoles, and various abnormal erythrocyte shapes, especially stomatocyte. According to these distinct changes of blood cell morphology, we identified two sitosterolemia patients who lacked the classical clinical phenomena. All the patients had been misdiagnosed with immune thrombocytopenia (ITP), Evans syndrome, or secondary ITP with delay being 28.8 years between symptom onset and correct diagnosis. These results indicate that sitosterolemia is certainly not as rare as originally thought. The phenomena of macrothrombocytopenia/hemolysis might represent a new platelet disorder. Plasma plant sterols and ABCG5/ABCG8 genes should be analyzed when such hematologic abnormalities are unexplained. PMID:24166850

Wang, Zhaoyue; Cao, Lijuan; Su, Yanhua; Wang, Gaifeng; Wang, Ruijuan; Yu, Ziqiang; Bai, Xia; Ruan, Changgeng

2014-03-01

332

Hemolytic Behavior of Staphylococci Isolated from Cows' Milk*  

PubMed Central

Patterns of hemolysis produced by staphylococci isolated from milk were investigated on media prepared with bovine, sheep, horse, and rabbit erythrocytes under a variety of cultural circumstances. Hemolytic patterns were sharper and easier to interpret on erythrocyte agar plates when incubated at 37°C in an atmosphere containing 30% CO2. Alpha-hemolysin production was greatly enhanced in this environment and was not detected at times when cultures were grown in air only. This was also true of deltahemolysin but to a lesser extent. Very satisfactory identification of alpha, beta- and delta-hemolysins was obtained by streaking BEA plates with the unknown strains perpendicularly to a strain producing beta-hemolysin and incubating in 30% CO2. This procedure avoided use of erythrocytes of different species of origin and use of staphylococcal alpha-antitoxin. Prior action of the beta-hemolysin on bovine cells was found to completely inhibit hemolysis from alpha-hemolysin but the reverse was not true. A strain inhibiting beta-hemolysis in air failed to exhibit its antihemolytic properties for 24 hours when incubated in 30% CO2. Patterns of hemolysis within areas subject to multiple hemolysins were found to reflect the nature and relative strength of contributing hemolysins or antihemolysins and could be modified by the time sequence of exposure to certain hemolysins or antihemolysins. ImagesFig. 2. PMID:4223753

Jasper, D. E.; Jain, N. C.

1966-01-01

333

Natural history of thrombotic thrombocytopenic purpura and hemolytic uremic syndrome.  

PubMed

The differential diagnosis of thrombotic microangiopathy (TMA) has become clearer following the establishment of the relationships between (1) diarrhea-associated hemolytic uremic syndrome (HUS) and Shiga toxin-producing Escherichia coli-HUS (STEC-HUS), (2) a markedly reduced ADAMTS-13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) level and typical thrombotic thrombocytopenic purpura (TTP), and (3) abnormalities in the complement regulatory system and atypical HUS (aHUS). These TMAs include typical TTP, other forms of TMA, STEC-HUS, and aHUS. The pathological mechanisms of TMA still overlap among several forms of TMA. With respect to the management of TMA, the use of plasma exchange (PE) for typical TTP, additional steroid therapy for TMA and rituximab for typical TTP with a high titer of the inhibitor of ADAMTS-13, as well as eculizumab for aHUS, have also been established. Although several issues remain in the pathophysiology and management of TMA, new findings will hopefully resolve these problems in the near future. PMID:25377323

Wada, Hideo; Matsumoto, Takeshi; Yamashita, Yoshiki

2014-11-01

334

Update on hemolytic uremic syndrome: Diagnostic and therapeutic recommendations  

PubMed Central

Hemolytic uremic syndrome (HUS) is a rare disease. In this work the authors review the recent findings on HUS, considering the different etiologic and pathogenetic classifications. New findings in genetics and, in particular, mutations of genes that encode the complement-regulatory proteins have improved our understanding of atypical HUS. Similarly, the complement proteins are clearly involved in all types of thrombotic microangiopathy: typical HUS, atypical HUS and thrombotic thrombocytopenic purpura (TTP). Furthermore, several secondary HUS appear to be related to abnormalities in complement genes in predisposed patients. The authors highlight the therapeutic aspects of this rare disease, examining both “traditional therapy” (including plasma therapy, kidney and kidney-liver transplantation) and “new therapies”. The latter include anti-Shiga-toxin antibodies and anti-C5 monoclonal antibody “eculizumab”. Eculizumab has been recently launched for the treatment of the atypical HUS, but it appears to be effective in the treatment of typical HUS and in TTP. Future therapies are in phases I and II. They include anti-C5 antibodies, which are more purified, less immunogenic and absorbed orally and, anti-C3 antibodies, which are more powerful, but potentially less safe. Additionally, infusions of recombinant complement-regulatory proteins are a potential future therapy. PMID:24255888

Salvadori, Maurizio; Bertoni, Elisabetta

2013-01-01

335

National comparative audit of the use of platelet transfusions in the UK.  

PubMed

The objective of this national audit was to examine the use of platelet transfusions against audit standards developed from national guidelines. Hospitals were asked to provide data on 40 consecutive patients receiving platelet transfusions (15 haematology patients, 10 cardiac, 10 critical care and five in other clinical specialties). One hundred and eighty-seven UK hospitals participated, including 168/263 (64%) hospitals in England. A total of 4421 patients receiving platelet transfusions were audited. The reason for transfusion was documented in the medical records for 93% of transfusions and 57% were used for prophylaxis (in the absence of bleeding). Overall 3726/4421 (84%) of the transfusions were evaluable and 43% (1601/3726) were found to be non-compliant with the audit standards. A major non-compliance was failure to measure the platelet count before transfusion (29% of transfusions). Other non-compliances included the use of platelet transfusion in the absence of bleeding in 11% of cardiac surgery patients receiving platelet transfusions, the use of a threshold platelet count more than 10 x 10(9)/L for 60% of prophylactic platelet transfusions in haematology patients without risk factors indicating the need for a higher threshold, and a threshold platelet count more than 30 x 10(9)/L for 59% of prophylactic platelet transfusions in critical care. The reasons for the high rate of non-compliance were not explored in this audit, but this is a topic worthy of further study. The main recommendations were that hospitals should ensure there are written local guidelines for platelet transfusions, clinicians must be provided with training about their appropriate use, and hospitals should carry out regular audits of practice. More research should be carried out to develop the evidence base for the use of platelet transfusions, more detailed guidelines should be developed for platelet transfusions in critical care and cardiac surgery, and the audit should be repeated in about three years. PMID:18359658

Qureshi, H; Lowe, D; Dobson, P; Grant-Casey, J; Parris, E; Dalton, D; Hickling, K; Waller, F; Howell, C; Murphy, M F

2007-12-01

336

Efficiency and Cost Analysis of Cell Saver Auto Transfusion System in Total Knee Arthroplasty  

PubMed Central

Background: Blood loss and replacement is still a controversial issue in major orthopaedic surgery. Allogenic blood transfusion may cause legal problems and concerns regarding the transmission of transfusion-related diseases. Cellsaver Systems (CSS) were developed as an alternative to allogenic transfusion but CSS transfusion may cause coagulation, infection and haemodynamic instability. Aims: Our aim was to analyse the efficiency and cost analysis of a cell saver auto-transfusion system in the total knee arthroplasty procedure. Study Design: Retrospective comparative study. Methods: Those patients who were operated on by unilateral, cemented total knee arthroplasty (TKA) were retrospectively evaluated. Group 1 included 37 patients who were treated using the cell saver system, and Group 2 involved 39 patients who were treated by allogenic blood transfusion. The groups were compared in terms of preoperative haemoglobin and haematocrit levels, blood loss and transfusion amount, whether allogenic transfusion was made, degree of deformity, body mass index and cost. Results: No significant results could be obtained in the statistical comparisons made in terms of the demographic properties, deformity properties, preoperative laboratory values, transfusion amount and length of hospital stay of the groups. Average blood loss was calculated to be less in Group 1 (p<0.05) and cost was higher in Group 1 (p<0.05). Conclusion: Cell saver systems do not decrease the amount of allogenic blood transfusion and costs more. Therefore, the routine usage of the auto-transfusion systems is a controversial issue. Cell saver system usage does not affect allogenic blood transfusion incidence or allogenic blood transfusion volume. It was found that preoperative haemoglobin and body mass index rates may affect allogenic blood transfusion. Therefore, it is foreseen that auto-transfusion systems could be useful in patients with low haemoglobin level and body mass index. PMID:25207187

Bilgili, Mustafa Gökhan; Erçin, Ersin; Peker, Gökhan; Kural, Cemal; Ba?aran, Serdar Hakan; Duramaz, Altu?; Avkan, Cevdet

2014-01-01

337

Graves' disease causing pancytopenia and autoimmune hemolytic anemia at different time intervals: a case report and a review of the literature.  

PubMed

Graves' disease (GD) is associated with various hematologic abnormalities but pancytopenia and autoimmune hemolytic anemia (AIHA) are reported very rarely. Herein, we report a patient with GD who had both of these rare complications at different time intervals, along with a review of the related literature. The patient was a 70-year-old man who, during a hospitalization, was also noted to have pancytopenia and elevated thyroid hormone levels. Complete hematologic workup was unremarkable and his pancytopenia was attributed to hyperthyroidism. He was started on methimazole but unfortunately did not return for followup and stopped methimazole after a few weeks. A year later, he presented with fatigue and weight loss. Labs showed hyperthyroidism and isolated anemia (hemoglobin 7?g/dL). He had positive direct Coombs test and elevated reticulocyte index. He was diagnosed with AIHA and started on glucocorticoids. GD was confirmed with elevated levels of thyroid stimulating immunoglobulins and thyroid uptake and scan. He was treated with methimazole and radioactive iodine ablation. His hemoglobin improved to 10.7?g/dL at discharge without blood transfusion. Graves' disease should be considered in the differential diagnosis of hematologic abnormalities. These abnormalities in the setting of GD generally respond well to antithyroid treatment. PMID:24319463

Naji, Peyman; Kumar, Geetika; Dewani, Shabana; Diedrich, William A; Gupta, Ankur

2013-01-01

338

Fulminant transfusion-associated graft-versus-host disease in a premature infant  

SciTech Connect

A fatal case of transfusion-associated graft-versus-host disease developed in a premature infant after receiving several blood products, including nonirradiated white blood cells. Transfusion-associated graft-versus-host disease can be prevented. Irradiation of blood products is the least controversial and most effective method. Treatment was unsuccessful in most reported cases of transfusion-associated graft-versus-host disease. Therefore irradiation of blood products before transfusing to patients susceptible to transfusion-associated graft-versus-host disease is strongly recommended.

Berger, R.S.; Dixon, S.L.

1989-05-01

339

Age of red blood cells and outcome in acute kidney injury  

PubMed Central

Introduction Transfusion of red blood cells (RBCs) and, in particular, older RBCs has been associated with increased short-term mortality in critically ill patients. We evaluated the association between age of transfused RBCs and acute kidney injury (AKI), hospital, and 90-day mortality in critically ill patients. Methods We conducted a prospective, observational, predefined sub-study within the FINNish Acute Kidney Injury (FINNAKI) study. This study included all elective ICU admissions with expected ICU stay of more than 24 hours and all emergency admissions from September to November 2011. To study the age of RBCs, we classified transfused patients into quartiles according to the age of oldest transfused RBC unit in the ICU. AKI was defined according to KDIGO (Kidney Disease: Improving Global Outcomes) criteria. Results Out of 1798 patients, 652 received at least one RBC unit. The median [interquartile range] age of the oldest RBC unit transfused was 12 [11-13] days in the freshest quartile and 21 [17-27] days in the quartiles 2 to 4. On logistic regression, RBC age was not associated with the development of KDIGO stage 3 AKI. Patients in the quartile of freshest RBCs had lower crude hospital and 90-day mortality rates compared to those in the quartiles of older blood. After adjustments, older RBC age was associated with significantly increased risk for hospital mortality. Age, Simplified Acute Physiology Score II (SAPS II)-score without age points, maximum Sequental Organ Failure Assessment (SOFA) score and the total number of transfused RBC units were independently associated with 90-day mortality. Conclusions The age of transfused RBC units was independently associated with hospital mortality but not with 90-day mortality or KDIGO stage 3 AKI. The number of transfused RBC units was an independent risk factor for 90-day mortality. PMID:24093554

2013-01-01

340

Risk Factors of Transfusion in Anemia of Very Low Birth Weight Infants  

PubMed Central

Purpose Anemia of prematurity is frequent in preterm infants, for which red blood cell (RBC) transfusion remains the treatment of choice. In this study, we attempted to evaluate the characteristics and risk factors of anemia of prematurity, and suggest ways to reduce anemia and the need for multiple transfusions. Materials and Methods Preterm infants weighing less than 1500 g (May 2008-May 2009) were divided into two groups depending on whether they received RBC transfusions (transfusion group and non transfusion group). Hemoglobin (Hb) concentration, phlebotomy blood loss, and the amount of RBC transfusion were analyzed. Risk factors of anemia and RBC transfusions were analyzed. Results Fifty infants that survived were enrolled in the present study: 39 in the transfusion group and 11 in the non transfusion group. Hb concentrations gradually decreased by eight weeks. In the transfusion group, gestational age and birth weight were smaller, bronchopulmonary dysplasia and sepsis were more frequent, full feeding was delayed, parenteral nutrition and days spent in the hospital were prolonged, and phlebotomy blood loss was greater than that in the non transfusion group. Conclusion Anemia of prematurity was correlated with increased laboratory blood loss, decreased birth weight, prolonged parenteral nutrition, and delayed body weight gain. Accordingly, reducing laboratory phlebotomy loss and parenteral nutrition, as well as improving body weight gain, may be beneficial to infants with anemia of prematurity. PMID:23364969

Jeon, Ga Won

2013-01-01

341

Premedication with acetaminophen or diphenhydramine for transfusion with leucoreduced blood products in children.  

PubMed

Febrile non-haemolytic or allergic reactions occur in 0.1-30% of transfusions; physicians often premedicate patients with acetaminophen or diphenhydramine to prevent these reactions. The effectiveness of this practice has not been demonstrated. In this retrospective review of all transfusions at our institution during 2002, 385 patients received 7900 evaluable leucoreduced, irradiated blood products (4280 single-donor apheresis platelets and 3620 packed red blood cells). Febrile reactions occurred in 0.95% of 4108 transfusions with, and 0.53% of 3792 transfusions without, acetaminophen premedication. Allergic reactions occurred in 0.90% of 4315 transfusions with, and 0.56% of 3585 transfusions without, diphenhydramine premedication. In a multivariate analysis that adjusted for age, patient category, transfusion location, product, transfusion history, and reaction history, premedication with acetaminophen was associated with a statistically non-significant increase in the odds of a febrile reaction (odds ratio 1.74; 95% confidence interval 0.71-4.23; P = 0.22), and diphenhydramine with a non-significant increase in allergic reactions (odds ratio 1.74; 95% confidence interval 0.99-3.06; P = 0.054). Reactions occurred in only 1.3% of the 518 transfusions to patients with a history of two or more prior reactions. Febrile and allergic transfusion reactions were rare in paediatric patients transfused with leucoreduced, irradiated blood products, whether premedication was used or not. PMID:16115137

Sanders, Robert P; Maddirala, Sunil D; Geiger, Terrence L; Pounds, Stanley; Sandlund, John T; Ribeiro, Raul C; Pui, Ching-Hon; Howard, Scott C

2005-09-01

342

Transfusion Cost Savings with Tranexamic Acid in Primary Total Knee Arthroplasty from 2009 to 2012.  

PubMed

Tranexamic acid (TXA) has proven to be very advantageous to the total knee arthroplasty (TKA) population. With TXA, the need for allogeneic blood transfusion is reduced and thus hospital costs are reduced. In our hospital system, before TXA was used, facility cost was an estimated $84.90/TKA for blood transfusion and required 0.13 man-hours/TKA (transfusion rate 6.5%); after incorporating intravenous TXA, cost was $82.59/TKA for blood transfusion and TXA medication and 0.007 man-hours/TKA (transfusion rate 0.3%). There were no transfusions when TXA was applied topically, and the facility cost was $39.14/TKA and no employee hours consumed. Topical TXA has the potential to significantly reduce blood transfusions and decrease hospital man-hours/TKA as well as achieve larger cost saving. PMID:25458093

Moskal, Joseph T; Harris, Ryan N; Capps, Susan G

2014-10-12

343

Distinct Renal Pathology and a Chemotactic Phenotype after Enterohemorrhagic Escherichia coli Shiga Toxins in Non-Human Primate Models of Hemolytic Uremic Syndrome  

PubMed Central

Enterohemorrhagic Escherichia coli cause approximately 1.5 million infections globally with 176,000 cases occurring in the United States annually from ingesting contaminated food, most frequently E. coli O157:H7 in ground beef or fresh produce. In severe cases, the painful prodromal hemorrhagic colitis is complicated by potentially lethal hemolytic uremic syndrome (HUS), particularly in children. Bacterial Shiga-like toxins (Stx1, Stx2) are primarily responsible for HUS and the kidney and neurologic damage that ensue. Small animal models are hampered by the inability to reproduce HUS with thrombotic microangiopathy, hemolytic anemia, and acute kidney injury. Earlier, we showed that nonhuman primates (Papio) recapitulated clinical HUS after Stx challenge and that novel therapeutic intervention rescued the animals. Here, we present detailed light and electron microscopic pathology examination of the kidneys from these Stx studies. Stx1 challenge resulted in more severe glomerular endothelial injury, whereas the glomerular injury after Stx2 also included prominent mesangiolysis and an eosinophilic inflammatory infiltration. Both toxins induced glomerular platelet-rich thrombi, interstitial hemorrhage, and tubular injury. Analysis of kidney and other organs for inflammation biomarkers showed a striking chemotactic profile, with extremely high mRNA levels for IL-8, monocyte chemoattractant protein 1, and macrophage inflammatory protein 1? and elevated urine chemokines at 48 hours after challenge. These observations give unique insight into the pathologic consequences of each toxin in a near human setting and present potential pathways for therapeutic intervention. PMID:23402998

Stearns-Kurosawa, Deborah J.; Oh, Sun-Young; Cherla, Rama P.; Lee, Moo-Seung; Tesh, Vernon L.; Papin, James; Henderson, Joel; Kurosawa, Shinichiro

2014-01-01

344

Biomarkers of polycyclic aromatic hydrocarbon (PAH)-associated hemolytic anemia in oiled wildlife.  

PubMed

Polycyclic aromatic hydrocarbons (PAHs) in crude oil cause a range of adverse effects in oiled seabirds, one of the most common being hemolytic anemia via oxidative attack of erythrocytes by PAH metabolites resulting in hemoglobin leakage and formation of Heinz bodies. In such cases, haptoglobin and ferritin are up-regulated to sequester free Hb and iron in the circulation. We investigated these plasma proteins as biomarkers of PAH-induced Heinz body hemolytic anemia in oiled seabirds. Concentration ranges of PAHs, HAP and FT in plasma samples were 10-184 ng/ml, 0-2.6 mg/ml and 0-7.6 ng/ml, respectively. Dose-response relationships between plasma PAH exposure and haptoglobin and ferritin (FT) were investigated, and evidence of erythrocyte Heinz body formation studied in 50 oiled common guillemots stranded on the Norfolk Wash coast (East England). Haptoglobin was negatively correlated, and FT was positively correlated with PAH exposure. Heinz bodies were also observed confirming the toxic mechanism causing hemolytic anemia and counts were positively correlated with exposure. Our results support the application of these complementary biomarkers to assess hemolytic effects of oiling in wildlife biomonitoring, which also discriminate the influence of hemolytic versus inflammatory effects in oiled guillemots. PMID:17674967

Troisi, Gera; Borjesson, Lars; Bexton, Steve; Robinson, Ian

2007-11-01

345

Acquired immunodeficiency syndrome associated with blood-product transfusions  

SciTech Connect

A 53-year-old white man had fever, malaise, and dyspnea on exertion. His chest roentgenogram was normal, but pulmonary function tests showed impaired diffusion capacity and a gallium scan showed marked uptake in the lungs. Results of an open-lung biopsy documented Pneumocystis carinii pneumonia. Immunologic test results were consistent with the acquired immunodeficiency syndrome. The patient denied having homosexual contact or using intravenous drugs. Twenty-nine months before the diagnosis of pneumocystis pneumonia was made, the patient had had 16 transfusions of whole blood, platelets, and fresh-frozen plasma during coronary artery bypass surgery at another medical center. This patient is not a member of any currently recognized high-risk group and is believed to have contracted the acquired immunodeficiency syndrome from blood and blood-product transfusions.

Jett, J.R.; Kuritsky, J.N.; Katzmann, J.A.; Homburger, H.A.

1983-11-01

346

Stored red blood cell transfusions: iron, inflammation, immunity, and infection.  

PubMed

Emily Cooley was a highly regarded medical technologist and morphologist. The "Emily Cooley Lectureship and Award" was established to honor her, in particular, and medical technologists, in general. This article reviews some basic concepts about the "life of a red blood cell" (RBC) and uses these to discuss the actual and potential consequences that occur in patients after clearance of transfused refrigerator storage-damaged RBCs by extravascular hemolysis. PMID:25196845

Spitalnik, Steven L

2014-10-01

347

Acute appendicitis secondary to acute promyelocytic leukemia.  

PubMed

Background The gastrointestinal tract is a rare site for extramedullary involvement in acute promyelocytic leukemia (APL). Case Report A 43-year-old female with no past medical history presented complaining of mild abdominal pain, fever, and chills for the past day. On examination, she was tachycardic and febrile, with mild tenderness of her right lower quadrant and without signs of peritoneal irritation. Laboratory examination revealed pancytopenia and DIC, with a fibrinogen level of 290 mg/dL. CT of the abdomen showed a thickened and hyperemic appendix without perforation or abscess, compatible with acute appendicitis. The patient was given IV broad-spectrum antibiotics and was transfused with packed red blood cells and platelets. She underwent uncomplicated laparoscopic appendectomy and bone marrow biopsy, which revealed neoplastic cells of 90% of the total bone marrow cellularity. Flow cytometry indicated presence of 92.4% of immature myeloid cells with t (15: 17) and q (22: 12) mutations, and FISH analysis for PML-RARA demonstrated a long-form fusion transcript, positive for APL. Appendix pathology described leukemic infiltration with co-expression of myeloperoxidase and CD68, consistent with myeloid sarcoma of the appendix. The patient completed a course of daunorubicin, cytarabine, and all trans-retinoic acid. Repeat bone marrow biopsy demonstrated complete remission. She will follow up with her primary care physician and hematologist/oncologist. Conclusions Myeloid sarcoma of the appendix in the setting of APL is very rare and it might play a role in the development of acute appendicitis. Urgent management, including bone marrow biopsy for definitive diagnosis and urgent surgical intervention, dramatically improve prognosis. PMID:25666852

Rodriguez, Eduardo A; Lopez, Marvin A; Valluri, Kartik; Wang, Danlu; Fischer, Andrew; Perdomo, Tatiana

2015-01-01

348

Teaching transfusion medicine: current situation and proposals for proper medical training  

PubMed Central

The current curricula in medical schools and hospital residence worldwide lack exposure to blood transfusion medicine, and require the reformulation of academic programs. In many countries, training in blood transfusion is not currently offered to medical students or during residency. Clinical evidence indicates that blood transfusions occur more frequently than recommended, contributing to increased risk due to this procedure. Therefore, the rational use of blood and its components is essential, due to the frequent undesirable reactions, to the increasing demand of blood products and the cost of the process. Significant improvements in knowledge of and skills in transfusion medicine are needed by both students and residents. Improvements are needed in both background knowledge and the practical application of this knowledge to improve safety. Studies prove that hemovigilance has an impact on transfusion safety and helps to prevent the occurrence of transfusion-related adverse effects. To ensure that all these aspects of blood transfusion are being properly addressed, many countries have instituted hospital transfusion committees. From this perspective, the interventions performed during the formation of medical students and residents, even the simplest, have proven effective in the acquisition of knowledge and medical training, thereby leading to a reduction in inappropriate use of blood. Therefore, we would like to emphasize the importance of the exposure of medical students and residents to blood services and transfusion medicine in order for them to acquire adequate medical training, as well as to discuss some changes in the current medical curricula regarding transfusion medicine that we judge critical. PMID:25638770

Flausino, Gustavo de Freitas; Nunes, Flávio Ferreira; Cioffi, Júnia Guimarăes Mourăo; Proietti, Anna Bárbara de Freitas Carneiro

2014-01-01

349

Rumen bacteria are involved in the onset of onion-induced hemolytic anemia in sheep.  

PubMed

The mechanism of onion-induced hemolytic anemia in ruminants was investigated. The ether-extract obtained from the mixture of rumen fluid and onion juice incubated at 38.5 degrees C for 9 hr induced oxidative damage in sheep erythrocytes in vitro, indicating the production of certain oxidants in the mixture. The increase of the oxidative effect in the mixture was inhibited completely by the removal of rumen microorganisms and partly by treatment with antibiotics and by oxygen gas. The sheep fed onions (50 g/kg body weight/day) for 15 days developed more severe Heinz body hemolytic anemia than did the sheep fed the equivalent amount of onions with 5 g/day ampicillin sodium salt. The results indicated that certain rumen bacteria appear to be involved in the onset of onion-induced hemolytic anemia in sheep. PMID:10342287

Selim, H M; Yamato, O; Tajima, M; Maede, Y

1999-04-01

350

HbA1C - overall glycemia marker and hemolytic anemia indicator.  

PubMed

Glycated hemoglobin A1C reflects a mean glycemia over the preceding 3 months (erythrocyte life span). In diabetes management, target value is set below 6.5%, to reduce the risk of chronic complications. However, there are different conditions that lead to a shortened lifespan of erythrocytes, resulting in falsely low HbA1C value. Case presented involves a 72-year-old patient with history of diabetes and possible iatrogenic-induced autoimmune hemolytic anemia. Thus, HbA1C may be a screening test for hemolysis in non-diabetic patients with hemolytic anemia, but in diabetic population with hemolytic disease it is considered to be a very poor marker for both, overall glycemia and haemolysis. PMID:22926387

Jandri? Balen, Marica; Lukenda, Vesna; Jandri?, Ivan; Raguž, Antonija; Zukanovi?, Sidbela; Miški?, Blaženka

2012-08-01

351

Bioethics and religious bodies: refusal of blood transfusions in Germany.  

PubMed

The refusal of medical treatment is a recurrent topic in bioethical debates and Jehovah's Witnesses often constitute an exemplary case in this regard. The refusal of a potentially life-saving blood transfusion is a controversial choice that challenges the basic medical principle of acting in patients' best interests and often leads physicians to adopt paternalistic attitudes toward patients who refuse transfusion. However, neither existing bioethical nor historical and social sciences scholarship sufficiently addresses experiences of rank-and-file Witnesses in their dealings with the health care system. This article draws on results of a nine-month (2010, 2011-2012) ethnographic research on the relationship between religious, legal, ethical, and emotional issues emerging from the refusal of blood transfusions by Jehovah's Witnesses in Germany (mainly in Berlin). It shows how bioethical challenges are solved in practice by some German physicians and what they perceive to be the main goal of biomedicine: promoting the health or broadly understood well-being of patients. I argue that two different understandings of the concept of autonomy are at work here: autonomy based on reason and autonomy based on choice. The first is privileged by German physicians in line with a Kantian philosophical tradition and constitutional law; the second, paradoxically, is utilized by Jehovah's Witnesses in their version of the Anglo-Saxon Millian approach. PMID:23538204

Rajtar, Ma?gorzata

2013-12-01

352

CTLA4-Ig Prevents Alloantibody Production and BMT Rejection in Response to Platelet Transfusions in Mice  

PubMed Central

Background Platelet transfusions can induce humoral and cellular alloimmunity. Anti-HLA antibodies can render patients refractory to subsequent transfusion, and both alloantibodies and cellular alloimmunity can contribute to subsequent bone marrow transplant rejection. Currently, there are no approved therapeutic interventions to prevent alloimmunization to platelet transfusions other than leukoreduction. Targeted blockade of T cell costimulation has shown great promise in inhibiting alloimmunity in the setting of transplantation, but has not been explored in the context of platelet transfusion. Study Design and Methods We tested the hypothesis that the costimulatory blockade reagent CTLA4-Ig would prevent alloreactivity against major and minor alloantigens on transfused platelets. BALB/c (H-2d) mice and C57BL/6 (H-2b) mice were used as platelet donors and transfusion recipients, respectively. Alloantibodies were measured by indirect immunofluorescence using BALB/c platelets and splenocytes as targets. Bone marrow transplants were carried out under reduced intensity conditioning using BALB/b (H-2b) donors and C57BL/6 (H-2b) recipients to model HLA identical transplants. Experimental groups were given CTLA4-Ig (before or after platelet transfusion) with control groups receiving isotype matched antibody. Results CTLA4-Ig abrogated both humoral alloimmunization (anti-H-2d antibodies) and transfusion induced bone marrow transplant rejection. Whereas a single dose of CTLA4-Ig at time of transfusion prevented alloimmunization to subsequent platelet transfusions, administration of CTLA4-Ig after initial platelet transfusion was ineffective. Delaying treatment until after platelet transfusion failed to prevent bone marrow transplant rejection. Conclusions These findings demonstrate a novel strategy using an FDA approved drug that has the potential to prevent the clinical sequela of alloimmunization to platelet transfusions. PMID:22321003

Gilson, Christopher R; Patel, Seema R; Zimring, James C

2014-01-01

353

Hemolytic anemia and progressive neurologic impairment: think about triosephosphate isomerase deficiency.  

PubMed

We have reported the first Tunisian case of triosephosphate isomerase (TPI) deficiency in a 2-year-old girl. She was the first child of a nonconsanguineous couple. The disease included a neonatal onset of chronic hemolytic anemia, recurrent low-respiratory infections then progressive neurological involvement. The diagnosis was made after her death from the TPI values of her parents who exhibited intermediate enzyme deficiency. Molecular study of TPI genes showed that the father and the mother are heterozygous for Glu105Asp mutation. Pediatricians must be alert to the differential diagnosis in patients having hemolytic anemia and other concomitant manifestations. PMID:24840153

Aissa, Khaoula; Kamoun, Fatma; Sfaihi, Lamia; Ghedira, Elyes Slim; Aloulou, Hajer; Kamoun, Thouraya; Pissard, Serge; Hachicha, Mongia

2014-08-01

354

Characterization of hemolytic Escherichia coli strains in ferrets: recognition of candidate virulence factor CNF1.  

PubMed

Diseases associated with Escherichia coli infection are the subject of renewed interest due to emerging conditions such as hemolytic uremia syndrome. A collection of 15 strains of beta-hemolytic E. coli was isolated from diarrheic feces and diseased tissues of ferrets. All 15 strains were positive in specific PCR assays for the presence of hlyA, pap1, and cnf1. Seven of the cnf1-positive isolates were tested and shown to have a cytopathic effect on HeLa cell monolayers. The pathogenesis of these strains warrants future study. PMID:15583337

Marini, Robert P; Taylor, Nancy S; Liang, Alvin Y; Knox, Kimberly A; Peńa, Jeremy Andrew; Schauer, David B; Fox, James G

2004-12-01

355

Characterization of Hemolytic Escherichia coli Strains in Ferrets: Recognition of Candidate Virulence Factor CNF1  

PubMed Central

Diseases associated with Escherichia coli infection are the subject of renewed interest due to emerging conditions such as hemolytic uremia syndrome. A collection of 15 strains of beta-hemolytic E. coli was isolated from diarrheic feces and diseased tissues of ferrets. All 15 strains were positive in specific PCR assays for the presence of hlyA, pap1, and cnf1. Seven of the cnf1-positive isolates were tested and shown to have a cytopathic effect on HeLa cell monolayers. The pathogenesis of these strains warrants future study. PMID:15583337

Marini, Robert P.; Taylor, Nancy S.; Liang, Alvin Y.; Knox, Kimberly A.; Peńa, Jeremy Andrew; Schauer, David B.; Fox, James G.

2004-01-01

356

Risks, options, and informed consent for blood transfusion in elective surgery.  

PubMed

Blood banking is undergoing a period of significant change as a result of several concurrent issues. Blood-transmitted diseases such as human immunodeficiency virus (HIV) and the alternatives to community-derived (homologous) blood such as autologous (patient's own) and designated (blood donor known to transfusion recipient) blood have had an impact on surgical transfusion practice. Many of these issues comprise the medicolegal elements of informed consent for elective blood transfusion, so that increasingly the need for a dialogue incorporating these issues between the transfusing physician and the potential transfusion recipient is recognized. If the process is to be effective, then early involvement of the patient in a dialogue concerning informed consent is necessary. An overview of the medical elements and content of informed consent for elective blood transfusion is presented. PMID:2112343

Goodnough, L T; Shuck, J M

1990-06-01

357

Cystitis - acute  

MedlinePLUS

Uncomplicated urinary tract infection; UTI - acute; Acute bladder infection; Acute bacterial cystitis ... The symptoms of a bladder infection include: Cloudy or bloody urine, which may have a foul or strong odor Low fever (not everyone will have a ...

358

Effect of blood transfusion on long-term survival after cardiac operation  

Microsoft Academic Search

Background. Blood transfusions have been linked to increased morbidity and mortality. Bleeding during and after cardiac operations and the hemodilution effects of cardiopulmonary bypass commonly result in blood transfusions. Because we could not find any studies evaluating the effects of transfusion on long-term survival after cardiac operation, we sought to determine these effects.Methods. We studied 1,915 patients who underwent first-time

Milo C Engoren; Robert H Habib; Anoar Zacharias; Thomas A Schwann; Christopher J Riordan; Samuel J Durham

2002-01-01

359

Tranexamic Acid Reduces Blood Loss and Blood Transfusion after TKA: A Prospective Randomized Controlled Trial  

Microsoft Academic Search

Background  TKA may be associated with considerable blood loss, and transfusion carries substantial risk of immunologic reaction and disease\\u000a transmission. Blood transfusion also involves additional cost, therefore a reduction in its use is important. Several methods\\u000a reportedly reduce postoperative blood loss and avoid homologous blood transfusion with traditional TKA approaches, but it\\u000a is unclear these reductions apply to a minimally invasive

Keerati Charoencholvanich; Pichet Siriwattanasakul

360

Iron supplementation for preterm infants receiving restrictive red blood cell transfusions: reassessment of practice safety  

Microsoft Academic Search

Objective:To reassess iron supplementation practice safety in very low birth weight (VLBW) preterm infants receiving restrictive red blood cell transfusions during initial hospitalization.Study Design:Iron status, including hemoglobin (Hb), serum iron, ferritin, and soluble transferrin receptor (sTfR) levels and reticulocyte count of transfused (n=236) and non-transfused (n=166) preterm infants at ?24 h and 2, 4 and 8 weeks were recorded. As

S Arnon; T Dolfin; S Bauer; R H Regev; I Litmanovitz

2010-01-01

361

Platelet storage and transfusions: new concerns associated with an old therapy  

PubMed Central

Platelet transfusion has long been practiced with rudimentary knowledge about optimal storage conditions and their implications for efficacy and, particularly, safety. Recent concerns about complications such as inflammation, thrombosis and altered recipient immunity have been raised about platelet transfusion. This review will discuss recent important findings that have raised these issues about platelet transfusion associated morbidity, mortality and the possible role of platelet storage in these associations. PMID:22662018

Sahler, Julie; Grimshaw, Katie; Spinelli, Sherry L.; Refaai, Majed A.; Phipps, Richard P.; Blumberg, Neil

2011-01-01

362

Platelet storage and transfusions: new concerns associated with an old therapy.  

PubMed

Platelet transfusion has long been practiced with rudimentary knowledge about optimal storage conditions and their implications for efficacy and, particularly, safety. Recent concerns about complications such as inflammation, thrombosis and altered recipient immunity have been raised about platelet transfusion. This review will discuss recent important findings that have raised these issues about platelet transfusion associated morbidity, mortality and the possible role of platelet storage in these associations. PMID:22662018

Sahler, Julie; Grimshaw, Katie; Spinelli, Sherry L; Refaai, Majed A; Phipps, Richard P; Blumberg, Neil

2011-01-01

363

Common Transfusion-transmitted Infectious Agents among Thalassaemic Children in Bangladesh  

Microsoft Academic Search

Transfusion-dependent children are more prone to acquiring various transfusion-transmitted infections (TTIs), such as hepatitis B (HBV), hepatitis C (HCV), HIV, and others. Since the magnitude of these infections among thalassaemic children in Bangladesh is not well-known, this study was conducted to assess the prevalence of TTIs among them (who received more than three blood transfusions) compared to their age- and

Abid Hossain Mollah; Nazmun Nahar; A. Siddique; Kazi Selim Anwar; Tariq Hassan

364

Transfusion practices in a neonatal intensive care unit in a city in Brazil  

PubMed Central

Objective Newborn infants are the most heavily transfused population inside intensive care units. The hemoglobin level used to indicate the need of transfusions is not well established. The aim of this study was to evaluate transfusional practices in newborns in the neonatal intensive care units of one specific city. Methods Red blood cell transfusion practices of all transfused newborns in all five of the neonatal intensive care units of the city were analyzed. Data are reported as descriptive statistics, including numbers and percentages and means and standard deviation. Univariate analysis, followed by stepwise logistic regression was performed in respect to transfusional data and outcomes. Results A total of 949 patients were admitted to the intensive care units during the 12-month study period with 20.9% receiving at least one transfusion, most (62.4%) of whom received more than one transfusion. The mean number of transfusions per infant was 2.7 ± 2.16; in the liberal transfusion group the mean number was 1.59 ± 1.63 and in the restrictive group it was 1.08 ± 1.51. The mean hemoglobin and hematocrit levels were 9.0 g/dL (±1.4 g/dL) and 27.4% (±4.3%), respectively. The most common indications for blood transfusions were sepsis and prematurity. Conclusion This study shows that the characteristics and the transfusion practices for newborns admitted in the neonatal intensive care units of Juiz de Fora are similar to recent pubications. There was no significant reduction in the number of transfusions per child in the restrictive group compared to the liberal group. Restrictive transfusions are an independent risk factor for peri-intraventricular hemorrhages and death. PMID:25031162

Portugal, Carolina Augusta Arantes; de Paiva, Amanda Póvoa; Freire, Érika Santos; Chaoubah, Alfredo; Duarte, Marta Cristina; Hallack Neto, Abrahăo Elias

2014-01-01

365

Predicting red blood cell transfusion in hospitalized patients: role of hemoglobin level, comorbidities, and illness severity  

PubMed Central

Background Randomized controlled trial evidence supports a restrictive strategy of red blood cell (RBC) transfusion, but significant variation in clinical transfusion practice persists. Patient characteristics other than hemoglobin levels may influence the decision to transfuse RBCs and explain some of this variation. Our objective was to evaluate the role of patient comorbidities and severity of illness in predicting inpatient red blood cell transfusion events. Methods We developed a predictive model of inpatient RBC transfusion using comprehensive electronic medical record (EMR) data from 21 hospitals over a four year period (2008-2011). Using a retrospective cohort study design, we modeled predictors of transfusion events within 24 hours of hospital admission and throughout the entire hospitalization. Model predictors included administrative data (age, sex, comorbid conditions, admission type, and admission diagnosis), admission hemoglobin, severity of illness, prior inpatient RBC transfusion, admission ward, and hospital. Results The study cohort included 275,874 patients who experienced 444,969 hospitalizations. The 24 hour and overall inpatient RBC transfusion rates were 7.2% and 13.9%, respectively. A predictive model for transfusion within 24 hours of hospital admission had a C-statistic of 0.928 and pseudo-R2 of 0.542; corresponding values for the model examining transfusion through the entire hospitalization were 0.872 and 0.437. Inclusion of the admission hemoglobin resulted in the greatest improvement in model performance relative to patient comorbidities and severity of illness. Conclusions Data from electronic medical records at the time of admission predicts with very high likelihood the incidence of red blood transfusion events in the first 24 hours and throughout hospitalization. Patient comorbidities and severity of illness on admission play a small role in predicting the likelihood of RBC transfusion relative to the admission hemoglobin. PMID:24884605

2014-01-01

366

Association between Red Blood Cell Transfusion and Bronchopulmonary Dysplasia in Preterm Infants  

PubMed Central

Anemia and the need for transfusion of packed red blood cells (PRBCs) are common in preterm infants. PRBC transfusion increases the oxygen carrying capacity of hemoglobin and may result in higher rates of organ dysfunction. To determine whether PRBC transfusion in preterm infants is associated with an increased incidence of bronchopulmonary dysplasia (BPD), this retrospective study was performed on neonates with birth weights ? 1,500?g or gestational age ? 32 weeks admitted from August, 2008 to November, 2013. Infants who received PRBC transfusion before the diagnosis of BPD and those who did not receive PRBC transfusion or received PRBC transfusion after diagnosis of BPD were compared for incidence of BPD and other morbidities. Of 231 preterm infants, 137 received PRBC transfusion before BPD was diagnosed (group 1) and 94 did not (group 2). The incidence of BPD was significantly higher in group 1 than in group 2 (37.2% vs. 2.1%, P < 0.00001). After adjusting for potential risk factors, the adjusted odds ratio for BPD was 9.80 (95% confidence interval, 1.70–56.36; P = 0.01). This study demonstrated an association between PRBC transfusion and BPD in preterm infants. A cautious approach to PRBC transfusion in these infants is warranted. PMID:24614152

Zhang, Zhiqun; Huang, Xianmei; Lu, Hui

2014-01-01

367

Association between red blood cell transfusion and bronchopulmonary dysplasia in preterm infants.  

PubMed

Anemia and the need for transfusion of packed red blood cells (PRBCs) are common in preterm infants. PRBC transfusion increases the oxygen carrying capacity of hemoglobin and may result in higher rates of organ dysfunction. To determine whether PRBC transfusion in preterm infants is associated with an increased incidence of bronchopulmonary dysplasia (BPD), this retrospective study was performed on neonates with birth weights ? 1,500 g or gestational age ? 32 weeks admitted from August, 2008 to November, 2013. Infants who received PRBC transfusion before the diagnosis of BPD and those who did not receive PRBC transfusion or received PRBC transfusion after diagnosis of BPD were compared for incidence of BPD and other morbidities. Of 231 preterm infants, 137 received PRBC transfusion before BPD was diagnosed (group 1) and 94 did not (group 2). The incidence of BPD was significantly higher in group 1 than in group 2 (37.2% vs. 2.1%, P < 0.00001). After adjusting for potential risk factors, the adjusted odds ratio for BPD was 9.80 (95% confidence interval, 1.70-56.36; P = 0.01). This study demonstrated an association between PRBC transfusion and BPD in preterm infants. A cautious approach to PRBC transfusion in these infants is warranted. PMID:24614152

Zhang, Zhiqun; Huang, Xianmei; Lu, Hui

2014-01-01

368

Transfusion-associated graft versus host disease in the immunocompetent patient: an ongoing problem.  

PubMed

Transfusion associated-graft versus host disease (TA-GVHD) is a rare complication of blood transfusion. It carries a very high mortality rate. Although the phenomenon has been well described in immunocompromised patients, this review focuses on the immunocompetent host. Cases of TA-GVHD continue to be reported following a variety of surgical procedures, especially cardiac procedures requiring cardiopulmonary bypass. Additional risk factors for TA-GVHD include blood component transfusion in populations with limited genetic diversity, the use of directed donations from family members, and the transfusion of fresh blood. As there is no effective treatment, the focus is on prevention. PMID:23792801

Jawa, Randeep S; Young, David H; Stothert, Joseph C; Kulaylat, Mahmoud N; Landmark, James D

2015-03-01

369

Phosphatidylserine Exposure and Red Cell Viability in Red Cell Aging and in Hemolytic Anemia  

Microsoft Academic Search

Phosphatidylserine (PS) normally localizes to the inner leaflet of cell membranes but becomes exposed in abnormal or apoptotic cells, signaling macrophages to ingest them. Along similar lines, it seemed possible that the removal of red cells from circulation because of normal aging or in hemolytic anemias might be triggered by PS exposure. To investigate the role of PS exposure in

Franz Edward Boas; Linda Forman; Ernest Beutler

1998-01-01

370

Nitric Oxide and Arginine Dysregulation: A Novel Pathway to Pulmonary Hypertension in Hemolytic Disorders  

PubMed Central

Secondary pulmonary hypertension (PH) is emerging as one of the leading causes of mortality and morbidity in patients with hemolytic anemias such as sickle cell disease (SCD) and thalassemia. Impaired nitric oxide (NO) bioavailability represents the central feature of endothelial dysfunction, and is a major factor in the pathophysiology of PH. Inactivation of NO correlates with hemolytic rate and is associated with the erythrocyte release of cell-free hemoglobin, which consumes NO directly, and the simultaneous release of the arginine-metabolizing enzyme arginase, which limits bioavailability of the NO synthase substrate arginine during the process of intravascular hemolysis. Rapid consumption of NO is accelerated by oxygen radicals that exists in both SCD and thalassemia. A dysregulation of arginine metabolism contributes to endothelial dysfunction and PH in SCD, and is strongly associated with prospective patient mortality. The central mechanism responsible for this metabolic disorder is enhanced arginine turnover, occurring secondary to enhanced plasma arginase activity. This is consistent with a growing appreciation of the role of excessive arginase activity in human diseases, including asthma and pulmonary arterial hypertension. New treatments aimed at improving arginine and NO bioavailability through arginase inhibition, suppression of hemolytic rate, oral arginine supplementation, or use of NO donors represent potential therapeutic strategies for this common pulmonary complication of hemolytic disorders. PMID:18991648

Gladwin, Mark T.; Kato, Gregory J.

2011-01-01

371

In vitro hemolytic activity of Lonomia obliqua caterpillar bristle extract on human and Wistar rat erythrocytes.  

PubMed

Human accidental envenomation caused by skin contact with the bristles of Lonomia obliqua caterpillar causes coagulation and fibrinolysis disorders. Alterations of hematologic parameters are observed only in severe cases of envenomation, but with no clinical evidence of intravascular hemolysis. However, since we have observed intravascular hemolysis in preliminary studies using Wistar rats as an experimental model for investigating L. obliqua envenomation, the objective of the present study was to investigate the in vitro hemolytic activity of the bristle extract of L. obliqua caterpillars on human and rat erythrocytes. Our results showed that the bristle extract has indirect and direct hemolytic activity on human and rat erythrocytes, although direct hemolytic activity was only observed at higher bristle extract concentrations. We also observed that the bristle extract has a proteolytic activity on band 3 of human and rat erythrocyte membranes. Thus, crude L. obliqua bristle extract was found to contain at least two components with hemolytic activity on erythrocytes, a phospholipase enzyme and another protein with a direct activity on the erythrocyte membrane. PMID:12782083

Seibert, Carla Simone; Shinohara, Elvira Maria Guerra; Sano-Martins, Ida Sigueko

2003-06-01

372

Antiproliferative, Cytotoxic and Hemolytic Activities of a Triterpene Glycoside from Psolus patagonicus and Its Desulfated Analog  

Microsoft Academic Search

Background: The major triterpene glycoside of the sea cucumber Psolus patagonicus and its desulfated analog were tested for their antiproliferative, cytotoxic and hemolytic activities, and their effect on NF-?B activation. Methods: The antiproliferative action of glycosides 1 and 2 were determined on 3 tumor cell lines. Their effect on the activation of NF-?B was evaluated by indirect immunofluorescence assay staining

Valeria P. Careaga; Carlos Bueno; Claudia Muniain; Laura Alché; Marta S. Maier

2009-01-01

373

Heinz body hemolytic anemia induced by DQ-2511, a new anti-ulcer drug, in dogs.  

PubMed

DQ-2511, a new anti-ulcer drug, was administered to beagle dogs for 4 weeks to investigate the mechanism whereby this drug induced hemolytic anemia and its reversibility in comparison with beta-acetylphenylhydrazine. Hemolytic anemia accompanied by an increase in the number of cells containing Heinz bodies that was preceded by a marked decrease in blood-reduced glutathione concentration was observed in dogs receiving 600 mg/kg of DQ-2511, but only a slight increase in the methemoglobin level was noted. beta-Acetylphenylhydrazine, however, caused hemolytic anemia accompanied by marked increases in both Heinz body-containing cells and methemoglobin concentration, but the blood-reduced glutathione concentration was not decreased consistently with the formation of Heinz bodies. Hemolytic anemia disappeared after a 4-week recovery period in the dogs that received DQ-2511. These results suggest that decreases in reduced glutathione in erythrocytes play an important role in the anemia and Heinz body formation induced by DQ-2511, but not by beta-acetylphenylhydrazine. PMID:8449384

Ohno, H; Tojo, H; Kakihata, K; Nomura, M; Takayama, S

1993-02-01

374

Immune-mediated hemolytic anemia associated with trimethoprim-sulphamethoxazole administration in a horse.  

PubMed Central

A 10-year-old, thoroughbred gelding was administered sulphonamide drugs during surgical treatment of guttural pouch mycosis. The horse became anemic and a diagnosis of immune-mediated hemolytic anemia was made after other causes of anemia had been ruled out. The anemia resolved after the drugs were withdrawn. PMID:9524723

Thomas, H L; Livesey, M A

1998-01-01

375

Comparing micellar, hemolytic, and antibacterial properties of di-and tricarboxyl dendritic amphiphiles  

E-print Network

amphiphiles Bhadreshkumar B. Maisuria a, , Marcelo L. Actis a,à , Shauntrece N. Hardrict a,§ , Joseph O April 2011 Keywords: Dendritic amphiphiles Staphylococcus aureus MRSA Critical micelle concentrations Hemolytic activities a b s t r a c t Homologous dicarboxyl dendritic amphiphiles--RCONHC(CH3)(CH2CH2COOH)2

Falkinham, Joseph

376

The erythropoietin receptor lends a Friendly hand  

E-print Network

immunologic effect of blood transfusion is the developmentpreviously numerous blood transfusions, and may thereforeblood cell (RBC) surface proteins. Alloantibodies are responsible for delayed hemolytic transfusion

Van Etten, R. A

2006-01-01

377

Blood transfusion and hemostatic agents used during radical cystectomy  

PubMed Central

Background: Radical cystectomy may result in significant blood loss necessitating transfusion. The purpose of this study was to determine what intra-operative techniques and hemostatic agents are currently used by uro-oncologists to prevent and control blood loss during radical cystectomy. Methods: In August 2011, members of the Society of Urologic Oncology (SUO) were solicited to complete an online survey. Residents, fellows and non-urologists were excluded. Canadian members received a personal email invitation. Respondents were asked to provide demographic information and opinions regarding blood loss and transfusion. Participants were also asked to report techniques used to reduce blood loss. Results: Of the 34 Canadian SUO members with registered email addresses, 27 (79%) completed the survey and met inclusion criteria as staff urologists who perform radical cystectomy. In addition, 52 non-Canadian SUO members were included in the analysis. Among all SUO respondents, a high proportion (73; 88%) reported using topical hemostatic agents during cystectomy. Thirty-six (46%) surgeons reported occasionally using procedural techniques and 9 (11%) using systemic hemostatic agents. Number of years since training was associated with decreased use of topical agents and increased use of procedural techniques (p < 0.01). Number of cystectomies per year was associated with decreased use of topical hemostatic agents (p < 0.01). Interpretation: Based on a survey of practice, there is significant risk of blood loss requiring transfusion during radical cystectomy. Surgeons frequently use topical hemostatic agents and rarely use systemic drugs to prevent or control blood loss. Trials evaluating agents and techniques to reduce blood loss during radical cystectomy are needed. PMID:23766829

Punjani, Nahid; Lavallée, Luke T.; Momoli, Franco; Fergusson, Dean; Witiuk, Kelsey; Mallick, Ranjeeta; Morash, Christopher; Cagiannos, Ilias; Breau, Rodney H.

2013-01-01

378

Legal and ethical issues in safe blood transfusion.  

PubMed

Legal issues play a vital role in providing a framework for the Indian blood transfusion service (BTS), while ethical issues pave the way for quality. Despite licensing of all blood banks, failure to revamp the Drugs and Cosmetic Act (D and C Act) is impeding quality. Newer techniques like chemiluminescence or nucleic acid testing (NAT) find no mention in the D and C Act. Specialised products like pooled platelet concentrates or modified whole blood, therapeutic procedures like erythropheresis, plasma exchange, stem cell collection and processing technologies like leukoreduction and irradiation are not a part of the D and C Act. A highly fragmented BTS comprising of over 2500 blood banks, coupled with a slow and tedious process of dual licensing (state and centre) is a hindrance to smooth functioning of blood banks. Small size of blood banks compromises blood safety. New blood banks are opened in India by hospitals to meet requirements of insurance providers or by medical colleges as this a Medical Council of India (MCI) requirement. Hospital based blood banks opt for replacement donation as they are barred by law from holding camps. Demand for fresh blood, lack of components, and lack of guidelines for safe transfusion leads to continued abuse of blood. Differential pricing of blood components is difficult to explain scientifically or ethically. Accreditation of blood banks along with establishment of regional testing centres could pave the way to blood safety. National Aids Control Organisation (NACO) and National Blood Transfusion Council (NBTC) deserve a more proactive role in the licensing process. The Food and Drug Administration (FDA) needs to clarify that procedures or tests meant for enhancement of blood safety are not illegal. PMID:25535417

Chandrashekar, Shivaram; Kantharaj, Ambuja

2014-09-01

379

Legal and ethical issues in safe blood transfusion  

PubMed Central

Legal issues play a vital role in providing a framework for the Indian blood transfusion service (BTS), while ethical issues pave the way for quality. Despite licensing of all blood banks, failure to revamp the Drugs and Cosmetic Act (D and C Act) is impeding quality. Newer techniques like chemiluminescence or nucleic acid testing (NAT) find no mention in the D and C Act. Specialised products like pooled platelet concentrates or modified whole blood, therapeutic procedures like erythropheresis, plasma exchange, stem cell collection and processing technologies like leukoreduction and irradiation are not a part of the D and C Act. A highly fragmented BTS comprising of over 2500 blood banks, coupled with a slow and tedious process of dual licensing (state and centre) is a hindrance to smooth functioning of blood banks. Small size of blood banks compromises blood safety. New blood banks are opened in India by hospitals to meet requirements of insurance providers or by medical colleges as this a Medical Council of India (MCI) requirement. Hospital based blood banks opt for replacement donation as they are barred by law from holding camps. Demand for fresh blood, lack of components, and lack of guidelines for safe transfusion leads to continued abuse of blood. Differential pricing of blood components is difficult to explain scientifically or ethically. Accreditation of blood banks along with establishment of regional testing centres could pave the way to blood safety. National Aids Control Organisation (NACO) and National Blood Transfusion Council (NBTC) deserve a more proactive role in the licensing process. The Food and Drug Administration (FDA) needs to clarify that procedures or tests meant for enhancement of blood safety are not illegal.

Chandrashekar, Shivaram; Kantharaj, Ambuja

2014-01-01

380

Pain and other non-neurological adverse events in children with sickle cell anemia and previous stroke who received hydroxyurea and phlebotomy or chronic transfusions and chelation: results from the SWiTCH clinical trial.  

PubMed

To compare the non-neurological events in children with sickle cell anemia (SCA) and previous stroke enrolled in SWiTCH. The NHLBI-sponsored Phase III multicenter randomized clinical trial stroke with transfusions changing to hydroxyurea (SWiTCH) (ClinicalTrials.gov NCT00122980) compared continuation of chronic blood transfusion/iron chelation to switching to hydroxyurea/phlebotomy for secondary stroke prevention and management of iron overload. All randomized children were included in the analysis (intention to treat). The Fisher's Exact test was used to compare the frequency of subjects who experienced at least one SCA-related adverse event (AE) or serious adverse event (SAE) in each arm and to compare event rates. One hundred and thirty three subjects, mean age 13 ± 3.9 years (range 5.2-19.0 years) and mean time of 7 years on chronic transfusion at study entry, were randomized and treated. Numbers of subjects experiencing non-neurological AEs were similar in the two treatment arms, including SCA-related events, SCA pain events, and low rates of acute chest syndrome and infection. However, fewer children continuing transfusion/chelation experienced SAEs (P = 0.012), SCA-related SAEs (P = 0.003), and SCA pain SAEs (P = 0.016) as compared to children on the hydroxyurea/phlebotomy arm. The timing of phlebotomy did not influence SAEs. Older age at baseline predicted having at least 1 SCA pain event. Patients with recurrent neurological events during SWiTCH were not more likely to experience pain. In children with SCA and prior stroke, monthly transfusions and daily iron chelation provided superior protection against acute vaso-occlusive pain SAEs when compared to hydroxyurea and monthly phlebotomy. PMID:23861242

Alvarez, Ofelia; Yovetich, Nancy A; Scott, J Paul; Owen, William; Miller, Scott T; Schultz, William; Lockhart, Alexandre; Aygun, Banu; Flanagan, Jonathan; Bonner, Melanie; Mueller, Brigitta U; Ware, Russell E

2013-11-01

381

Pathology Case Study: Fever and Severe Rigors During Transfusion  

NSDL National Science Digital Library

This is a case study presented by the University of Pittsburgh Department of Pathology in which a 55-year-old woman with a history of breast cancer developed fever and severe rigors during a blood. Visitors are given the hospital course record and the blood bank laboratory evaluation, including images, and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in transfusion pathology.

Aronica, Patricia; Triulzi, Darrell

2007-08-16

382

Oscillations in plasma cortisol levels of newborns during exchange transfusion.  

PubMed

Plasma cortisol concentration was determined in blood samples obtained in six newborns during exchange transfusion at 3--5 minute intervals. A radiotransin-assay using horse serum as a binding protein and toluene-based scintillation fluid for separation of unbound tracer proved to be a relatively specific method for determination of cortisol level in the plasma of newborns. Irregular oscillations were observed in four newborns, whereas a single peak could be demonstrated in two cases during the 40--70 minute period observed. The results suggest that the CRF-ACTH-cortisol secretion may already be episodic in the newborn period. PMID:7428711

Zoltán, E; Sólyom, J

1980-06-01

383

New insights into childhood autoimmune hemolytic anemia: a French national observational study of 265 children  

PubMed Central

Background Autoimmune hemolytic anemia is a rare condition in children. Little is known about its initial presentation and the subsequent progression of the disease. Design and Methods Since 2004, a national observational study has been aiming to thoroughly describe cases and identify prognostic factors. Patients from all French hematologic pediatric units have been included if they had a hemoglobin concentration less than 11 g/dL, a positive direct antiglobulin test and hemolysis. Evans’ syndrome was defined by the association of autoimmune hemolytic anemia and immunological thrombocytopenic purpura. Data from patients’ medical records were registered from birth to last follow-up. Autoimmune hemolytic anemia was classified as primary or secondary. Remission criteria, qualifying the status of anemia at last follow-up, were used with the aim of identifying a subgroup with a favorable prognosis in continuous complete remission. Results The first 265 patients had a median age of 3.8 years at diagnosis. In 74% of cases the direct antiglobulin test was IgG/IgG+C3d. Consanguinity was reported in 8% of cases and first degree familial immunological diseases in 15% of cases. Evans’ syndrome was diagnosed in 37% of cases. Autoimmune hemolytic anemia was post-infectious in 10%, immunological in 53% and primary in 37% of cases. After a median follow-up of 3 years, 4% of children had died, 28% were still treatment-dependent and 39% were in continuous complete remission. In multivariate analysis, IgG and IgG+C3d direct antiglobulin tests were associated with a lower rate of survival with continuous complete remission (adjusted hazard ratio, 0.43; 95% confidence interval, 0.21–0.86). Conclusions This nationwide French cohort is the largest reported study of childhood autoimmune hemolytic anemia. The rarity of this condition is confirmed. Subgroups with genetic predisposition and underlying immune disorders were identified. PMID:21228033

Aladjidi, Nathalie; Leverger, Guy; Leblanc, Thierry; Picat, Marie Quitterie; Michel, Gérard; Bertrand, Yves; Bader-Meunier, Brigitte; Robert, Alain; Nelken, Brigitte; Gandemer, Virginie; Savel, Hélčne; Stephan, Jean Louis; Fouyssac, Fanny; Jeanpetit, Julien; Thomas, Caroline; Rohrlich, Pierre; Baruchel, André; Fischer, Alain; Chęne, Genevičve; Perel, Y.

2011-01-01

384

Trichomonas vaginalis: identification of a phospholipase A-dependent hemolytic activity in a vesicular subcellular fraction.  

PubMed

Trichomonad total extracts (TTE), or vesicular (P30) and soluble (530) subcellular fractions from 3 pathogenic Trichomonas vaginalis strains (GT-3. GT-13. and GT-15), lysed both human and Sprague-Dawley rat erythrocytes in a time- and dose-dependent manner. The entire hemolytic activity of TTE was located in P30, showing 2 peaks of maximum activity, one at pH 6.0 and another at pH 8.0. in the presence of 1 mM Ca2+. Hemolytic activity on rat erythrocytes was greater at pH 6.0 16.71 +/- 0.33 hemolytic units IHU]/mg/hr to 11.60 +/- 0.24 HU/mg/hr) than at pH 8.0 (3.81 +/- 0.30 HU/mg/hr to 5.75 +/- 0.65 HU/mg/hr). and it was greater than that on human red blood cells at pH 6.0 (2.67 +/- 0.19 HU/mg/hr to 4.08 +/- 0.15 HU/mg/hr) or pH 8.0 (2.24 +/- 0.0 9 HU/mg/hr to 2.81 +/- 0.06 HU/mg/hr). The alkaline and acidic hemolytic activity diminished (60-93% at pH 6.0 and 78-93% at pH 8.0) by the effect of 80 microM Rosenthal's inhibitor, which also inhibited 27-45% and 29-54% trichomonad alkaline and acidic phospholipase A activities, respectively. Vesicles, vacuoles, and hydrogenosomes were rich in P30. Trichomonas vaginalis has a hemolytic PLA, which could be involved in its cytopathogenic mechanism. PMID:12659311

Vargas-Villarreal, Javier; Mata-Cárdenas, Benito D; González-Salazar, Francisco; Lozano-Garza, Hector G; Cortes-Gutierrez, Elva I; Palaclos-Corona, Rebeca; Martínez-Rodríguez, Herminia G; Ramírez-Bon, Enrique; Said-Fernández, Salvador

2003-02-01

385

IMPACT OF RED BLOOD CELL TRANSFUSION ON GLOBAL AND REGIONAL MEASURES OF OXYGENATION  

PubMed Central

Anemia is common in critically ill patients. While the goal of transfusion of red blood cells (RBCs) is to increase oxygen carrying capacity, there are contradictory results about whether RBC transfusion to treat moderate anemia (e.g. hemoglobin 7–10 g/dL) improves tissue oxygenation or changes outcomes. While increasing levels of anemia eventually lead to a level of critical oxygen delivery (DO2), increased cardiac output and oxygen extraction are homestatic mechanisms the body uses to prevent a state of dysoxia in the setting of diminished DO2 due to anemia. In order for cardiac output to increase in the face of anemia, normovolemia must be maintained. Transfusion of RBCs increases blood viscosity which may actually decrease cardiac output (barring a state of hypovolemia prior to transfusion). Studies have generally shown that transfusion of RBCs fails to increase oxygen uptake (VO2) unless VO2/DO2 dependency exists, e.g., severe anemia or strenuous exercise. Recently near-infrared spectroscopy (NIRS), which approximates the hemoglobin saturation of venous blood, has been used to investigate whether transfusion of RBCs increases NIRS measurements of tissue oxygenation in regional tissue beds (e.g., brain, peripheral skeletal muscle). These studies have generally shown increases in NIRS derived measurements of tissue oxygenation following transfusion. Studies evaluating the effect of transfusion on the microcirculation have shown that transfusion increases the functional capillary density. This article will review fundamental aspects of oxygen delivery and extraction, and the effects of RBC transfusion on tissue oxygenation as well as the effects of RBC transfusion on the microcirculation. PMID:22238040

Roberson, Russell S.; Bennett-Guerrero, Elliott

2011-01-01

386

Is single-unit blood transfusion bad post-coronary artery bypass surgery?†  

PubMed Central

OBJECTIVES Publications in the surgical literature are very consistent in their conclusions that blood is dangerous with regard to in-hospital mortality, morbidity and long-term survival. Blood is frequently used as a volume expander while simultaneously increasing the haematocrit. We investigated the effects of a single-unit blood transfusion on long-term survival post-cardiac surgery in isolated coronary artery bypass grafting patients. METHODS A prospective single-institution cardiac surgery database was analysed involving 4615 patients. Univariate, multivariate stepwise Cox regression analysis and propensity matching were performed to identify whether a single-unit blood transfusion was detrimental to long-term survival. RESULTS Univariate analysis revealed that blood was significantly associated with a reduced long-term survival even with a single-unit transfused, P = 0.0001. Cox multivariate regression analysis identified age, ejection fraction, preoperative dialysis, logistic EuroSCORE, postoperative CKMB, blood transfusion, urgent operative status and atrial fibrillation as significant factors determining long-term survival. When the Cox regression was repeated with patients who received no blood or only one unit of blood, transfusion was not a risk factor for long-term survival. An interaction analysis revealed that blood transfusion was significantly interacting with preoperative haemoglobin levels, P = 0.02. Propensity analysis demonstrated that a single-unit transfusion is not associated with a detrimental long-term survival, P = 0.3. CONCLUSIONS Cox regression and propensity matching both indicate that a single-unit transfusion is not a significant cause of reduced long-term survival. Preoperative anaemia is a significant confounding factor. Despite demonstrating the negligible risks of a single-unit blood transfusion, we are not advocating liberal transfusion and would recommend changing from a double-unit to a single-unit transfusion policy. We speculate that blood is not bad, but that the underlying reason that it is given might be. PMID:23449665

Warwick, Richard; Mediratta, Neeraj; Chalmers, John; Pullan, Mark; Shaw, Matthew; Mcshane, James; Poullis, Michael

2013-01-01

387

Safety and efficacy of intravenous iron therapy in reducing requirement for allogeneic blood transfusion: systematic review and meta-analysis of randomised clinical trials  

PubMed Central

Objectives To evaluate the efficacy and safety of intravenous iron, focusing primarily on its effects on haemoglobin, requirement for transfusion, and risk of infection. Design Systematic review and meta-analysis of randomised controlled trials investigating the safety and efficacy of intravenous iron therapy. Data sources Randomised controlled trials from Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1966 to June 2013, with no language restrictions. Eligibility criteria for selecting studies Eligible trials were randomised controlled trials of intravenous iron compared with either no iron or oral iron. Crossover and observational studies were excluded. Main outcome measures Change in haemoglobin concentration and risk of allogeneic red blood cell transfusion (efficacy) and risk of infection (safety). Results Of the 75 trials meeting the inclusion criteria, 72 studies including 10 605 patients provided quantitative outcome data for meta-analysis. Intravenous iron was associated with an increase in haemoglobin concentration (standardised mean difference 6.5 g/L, 95% confidence interval 5.1 g/L to 7.9 g/L) and a reduced risk of requirement for red blood cell transfusion (risk ratio 0.74, 95% confidence interval 0.62 to 0.88), especially when intravenous iron was used with erythroid stimulating agents (ESAs) or in patients with a lower baseline plasma ferritin concentration. There were no significant interactions between the efficacy of intravenous iron and type or dose administered. Intravenous iron was, however, associated with a significant increase in risk of infection (relative risk 1.33, 95% confidence interval 1.10 to 1.64) compared with oral or no iron supplementation. The results remained similar when only high quality trials were analysed. Conclusions Intravenous iron therapy is effective in increasing haemoglobin concentration and reducing the risk of allogeneic red blood cell transfusion and could have broad applicability to a range of acute care settings. This potential benefit is counterbalanced by a potential increased risk of infection. PMID:23950195

2013-01-01

388

A radiolabeled antiglobulin test for crossmatching platelet transfusions  

SciTech Connect

Despite the use of HLA-matched platelets for alloimmunized recipients, transfusion failures occur. In order to reduce these failures, researchers investigated the use of a radiolabeled antiglobulin technique for platelet crossmatching. The principle of the test is that of an indirect Coombs test using /sup 125/I labeled goat anti-human IgG. Incompatibility is determined by calculating a radioactivity antiglobulin test (RAGT) index. Using this technique, researchers performed 89 crossmatches on 19 leukemic or aplastic patients who were refractory to random donor platelets and receiving varying degrees of HLA-matched platelets. Effectiveness of the transfusion was assessed from the posttransfusion corrected platelet count increment (CCI) determined at 1 and 20 hr. When the RAGT index was 1.9 or less, the mean CCI at 1 lhr was 17,570 +/- 7003/cu mm, n . 55. When the RAGT index was 2.0 or greater, the mean CCI was 4237 +/- 4100/cu mm, n . 34. At 20 hr when the RAGT index was 1.9 or less, the mean CCI was 8722 +/- 3143/cu mm, n . 33, and when the index was 2.0 or greater, the mean CCI was 571 +/- 1286/cu mm, n . 23. Using this technique, one false negative resulted. Nine positive crossmatches with good increments at 1 hr were found; at 20 hr, however, the survival of these units was zero. These data suggest that this method is a useful adjunct in the selection of platelets in the refractory patient.

Kickler, T.S.; Braine, H.G.; Ness, P.M.; Koester, A.; Bias, W.

1983-02-01

389

Applying radio-frequency identification (RFID) technology in transfusion medicine.  

PubMed

ISO/IEC 18000-3 mode 1 standard 13.56 MHz RFID tags have been accepted by the International Society for Blood Transfusion (ISBT) and the United States Food and Drug Administration (FDA) as data carriers to integrate with and augment ISBT 128 barcode data carried on blood products. The use of 13.56 MHz RFID carrying ISBT 128 data structures allows the global deployment and use of RFID, supporting both international transfer of blood and international disaster relief. The deployment in process at the BloodCenter of Wisconsin and testing at the University of Iowa Health Center is the first FDA-permitted implementation of RFID throughout in all phases of blood banking, donation through transfusion. RFID technology and equipment selection will be discussed along with FDA-required RF safety testing; integration with the blood enterprise computing system and required RFID tag performance. Tag design and survivability is an issue due to blood bag centrifugation and irradiation. Deployment issues will be discussed. Use of RFID results in significant return on investment over the use of barcodes in the blood center operations through labor savings and error reduction. PMID:22079476

Hohberger, Clive; Davis, Rodeina; Briggs, Lynne; Gutierrez, Alfonso; Veeramani, Dhamaraj

2012-05-01

390

Red Blood cell Alloimmunization in Sickle Cell Disease: Pathophysiology, Risk Factors, and Transfusion Management  

E-print Network

1 Red Blood cell Alloimmunization in Sickle Cell Disease: Pathophysiology, Risk Factors, hyperhemolysis, transfusion management, T regulatory cells (Tregs), RH variant, rare blood groups inserm-00696264-11-327361 #12;2 Abstract Red blood cell transfusions have reduced morbidity and mortality for patients

Boyer, Edmond

391

NOTE: Arterio-venous flow between monochorionic twins determined during intra-uterine transfusion  

NASA Astrophysics Data System (ADS)

Twin-twin transfusion syndrome (TTTS) is a severe complication of monozygotic (identical) twin fetuses sharing one single (monochorionic) placenta. TTTS is caused by a net inter-twin transfusion of blood through placental anastomoses, from one twin (the donor) to the other (the recipient), which link the two feto-placental circulations. Currently, the only reliable method to measure the net inter-twin transfusion clinically is when incomplete laser therapy of TTTS occurs and one of the twins becomes anemic and requires an intra-uterine transfusion of adult red blood cells. Then, differences between adult hemoglobin concentrations measured during the transfusion and at birth relate not only to the net inter-twin transfusion but also to the finite lifetime of the adult red blood cells. We have analyzed this situation, derived the differential equations of adult hemoglobin in the donor and recipient twins, given the solutions and given expressions relating the net inter-twin flow with clinically measured parameters. We have included single and multiple intra-uterine transfusions. In conclusion, because incomplete laser therapy occurs frequently, and some cases require an intra-uterine transfusion, this method may allow collecting a wealth of net inter-twin flow data from clinicians involved in laser therapy of TTTS. To aid to the widespread use of this method, we have presented the equations as clearly as possible in tables for easy use by others.

van Gemert, Martin J. C.; van den Wijngaard, Jeroen P. H. M.; Lopriore, Enrico; Pasman, Suzanne A.; Vandenbussche, Frank P. H. A.

2008-04-01

392

An audit of the use of platelet transfusions at Universitas Academic Hospital, Bloemfontein, South Africa.  

PubMed

An audit was performed at a tertiary hospital in Bloemfontein, South Africa, to establish whether clinicians adhered to local platelet transfusion guidelines. The audit showed poor compliance with local guidelines, with 34% of platelet transfusions not aligned with guidelines and 29.9% of transfusions administered to patients with platelet counts of??150?×?10(9)/L. When compared to medical disciplines, surgical disciplines tended significantly more to transfuse platelets inappropriately (17.1% and 53.7%, respectively; p?transfusion was not clearly stated. Considerable cost could be avoided with improved adherence to guidelines. This study emphasises the need for improving education in transfusion medicine amongst medical doctors. It is hoped that the information gleaned from this study would assist in the design of educational programmes in transfusion medicine as we attempt to close the existing gaps in knowledge and skills in the field, while ensuring that blood is transfused in a cost-effective and appropriate manner. PMID:25457007

Sonnekus, P H; Louw, V J; Ackermann, A M; Barrett, C L; Joubert, G; Webb, M J

2014-12-01

393

Restrictive versus liberal blood transfusion policy for hepatectomies in cirrhotic patients  

Microsoft Academic Search

To evaluate the worth of intra- and postoperative blood transfusion in cirrhotic patients undergoing resection for hepatocellular carcinoma, we compared 13 patients receiving transfusions and 14 matched contemporary patients who did not receive blood. Preoperative hematological and biochemical parameters, the type and extent of liver resection, and the mean blood loss (862 and 870 ml) were similar in the 2

Masatoshi Makuuchi; Tadatoshi Takayama; Peter Gunvén; Tomoo Kosuge; Susumu Yamazaki; Hiroshi Hasegawa

1989-01-01

394

Targeting Continuing Medical Education on Decision Makers: Who Decides to Transfuse Blood?  

ERIC Educational Resources Information Center

Staff communication patterns were observed during 13 open-heart surgeries to identify the transfusion decision makers. It was determined that targeting decision makers for continuing medical education would improve the quality of transfusion practice and increase the efficiency of continuing education. (SK)

Goodnough, Lawrence T.; And Others

1992-01-01

395

ORIGINAL ARTICLE Blood Transfus DOI 10.2450/2012.0099-11  

E-print Network

1 ORIGINAL ARTICLE Blood Transfus DOI 10.2450/2012.0099-11 © SIMTI Servizi Srl Temporal sequence BS et al Blood Transfus DOI 10.2450/2012.0099-11 form of vesicles during cold storage8-12 , however of major biochemical events during Blood Bank storage of packed red blood cells Brad S. Karon1 , Camille M

Thomas, David D.

396

Relation between recurrence of cancer of the colon and blood transfusion  

Microsoft Academic Search

Data suggest that blood transfusion can cause immunosuppression. The incidence of recurrence of tumours was examined retrospectively in patients who had undergone potentially curative operations for cancer of the colon during 1970-81. Tumours recurred in six of 68 patients (9%) who had not been given transfusions and in 56 of 129 patients (43%) who had (p much less than 0.0001).

N Blumberg; M M Agarwal; C Chuang

1985-01-01

397

TRANSFUSION MEDICINE Desialylation accelerates platelet clearance after refrigeration and initiates GPIb  

E-print Network

TRANSFUSION MEDICINE Desialylation accelerates platelet clearance after refrigeration and initiates. (Blood. 2012;119(5):1263-1273) Introduction Platelets have the shortest shelf life of all major blood life is limited to 5 days mainly because of bacterial growth and the risk of transfusion

von Andrian, Ulrich H.

398

Alcohol-positive multiple trauma patients with and without blood transfusion: an outcome analysis  

Microsoft Academic Search

BACKGROUND: Blood transfusion is a common therapy for multiple trauma patients, and is often performed soon after hospital admission. It is unclear whether the need for a blood transfusion in multiply injured patients presenting with a positive blood alcohol concentration (BAC) is associated with increased morbidity\\/mortality, since their risk behavior differs significantly from patients with a negative BAC. In this

Manuel F Struck; Thomas Schmidt; Ralph Stuttmann; Peter Hilbert

2009-01-01

399

Risk of recurrent stroke in patients with sickle cell disease treated with erythrocyte transfusions  

Microsoft Academic Search

Objective: To determine the effect of a transfusion program on risk of stroke recurrence in children with sickle cell disease. Design: The clinical course and experience with transfusion therapy at eight centers were reviewed for subjects whose initial stroke occurred after January 1988. Results: Sixty subjects were observed for 191.7 patient-years. Eight had a single recurrent stroke (two intracranial hemorrhages

Charles H. Pegelow; Robert J. Adams; Virgil McKie; Miguel Abboud; Brian Berman; Scott T. Miller; Nancy Olivieri; Elliott Vichinsky; Winfred Wang; Donald Brambilla

1995-01-01

400

Discontinuing Prophylactic Transfusions Used to Prevent Stroke in Sickle Cell Disease  

Microsoft Academic Search

background Prophylactic transfusion prevents strokes in children with sickle cell anemia who have abnormalities on transcranial Doppler ultrasonographic examination. However, it is not known how long transfusion should be continued in these children. methods We studied children with sickle cell disease who had a high risk of stroke on the basis of a transcranial Doppler screening examination and who had

Robert J. Adams

2010-01-01

401

Assessment of Impact of Training in Improving Knowledge of Blood Transfusion among Clinicians  

PubMed Central

Summary Background Blood is a precious resource that needs to be prescribed, handled, stored and transfused as per guidelines to ensure recipient safety. The present study aims to assess the basic knowledge of clinicians pertaining to safe transfusion practice, impart relevant training, and assess the impact of such training programs. Methods A total of 25 fresh bachelor of medicine and bachelor of surgery graduates were enrolled for the study. The participants were given a pre-assessment questionnaire related to the entire transfusion chain followed by interactive training of the participants and post-training re-assessment. Results The mean score in the pre-training assessment was 51% while in the post-training assessment the mean score was 85.4%; the difference was statistically significant. There were significant differences in knowledge pertaining to storage temperature, shelf life of red cells and platelets, alternate group choice for fresh frozen plasma, and documentation of transfusion reaction. The participants had inadequate knowledge pertaining to cross-match procedure and management of transfusion reactions. Conclusion The study assessed the knowledge and awareness of clinicians regarding blood transfusion practice. Mandatory training and inclusion of transfusion medicine as a subject at undergraduate level can help in improving transfusion practice and ensuring recipient safety. PMID:25053936

Kaur, Paramjit; Kaur, Gagandeep; Kaur, Ravneet; Sood, Tanvi

2014-01-01

402

Manuscrit bdc080112 R1 Administration des transfusions sanguines l'hpital ou  

E-print Network

Manuscrit bdc080112 R1 Administration des transfusions sanguines à l'hôpital ou à domicile ? Le choix des patients atteints de cancer Blood transfusions at home or in the hospital? The preferences modalités d'administration de la TAD sont les suivantes : pour les patients suivis par la coordination des

Paris-Sud XI, Université de

403

The Deleterious Effect of Red Blood Cell Storage on Microvascular Response to Transfusion  

PubMed Central

Background The transfusion of relatively older red blood cells (RBCs) has been associated with both morbidity and mortality in trauma patients in observational studies. Although the mechanisms responsible for this phenomenon remain unclear, alterations in the microcirculation as a result of the transfusion of relatively older blood may be a causative factor. To assess this hypothesis, we evaluated microvascular perfusion in trauma patients during RBC transfusion. Methods Anemic but otherwise stable trauma ICU patients with orders for transfusion were identified. Thenar muscle tissue oxygen saturation (StO2) was measured continuously by near infrared spectroscopy during the course of transfusion of one RBC unit. Sublingual microcirculation was observed by sidestream dark field illumination microscopy before and after transfusion of one RBC unit. Thenar muscle StO2 was recorded over the course of transfusion. Pre- and post-transfusion perfused capillary vascular density (PCD) was determined by semi-quantitative image analysis. Changes in StO2 and PCD relative to age of RBC unit were evaluated using mixed models that adjusted for baseline StO2 and Spearman's correlation, respectively. Results Overall, 93 patients were recruited for study participation, 69% were male and average Injury Severity Score was 26.4. Average pre-transfusion hemoglobin was 7.5 mg/dL and the average age of RBC unit transfused was 29.4 days. Average peri-transfusion StO2 was negatively associated with increasing RBC age (slope -0.11, p = 0.0014). Change in PCD from pre- to post-transfusion was found to correlate negatively with RBC storage age (Spearman correlation = -0.27, p = 0.037). Conclusions The transfusion of relatively older RBC units was associated with a decline in both StO2 and PCD. Collectively, these observations demonstrate that transfusions of older RBC units are associated with the inhibition of regional microvascular perfusion. In patients requiring multiple units of RBCs, alteration of the microcirculation by relatively older units could potentially contribute to adverse outcomes. Level of Evidence: II, prognostic study PMID:24158198

Weinberg, Jordan A.; MacLennan, Paul A.; Vandromme–Cusick, Marianne J.; Magnotti, Louis J.; Kerby, Jeffrey D.; Rue, Loring W.; Angotti, Jonathan M.; Garrett, Cristen A.; Hendrick, Leah E.; Croce, Martin A.; Fabian, Timothy C.; Barnum, Scott R.; Patel, Rakesh P.

2013-01-01

404

Neurocognitive Profiles of Preterm Infants Randomly Assigned to Lower or Higher Hematocrit Thresholds for Transfusion  

PubMed Central

Objective Preterm infants are frequently transfused with red blood cells based on standardized guidelines or clinical concern that anemia taxes infants’ physiological compensatory mechanisms and thereby threatens their health and well-being. The impact of various transfusion guidelines on long-term neurocognitive outcome is not known. The purpose of this study is to evaluate long-term neurocognitive outcome on children born prematurely and treated at birth with different transfusion guidelines. Methods Neurocognitive outcomes were examined at school age for 56 preterm infants randomly assigned to a liberal (n = 33) or restrictive (n = 23) transfusion strategy. Tests of intelligence, achievement, language, visual-spatial/motor, and memory skills were administered. Between-group differences were assessed. Results Those in the liberal transfusion group performed more poorly than those in the restrictive group on measures of associative verbal fluency, visual memory, and reading. Conclusions Findings highlight possible long-term neurodevelopmental consequences of maintaining higher hematocrit levels. PMID:21360360

Conrad, Amy L.; Richman, Lynn; Lindgren, Scott; Nopoulos, Peg; Bell, Edward F.

2011-01-01

405

The effect of tranexamic acid on transfusion rate in primary total hip arthroplasty.  

PubMed

Total hip arthroplasty (THA) may produce blood loss requiring allogenic blood transfusion. Recently several authors have reported success decreasing their transfusion rate with tranexamic acid (TXA). We retrospectively reviewed our last 1595 primary THA in 1494 patients looking at whether the patients received TXA via IV infusion, topical application, or neither, and the need for a blood transfusion. Infusion of TXA acid produced a statistically significant difference in transfusion rate (p<0.001) while topical TXA failed to reach statistical significance (P=0.15). The transfusion rate without TXA was 19.86%, 4.39% with TXA infusion (odds ratio=5.36), and 12.86% (odds ratio=1.67) with topical TXA. PMID:23790499

Wind, Tyler C; Barfield, William R; Moskal, Joseph T

2014-02-01

406

Red blood cell transfusion strategies and Maximum surgical blood ordering schedule  

PubMed Central

Blood transfusion is one of the practices that is in vogue because it expands blood volume and purportedly improves the oxygen carrying capacity. Despite this supposed physiological benefit, paradoxically, both anaemia and transfusion are independently associated with organ injury and increased morbidity. Historically, transfusion was used to maintain blood haemoglobin concentration above 10 g/dL and a haematocrit above 30%. There is now a greater emphasis on interventions to reduce the use of transfusion as it is a scarce and expensive resource with many serious adverse effects. Institutional maximum surgical blood ordering schedule algorithm developed with data analysis and consensus of surgeons, anaesthesiologists and blood banks can reduce the overuse of blood. A PubMed search was performed with search words/combination of words ‘erythrocyte transfusion, adverse effects, economics, mortality, therapy, therapeutic use and utilisation’. Search yielded a total of 1541 articles that were screened for clinical relevance for the purpose of this review.

Iyer, Shivakumar S; Shah, Jignesh

2014-01-01

407

Timing of Re-Transfusion Drain Removal Following Total Knee Replacement  

PubMed Central

INTRODUCTION The use of postoperative drains following total knee replacement (TKR) has recently been modified by the use of re-transfusion drains. The aim of our study was to investigate the optimal time for removal of re-transfusion drains following TKR. PATIENTS AND METHODS The medical records of 66 patients who had a TKR performed between October 2003 and October 2004 were reviewed; blood drained before 6 h and the total volume of blood drained was recorded. RESULTS A total of 56 patients had complete records of postoperative drainage. The mean volume of blood collected in the drain in the first 6 h was 442 ml. The mean total volume of blood in the drain was 595 ml. Therefore, of the blood drained, 78% was available for transfusion. CONCLUSION Re-transfusion drains should be removed after 6 h, when no further re-transfusion is permissible. PMID:16551400

Leeman, MF; Costa, ML; Costello, E; Edwards, D

2006-01-01

408

Genital Infection as a First Sign of Acute Myeloid Leukemia  

PubMed Central

Fournier's gangrene is a life-threatening disorder caused by aerobic and anaerobic bacterial infection. We report a case of genital infection as the initial warning sign of acute myeloid leukemia. We were able to prevent progression to Fournier's gangrene in our patient by immediate intensive therapy with incision, blood transfusions and intravenous administration of antibiotics. This case suggests that hematologists and dermatologists should keep in mind that genital infection can be a first sign of hematologic malignancy. PMID:21173921

Oiso, Naoki; Rai, Shinya; Kawara, Shigeru; Tatsumi, Yoichi; Kawada, Akira

2010-01-01

409

zentrum hygiene und humangenetik ABTEIlUNG TRANSFUSIONSMEDIZIN centre for hygiene and human Genetics DEPARTMENT OF TRANSFUSION MEDICINE  

E-print Network

Genetics DEPARTMENT OF TRANSFUSION MEDICINE Abteilungsdirektor/in | Head of Department Prof. Dr. med of the Department of Transfusion Medicine is the representation of this field in patient care, teaching, science Transfusionsmedizin Research Foci Peripheral Blood Stem Cells Preparation of Blood Components Molecular Transfusion

Gollisch, Tim

410

Comparison of restrictive and liberal transfusion strategy on postoperative delirium in aged patients following total hip replacement: a preliminary study.  

PubMed

Few studies have examined the association between perioperative blood transfusion and postoperative delirium (POD) in aged patients undergoing total hip replacement surgery. In this prospective study, 186 patients older than 65 years undergoing elective unilateral total hip replacement surgery were enrolled. Of those, 94 patients were randomly assigned to the restrictive strategy transfusion strategy group, in which red blood cells were transfused in order to maintain 10.0 g/dL>hemoglobin?8.0 g/dL. Ninety-two patients were randomly assigned to the liberal transfusion strategy group, in which red blood cells were transfused in order to maintain hemoglobin?10.0 g/dL. POD was diagnosed by confusion assessment method. The baseline characteristics of patients, the length of hospital stay, the incidence of POD, myocardial infarction, stroke, wound infection, pulmonary embolism, and the transfusion volume were recorded. No difference was observed in the baseline characteristics, the length of hospital stay, and the incidence of POD, myocardial infarction, stroke, wound infection, and pulmonary embolism between the two groups (P>0.05). The proportion of patients transfused with red blood cell and frozen plasma was decreased in the restrictive transfusion group compared with the liberal transfusion group (P<0.05). In conclusion, restrictive transfusion does not influence the incidence of POD but reduces blood transfusion. Thus, restrictive transfusion may serve as an effective and safe strategy for aged patients following total hip replacement. PMID:24745810

Fan, Yun-Xia; Liu, Fang-Fang; Jia, Min; Yang, Jiao-Jiao; Shen, Jin-Chun; Zhu, Guang-Ming; Zhu, Si-Hai; Li, Wei-Yan; Yang, Jian-Jun; Ji, Mu-Huo

2014-01-01

411

Phosphatidylserine-expressing cell by-products in transfusion: a pro-inflammatory or an anti-inflammatory effect?  

E-print Network

byproducts present in labile blood products can be responsible for transfusion-induced immunomodulation1 Phosphatidylserine-expressing cell by-products in transfusion: a pro-inflammatory or an anti-inflammatory effect? Rôle des débris cellulaires exprimant la phosphatidylserine en transfusion : un effet pro- ou

Boyer, Edmond

412

Le principe de prcaution appliqu la transfusion sanguine : quel impact sur les pratiques et la gestion des risques ?  

E-print Network

la gestion des risques ? The precautionary principle applied to blood transfusion. What is its impact through blood transfusion. However, there has been no preliminary reflection on the definition, objectives application remains unanswered. This study, based on interviews with blood transfusion practitioners, aims

Paris-Sud XI, Université de

413

Serogroup-Specific Bacterial Engineered Glycoproteins as Novel Antigenic Targets for Diagnosis of Shiga Toxin-Producing-Escherichia coli-Associated Hemolytic-Uremic Syndrome.  

PubMed

Human infection with Shiga toxin-producing Escherichia coli (STEC) is a major cause of postdiarrheal hemolytic-uremic syndrome (HUS), a life-threatening condition characterized by hemolytic anemia, thrombocytopenia, and acute renal failure. E. coli O157:H7 is the dominant STEC serotype associated with HUS worldwide, although non-O157 STEC serogroups can cause a similar disease. The detection of anti-O157 E. coli lipopolysaccharide (LPS) antibodies in combination with stool culture and detection of free fecal Shiga toxin considerably improves the diagnosis of STEC infections. In the present study, we exploited a bacterial glycoengineering technology to develop recombinant glycoproteins consisting of the O157, O145, or O121 polysaccharide attached to a carrier protein as serogroup-specific antigens for the serological diagnosis of STEC-associated HUS. Our results demonstrate that using these antigens in indirect ELISAs (glyco-iELISAs), it is possible to clearly discriminate between STEC O157-, O145-, and O121-infected patients and healthy children, as well as to confirm the diagnosis in HUS patients for whom the classical diagnostic procedures failed. Interestingly, a specific IgM response was detected in almost all the analyzed samples, indicating that it is possible to detect the infection in the early stages of the disease. Additionally, in all the culture-positive HUS patients, the serotype identified by glyco-iELISAs was in accordance with the serotype of the isolated strain, indicating that these antigens are valuable not only for diagnosing HUS caused by the O157, O145, and O121 serogroups but also for serotyping and guiding the subsequent steps to confirm diagnosis. PMID:25472487

Melli, Luciano J; Ciocchini, Andrés E; Caillava, Ana J; Vozza, Nicolás; Chinen, Isabel; Rivas, Marta; Feldman, Mario F; Ugalde, Juan E; Comerci, Diego J

2015-02-01

414

Pandemic H1N1 influenza A viral infection complicated by atypical hemolytic uremic syndrome and diffuse alveolar hemorrhage  

Microsoft Academic Search

We report here on a case of a 27-year-old man with atypical hemolytic uremic syndrome and diffuse alveolar hemorrhage associated\\u000a with influenza A H1N1 infection. Treatment with oseltamivir, plasma exchange and hemodiafiltration for the hemolytic uremic\\u000a syndrome and meticulous supportive care with steroid pulse therapy for the pulmonary alveolar hemorrhage was successful in\\u000a this case. We discuss the relationship between

Harin Rhee; Sang Heon Song; Yong Jae Lee; Hyun Ju Choi; Jin Hee Ahn; Eun Young Seong; Soo Bong Lee; Ihm Soo Kwak

415

Purification, characterization and activities of two hemolytic and antibacterial proteins from coelomic fluid of the annelid Eisenia fetida andrei  

Microsoft Academic Search

The coelomic fluid of the earthworm Eisenia fetida andrei exhibits antibacterial, hemolytic and hemagglutinating activities. These activities are mainly mediated by two proteins, named fetidins, of apparent molecular mass 40 kDa and 45 kDa, respectively. For the first time, the two proteins have been purified to homogeneity from dialysed coelomic fluid by means of anion-exchange chromatography. Three peaks had hemolytic

Alexandra Milochau; Marguerite Lassčgues; Pierre Valembois

1997-01-01

416

Opposite effects of interleukin-2 on normal and transfusion-suppressed healing of experimental intestinal anastomoses.  

PubMed Central

OBJECTIVE: This study was done to investigate whether administration of interleukin-2 (IL-2) can abrogate the negative effects of blood transfusions on anastomotic healing. SUMMARY BACKGROUND DATA: Recently, the authors showed that blood transfusion severely impairs anastomotic repair and significantly increases the susceptibility to intra-abdominal septic complications in rats. It has been reported that blood transfusions suppress IL-2 production and that IL-2 may stimulate wound healing. METHODS: Lewis rats underwent resection and anastomosis of both the ileum and colon. Subsequently, they received either 3 mL of saline (control and IL-2 groups) or 3 mL of blood from brown Norway donors (transfusion and transfusion/IL-2 groups) intravenously. From the operation onward, the animals in the IL-2 and transfusion/IL-2 groups received daily injections of 5.4 x 10(5) IU of IL-2 in dextrose solution subcutaneously; the rats in the other groups received only the dextrose solution. The animals were killed 3 or 7 days after the operation and examined for septic complications and anastomotic repair. RESULTS: Transfusion led to an enhanced incidence of anastomotic abscesses, which was almost completely abrogated after IL-2 administration. The anastomotic strength was consistently and significantly reduced after transfusion. Seven days after surgery, the anastomotic strength was completely restored by IL-2 treatment. For instance, the average bursting pressure (+/- the standard deviation) of the ileal anastomoses in the control, transfusion, and transfusion/IL-2 groups were 86 +/- 15, 32 +/- 8,* and 63 +/- 10 mmHg* [symbol: see text] on day 3 and 293 +/- 36, 227 +/- 16,* and 299 +/- 19 mmHg on day 7, respectively (where * = significant vs. control group and [symbol: see text] = significant vs. transfusion group). In addition, IL-2 administration elevated the anastomotic hydroxyproline content, which was significantly decreased by transfusion alone, to the level found in the control group. The administration of IL-2 to control animals resulted unexpectedly in a significant reduction in anastomotic strength. CONCLUSIONS: Exogenous IL-2 reverses the negative effects of blood transfusions on anastomotic repair, but it impairs healing under normal conditions. PMID:8257231

Tadros, T; Wobbes, T; Hendriks, T

1993-01-01

417

Impact of Respiratory Viral Infections on Alpha Hemolytic Streptococci and Otopathogens in the Nasopharynx of Young Children  

PubMed Central

Background We studied nasopharyngeal (NP) colonization in a cohort of children to determine the impact of viral upper respiratory infections (URI) on non-pneumococcal alpha hemolytic streptococci (AHS) and otopathogen colonization in association with acute otitis media (AOM). Methods NP samples were collected routinely when children were aged 6, 9, 12, 15, 18, 24, and 30 months and during episodes of AOM. NP samples were prospectively obtained from 248 children during a 5-year time span; 1,018 during routine visits, 161 at the time of AOM and 59 at follow-up visits 3 weeks after AOM. Results The overall NP colonization rate of AHS was 50.8% during a non-AOM visit but declined to 38.3% during a viral URI with concurrent AOM (p=0.0006). Of 56 AOM visits with paired follow-ups, 6 (10.7%) had AHS in the NP at the time of viral URI and concurrent AOM whereas 29 (51.8%) had AHS at the follow-up (p<0.001). Lower NP colonization rates with AHS were associated with significant increases in Streptococcus pneumoniae carriage during non-AOM visits (p<0.001) and during viral URI and concurrent AOM visits (p=0.003). AHS NP colonization rates were not different when children had a viral URI without AOM versus when they were URI negative, but NP colonization with non-typeable Haemophilus influenzae rates increased (p<0.001) and Moraxella catarrhalis decreased (p<0.001) during viral URI. Conclusion Respiratory viral infections alter NP carriage rates of commensal AHS and otopathogens, including prior to AOM. PMID:23241988

Friedel, Victoria; Chang, Arthur; Wills, Jennifer; Vargas, Roberto; Xu, Qingfu; Pichichero, Michael

2012-01-01

418

Penicillin-induced immune hemolytic anemia. Occurrence of massive intravascular hemolysis.  

PubMed

A patient with penicillin-induced immune hemolytic anemia had massive intravascular hemolysis with hemoglobinemia and hemoglobinuria. Substantial amounts of complement components C3 and C4 were detected on the patient's red blood cells (RBCs), in addition to the usual IgG antibody to penicillin. The patient's serum demonstrated a high titer of antibody to penicillin (8,000), which did not cause hemolysis in vitro, but did cause complement fixation when incubated with normal serum. The presence of complement components on the patient's RBCs, and the finding that the serum fixed complement in vitro suggests that penicillin-antipenicillin immune complexes may have been present in the serum. We attribute the severity of the hemolysis to participation of the complement system in the hemolytic process and to the high titer of antibody to pencillin. PMID:1173853

Ries, C A; Rosenbaum, T J; Garratty, G; Petz, L D; Fudenberg, H H

1975-08-01

419

Detection of hemolytic bacteria from Palythoa caribaeorum (Cnidaria, Zoantharia) using a novel palytoxin-screening assay.  

PubMed

Palytoxin (PTX), one of the most potent and chemically complex marine toxins, is predominantly found in zoanthid corals and sporadically in dinoflagellates. Its biosynthesis and metabolic pathways are largely unknown. However, the widespread occurrence of the toxin in phylogenetically distinct marine organisms is consistent with its production by microorganisms and subsequent accumulation in the food chain. To investigate a possible microbial origin, bacteria from two zoanthid corals (Palythoa caribaeorum, Zoanthus pulchellus) and one sponge (Neofibularia nolitangere) were isolated. More than 250 bacteria were screened for hemolysis using a newly developed PTX-screening assay of which 7% showed PTX-like hemolytic activity. 16S rRNA gene sequencing revealed that these bacterial isolates belonged to strains of Bacillus cereus group (n = 11) as well as the genera Brevibacterium (n = 4) and Acinetobacter (n = 2). The results indicate the presence of Na+/K+-ATPase toxins and possibly PTX in hemolytic bacteria from P. caribaeorum. PMID:19504172

Seemann, Petra; Gernert, Christine; Schmitt, Susanne; Mebs, Dietrich; Hentschel, Ute

2009-11-01

420

Severe hemolytic anemia associated with the homozygous state for an unstable hemoglobin variant (Hb Bushwick).  

PubMed

We have investigated a 13-year-old girl from first cousin parents who presented with severe hemolytic anemia. Hematologic studies showed unstable hemoglobin (Hb) disease (chronic Heinz body anemia), and DNA analysis showed that the patient was homozygous for the previously reported abnormal Hb called Hb Bushwick (beta 74E18 gly-->val). Hb Bushwick is unstable in vitro and in vivo. In addition, using globin chain biosynthetic studies, we show that the beta (Bushwick) chains are unstable. Six members of the patient's family were heterozygous for Hb Bushwick and had a compensated hemolytic disorder. By contrast, the homozygous patient had chronic anemia caused by a combination of hemolysis and ineffective erythropoiesis that was subject to severe exacerbation concomitant with infection. Thus, although unstable Hb disease is correctly regarded as dominant, we clearly see a dosage effect in its expression, whereby the homozygous state is still compatible with life although the red blood cells contain nearly 100% unstable Hb. PMID:7655024

Srivastava, P; Kaeda, J S; Roper, D; Vulliamy, T J; Buckley, M; Luzzatto, L

1995-09-01

421

A Thermolabile Aldolase A Mutant Causes Fever-Induced Recurrent Rhabdomyolysis without Hemolytic Anemia  

PubMed Central

Aldolase A deficiency has been reported as a rare cause of hemolytic anemia occasionally associated with myopathy. We identified a deleterious homozygous mutation in the ALDOA gene in 3 siblings with episodic rhabdomyolysis without hemolytic anemia. Myoglobinuria was always triggered by febrile illnesses. We show that the underlying mechanism involves an exacerbation of aldolase A deficiency at high temperatures that affected myoblasts but not erythrocytes. The aldolase A deficiency was rescued by arginine supplementation in vitro but not by glycerol, betaine or benzylhydantoin, three other known chaperones, suggesting that arginine-mediated rescue operated by a mechanism other than protein chaperoning. Lipid droplets accumulated in patient myoblasts relative to control and this was increased by cytokines, and reduced by dexamethasone. Our results expand the clinical spectrum of aldolase A deficiency to isolated temperature-dependent rhabdomyolysis, and suggest that thermolability may be tissue specific. We also propose a treatment for this severe disease. PMID:25392908

Mamoune, Asmaa; Bahuau, Michel; Hamel, Yamina; Serre, Valérie; Pelosi, Michele; Habarou, Florence; Nguyen Morel, Marie-Ange; Boisson, Bertrand; Vergnaud, Sabrina; Viou, Mai Thao; Nonnenmacher, Luc; Piraud, Monique; Nusbaum, Patrick; Vamecq, Joseph; Romero, Norma; Ottolenghi, Chris; Casanova, Jean-Laurent; de Lonlay, Pascale

2014-01-01

422

Exploiting the Nephrotoxic Effects of Venom from the Sea Anemone, Phyllodiscus semoni, to Create a Hemolytic Uremic Syndrome Model in the Rat  

PubMed Central

In the natural world, there are many creatures with venoms that have interesting and varied activities. Although the sea anemone, a member of the phylum Coelenterata, has venom that it uses to capture and immobilise small fishes and shrimp and for protection from predators, most sea anemones are harmless to man. However, a few species are highly toxic; some have venoms containing neurotoxins, recently suggested as potential immune-modulators for therapeutic application in immune diseases. Phyllodiscus semoni is a highly toxic sea anemone; the venom has multiple effects, including lethality, hemolysis and renal injuries. We previously reported that venom extracted from Phyllodiscus semoni induced acute glomerular endothelial injuries in rats resembling hemolytic uremic syndrome (HUS), accompanied with complement dysregulation in glomeruli and suggested that the model might be useful for analyses of pathology and development of therapeutic approaches in HUS. In this mini-review, we describe in detail the venom-induced acute renal injuries in rat and summarize how the venom of Phyllodiscus semoni could have potential as a tool for analyses of complement activation and therapeutic interventions in HUS. PMID:22851928

Mizuno, Masashi; Ito, Yasuhiko; Morgan, B. Paul

2012-01-01

423

Hemolytic staining of the endocardium of the left heart chambers: a new sign for autopsy diagnosis of freshwater drowning.  

PubMed

Despite the availability of modern imaging and molecular tools, traditional autopsy, and laboratory findings remain the gold standard for the diagnosis of drowning. This article presents two cases of freshwater drowning in which hemolytic staining of the endocardium of the left heart chambers was observed at autopsy. One case was a suicidal drowning of an 84-year-old man, and the other case was an accidental drowning of an 86-year-old woman. In both cases, there was marked hemolytic staining of the endocardium of the left atrium and ventricle. The endocardium of the right heart chambers was clear and transparent in appearance. Hemolytic intimal staining of the aortic root was observed in one case. Gettler's test was positive in both cases. Hemolytic discoloration of the endocardium of the left heart chambers after freshwater drowning is analogous to hemolytic staining of the aortic root. Both staining patterns result from the hypo-osmolar hemolysis that occurs in the left heart chambers and systemic circulation after hypotonic fluid passes across the alveolocapillary membrane. Hemolytic discoloration of the endocardium of the left heart chambers at autopsy may support a diagnosis of freshwater drowning. PMID:25326681

Zátopková, Lenka; Hejna, Petr; Janík, Martin