MedWorm: Transfusion Therapy

Genetic modifiers of beta-thalassemia and clinical severity asassessed by age at first transfusion.

Haematologica — Sun, 22 Jan 2012 05:00:00 +0100

Conclusions. This detailed analysis clarifies the impact of genetic modifiers on clinical severity of the disease measured by time to first transfusion by determining their relative contributions in a homogeneous cohort of beta0-thalassemia patients. It may also support clinical decisions regarding the beginning of transfusion therapy in patients with beta-thalassemia. PMID: 22271886 [PubMed - as supplied by publisher] (Source: Haematologica)

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Prospects for primary stroke prevention in children with sickle cell anaemia

British Journal of Haematology — Mon, 09 Jan 2012 05:00:00 +0100

SummaryThis review will focus on the strengths and limitations associated with the current standard of care for primary prevention of ischaemic strokes in children with sickle cell anaemia (SCA) ‐ transcranial Doppler ultrasound (TCD) screening followed by regular blood transfusion therapy when TCD measurement is above a threshold defined by a randomized clinical trial (RCT). The theoretical basis for potential alternative strategies for primary prevention of neurological injury in SCA is also discussed. These strategies will include, but will not be limited to: immunizations to prevent bacterial infections, particularly in low income countries; management of elevated blood pressure; and targeted strategies to increase baseline haemoglobin levels with therapies such as hyroxycarbamide or...

Sleep-Disordered Breathing and Transcranial Dopplers in Sickle Cell Disease [Original Article]

Archives of Otolaryngology — Mon, 19 Dec 2011 05:00:00 +0100

Conclusion There is a high prevalence of snoring and sleep-disordered breathing among children with sickle cell disease, but our results do not support an association with cerebrovascular risk. (Source: Archives of Otolaryngology)

Transfusion therapy: clinical principles and practice, third ed.

Annals of Clinical and Laboratory Science — Fri, 18 Nov 2011 22:18:03 +0100

Authors: Roseff SD PMID: 22075517 [PubMed - in process] (Source: Annals of Clinical and Laboratory Science)

Algorithmic and consultative integration of transfusion medicine and coagulation: a personalized medicine approach with reduced blood component utilization.

Annals of Clinical and Laboratory Science — Fri, 18 Nov 2011 22:18:03 +0100

Conclusion We report on the successful development of a model - based on the algorithmic and consultative integration of transfusion medicine and coagulation - that customizes blood component, derivative, and recombinant therapies appropriate for an individual patient's need, resulting in targeted transfusion therapy and associated with reduced blood component utilization. PMID: 22075502 [PubMed - in process] (Source: Annals of Clinical and Laboratory Science)

Evaluation of haemoglobin, haematocrit, haemolysis, residual protein content and leucocytes in 345 red blood cell concentrates used for the treatment of patients with β-thalassaemia.

Blood Transfusion — Wed, 16 Nov 2011 05:00:00 +0100

CONCLUSIONS: The preparation procedures had been carried out satisfactorily; nevertheless, transfusion therapy with some "low dose" normal units could be less effective and might, therefore, result in greater transfusion requirements in patients receiving such units. PMID: 22153690 [PubMed - as supplied by publisher] (Source: Blood Transfusion)

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Frequencies of blood types A, B, and AB in non‐pedigree domestic cats in Beijing

Veterinary Clinical Pathology — Thu, 03 Nov 2011 04:00:00 +0100

ConclusionsThe frequency of blood type B in the Beijing area was relatively high and similar to that reported for other Asian countries and Australia. Blood‐typing is recommended to match donors and recipients before transfusion therapy and planned matings to avoid hemolytic transfusion and neonatal isoerythrolysis reactions, respectively, due to blood‐type incompatibility. (Source: Veterinary Clinical Pathology)

Management of major trauma haemorrhage: treatment priorities and controversies

British Journal of Haematology — Fri, 21 Oct 2011 04:00:00 +0100

SummaryThe severely injured trauma patient often arrives in the emergency department bleeding, coagulopathic and in need of a blood transfusion. The diagnosis and management of these patients has vastly improved with a better understanding of acute traumatic coagulopathy (ATC). In the emergency setting, traditional laboratory coagulation screens are of limited use in the diagnosis and management of life‐threatening bleeding. Whole blood assays, such as thrombelastography (TEG) and rotational thrombelastometry (ROTEM) provide a rapid evaluation of clot formation, strength and lysis. Rapid diagnosis of ATC and aggressive haemostatic transfusion strategies utilizing early high doses of plasma are associated with improved outcomes in trauma. At present there is no accurate guide for transfus...

Transfusional iron overload in children with sickle cell anemia on chronic transfusion therapy for secondary stroke prevention

American Journal of Hematology — Thu, 20 Oct 2011 04:00:00 +0100

This study underscores the need for better monitoring of iron burden with timely treatment adjustments in chronically transfused children with SCA. Am. J. Hematol., 2011. © 2011 Wiley‐Liss, Inc. (Source: American Journal of Hematology)

Problems with implementing a standardised transcranial Doppler screening programme: impact of instrumentation variation on STOP classification

Pediatric Radiology — Fri, 14 Oct 2011 10:39:53 +0100

Conclusion The current approach for applying STOP thresholds to imaging TCD data may not be required. Centres need to validate their imaging TCD practice to avoid inappropriate selection of patients for transfusion therapy. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s00247-011-2263-4Authors Soundrie T. Padayachee, Ultrasonic Angiology Department, Borough Wing, Guy’s Hospital, Guy’s & St Thomas’ (GSTT) NHS Foundation Trust, St Thomas Street, London, SE1 9RT UKNicholas Thomas, Ultrasonic Angiology Department, Borough Wing, Guy’s Hospital, Guy’s & St Thomas’ (GSTT) NHS Foundation Trust, St Thomas Street, London, SE1 9RT UKAndrew J. Arnold, Ultrasonic Angiology Department, Borough Wing, Guy’s Hospital, Guy’s & St Thomas’ (...

How I manage neonatal thrombocytopenia

British Journal of Haematology — Thu, 29 Sep 2011 09:21:35 +0100

SummaryAlthough neonatal thrombocytopenia (platelet count < 150 × 109/l) is a common finding in hospital practice, a careful clinical history and examination of the blood film is often sufficient to establish the diagnosis and guide management without the need for further investigations. In preterm neonates, early‐onset thrombocytopenia (<72 h) is usually secondary to antenatal causes, has a characteristic pattern and resolves without complications or the need for treatment. By contrast, late‐onset thrombocytopenia in preterm neonates (>72 h) is nearly always due to post‐natally acquired bacterial infection and/or necrotizing enterocolitis, which rapidly leads to severe thrombocytopenia (platelet count < 50 × 109/l). Thrombocytopenia is much less common in...

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How I treat thalassemia

Blood — Thu, 29 Sep 2011 04:00:00 +0100

The purpose of this article is to set forth our approach to diagnosing and managing the thalassemias, including β-thalassemia intermedia and β-thalassemia major. The article begins by briefly describing recent advances in our understanding of the pathophysiology of thalassemia. In the discussion on diagnosing the condition, we cover the development of improved diagnostic tools, including the use of very small fetal DNA samples to detect single point mutations with great reliability for prenatal diagnosis of homozygous thalassemia. In our description of treatment strategies, we focus on how we deal with clinical manifestations and long-term complications using the most effective current treatment methods for β-thalassemia. The discussion of disease management focuses on our u...

Oxidative stress and antioxidant capacity in sickle cell anaemia patients receiving different treatments and medications for different periods of time

Annals of Hematology — Tue, 27 Sep 2011 06:18:17 +0100

Abstract To evaluate, in a longitudinal study, the profile of lipid peroxidation and antioxidant capacity markers in sickle cell anaemia patients receiving different treatments and medication over different time periods. The three groups were: patients undergoing transfusion therapy and receiving iron chelator deferasirox (DFX group, n = 20); patients receiving deferasirox and hydroxyurea (DFX + HU group, n = 10), and patients receiving only folic acid (FA group, n = 15). Thiobarbituric acid-reactive substance (TBARS) assays and trolox-equivalent antioxidant capacity (TEAC) assays were evaluated during two different periods of analysis, T0 and T1 (after ~388 days). Higher FA group TBARS values were observed compared with the DFX + HU group (p = 0.016) at...

Perioperative course of FXIII in children undergoing major surgery

Pediatric Anesthesia — Tue, 20 Sep 2011 04:00:00 +0100

Conclusions: Coagulation factor XIII decreased early during major surgery owing to hemodilution. Overall intraoperative FXIII levels remain low despite of transfusion of fresh frozen plasma. (Source: Pediatric Anesthesia)

Perioperative course of FXIII in children undergoing major surgery.

Paediatric Anaesthesia — Tue, 20 Sep 2011 04:00:00 +0100

[Preoperative anemia in orthopedic surgery : Clinical impact, diagnostics and treatment.]

Der Orthopade — Sat, 17 Sep 2011 04:00:00 +0100

Authors: Kendoff D, Tomeczkowski J, Fritze J, Gombotz H, von Heymann C Abstract In a national audit of elective orthopedic surgery conducted in the US, 30% of patients were found to have hemoglobin (Hgb) levels < 13 g/dl at preadmission testing. Preoperative anemia has been associated with increased mortality and morbidity after surgery, increased allogeneic blood transfusion therapy and increased rates of postoperative infection leading to a longer length of hospital stay. Because of the risks associated with allogeneic blood transfusions according to German law patients have to be offered the option of autologous transfusion if the risk associated with allogeneic blood transfusion is > 10%. However, one of these measures, the autologous blood donation, can exaggerate a...

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Regular long-term red blood cell transfusions for managing chronic chest complications in sickle cell disease.

Cochrane Database of Systematic Reviews — Fri, 16 Sep 2011 09:32:03 +0100

CONCLUSIONS: There is a need for randomized controlled trials looking at the role of long-term transfusion therapy in pulmonary hypertension and chronic sickle lung disease. Due to the chronic nature of the conditions, such trials should aim to use a combination of objective and subjective measures to assess participants during an extended 'steady state' baseline, and after the intervention. PMID: 21901721 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

Immune regulation in chronically transfused allo‐antibody responder and nonresponder patients with sickle cell disease and β‐thalassemia major

American Journal of Hematology — Thu, 11 Aug 2011 04:00:00 +0100

AbstractRed blood cell alloimmunization is a major complication of transfusion therapy. Host immune markers that can predict antibody responders remain poorly described. As regulatory T cells (Tregs) play a role in alloimmunization in mouse models, we analyzed the Treg compartment of a cohort of chronically transfused patients with sickle cell disease (SCD, n = 22) and β‐thalassemia major (n = 8) with and without alloantibodies. We found reduced Treg activity in alloantibody responders compared with nonresponders as seen in mice. Higher circulating anti‐inflammatory IL‐10 levels and lower IFN‐γ levels were detected in non‐alloimmunized SCD patients. Stimulated sorted CD4+ cells from half of the alloimmunized patients had increased frequency of IL‐4 expression compared with no...

Immune regulation in chronically transfused allo‐antibody responder and non‐responder patients with sickle cell disease and β‐thalassemia major

American Journal of Hematology — Wed, 10 Aug 2011 23:00:00 +0100

Splanchnic-cerebral oxygenation ratio as a marker of preterm infant blood transfusion needs.

Transfusion — Sun, 24 Jul 2011 23:00:00 +0100

CONCLUSION: SCOR may help identify premature infants who will benefit from RBC transfusion. PMID: 21790634 [PubMed - as supplied by publisher] (Source: Transfusion)

Stroke recurrence in children with sickle cell disease treated with hydroxyurea following first clinical stroke

American Journal of Hematology — Mon, 18 Jul 2011 23:00:00 +0100

AbstractChronic transfusion therapy is the treatment of choice for preventing stroke recurrence in children with sickle cell disease. The majority of children affected by this devastating complication live in the developing world where access to regular blood transfusions may be impractical. Since 2000, in the absence of regular blood supplies, all children at the Sickle Cell Unit who had experienced a first clinical stroke were offered Hydroxyurea (HU) as the only intervention to prevent stroke recurrence. Forty‐four children were identified as having experienced a first clinical stroke between January 1st 2000 and September 30th 2009; one died at that presentation. Forty‐three children were therefore followed for 111 person‐years, of whom 10 (23.3%) agreed to start HU. Only one chi...

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GI Bleeding, Colon Varicosities, and Visceral Enlargement as a Manifestation of Klippel–Trenaunay Syndrome

Clinical Gastroenterology and Hepatology — Fri, 01 Jul 2011 04:00:00 +0100

A 27-year-old white male presented with fatigue, pallor, and black stools for 4 months. Past medical history revealed varicosities of right lower extremity since childhood, urinary bladder hemangioma, and hemorrhoids. Physical examination was mostly benign except for severe pallor and bluish-purple hemangiomas along with varicose veins of right lower limb () and right gluteal region (). The stool test for occult blood was positive. Hemoglobin was 2.8 g/dL, and hematocrit was 10.1%. Following transfusion therapy, he underwent upper gastrointestinal and small bowel follow-through. No focal mucosal abnormalities were seen in the stomach or duodenum. A plain abdominal X-ray was normal except for multiple round calcifications in the lower abdomen (). Colonoscopy revealed large dilated tortuous ...

Effect of chronic transfusion therapy on progression of neurovascular pathology in pediatric patients with sickle cell anemia.

Blood Cells, Molecules and Diseases — Thu, 30 Jun 2011 23:00:00 +0100

CONCLUSION: We show that children with CVA experience progression of cerebral vasculopathy despite CBT. In contrast, CBT for abnormal TCD confers protection against the development and/or progression of cerebral vasculopathy. This effect appears to be real given our large cohort of patients with longer follow up as compared to previous studies. PMID: 21724428 [PubMed - as supplied by publisher] (Source: Blood Cells, Molecules and Diseases)

Pretreatment with phosphatase and tensin homolog deleted on chromosome 10 (PTEN) inhibitor SF1670 augments the efficacy of granulocyte transfusion in a clinically relevant mouse model

Blood — Wed, 15 Jun 2011 23:00:00 +0100

The clinical outcome of granulocyte transfusion therapy is often hampered by short ex vivo shelf life, inefficiency of recruitment to sites of inflammation, and poor pathogen-killing capability of transplanted neutrophils. Here, using a recently developed mouse granulocyte transfusion model, we revealed that the efficacy of granulocyte transfusion can be significantly increased by elevating intracellular phosphatidylinositol (3,4,5)-trisphosphate signaling with a specific phosphatase and tensin homolog deleted on chromosome 10 (PTEN) inhibitor SF1670. Neutrophils treated with SF1670 were much sensitive to chemoattractant stimulation. Neutrophil functions, such as phagocytosis, oxidative burst, polarization, and chemotaxis, were augmented after SF1670 treatment. The recruitment of SF1670-pr...

Clinical observations on intensive immunosuppressive therapy combined with umbilical cord blood support for the treatment of severe aplastic anemia

Journal of Hematology and Oncology — Thu, 09 Jun 2011 23:00:00 +0100

Conclusion: Enhanced, intensive, immuno-suppressive therapy with umbilical cord blood support may be an effective option for SAA therapy. (Source: Journal of Hematology and Oncology)

Platelet gene therapy improves hemostatic function for integrin {alpha}IIb{beta}3-deficient dogs [Medical Sciences]

Proceedings of the National Academy of Sciences — Mon, 06 Jun 2011 23:00:00 +0100

Activated blood platelets mediate the primary response to vascular injury. Although molecular abnormalities of platelet proteins occur infrequently, taken collectively, an inherited platelet defect accounts for a bleeding diathesis in ≈1:20,000 individuals. One rare example of a platelet disorder, Glanzmann thrombasthenia (GT), is characterized by life-long morbidity and mortality due to molecular abnormalities in a major platelet adhesion receptor, integrin αIIbβ3. Transfusion therapy is frequently inadequate because patients often generate antibodies to αIIbβ3, leading to immune-mediated destruction of healthy platelets. In the most severe cases allogeneic bone marrow transplantation has been used, yet because of the risk of the procedure it has been limited to few patients. Thus, ...

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Non-invasive measurement of hemoglobin during cesarean hysterectomy: a case series

International Journal of Obstetric Anesthesia — Sun, 05 Jun 2011 23:00:00 +0100

We present a review of five patients with suspected abnormal placentation who received SpHb monitoring during cesarean hysterectomy at our institution. We discuss the potential clinical utility of non-invasive hemoglobin monitoring for pregnant patients at high risk of obstetric hemorrhage, and the potential role of SpHb in guiding transfusion therapy. (Source: International Journal of Obstetric Anesthesia)

Whole blood transfusion in small animals: indications and effects.

An Acad Bras Cienc — Tue, 31 May 2011 23:00:00 +0100

Authors: Godinho-Cunha LF, Ferreira RM, Silvestre-Ferreira AC Transfusion therapy is a major resource that can improve the patient's capability to overcome the underlying disease. However, the effects of whole blood infusion, and how they affect the patient's outcome, are not yet clear. For this study, a protocol was developed in order to monitor a group of 15 animals (9 dogs, 6 cats) that received a total of 19 transfusions; 3 animals received more than one transfusion each. The most common indications for blood transfusion included acute blood loss (47%), coagulopathy (33%) and other anaemias (20%). The mean pre-transfusion packed cell volume (PCV) of animals with acute blood loss (18%) was higher than in the group of coagulopathy (15%) or other anaemias (15%). The survival rates at ...

Quality of life, physical function and mri t2* in elderly low risk mds patients treated to a haemoglobin level of ≥120 g/l with darbepoetin alfa +/‐ filgrastim or erythrocyte transfusions

European Journal of Haematology — Sun, 29 May 2011 23:00:00 +0100

Conclusions: In elderly anemic MDS patients an increment in haemoglobin is associated with improved QoL, whether induced by growth factor treatment or transfusion therapy. (Source: European Journal of Haematology)

Quality of life, physical function and MRI T2* in elderly low‐risk MDS patients treated to a haemoglobin level of ≥120 g/L with darbepoetin alfa ± filgrastim or erythrocyte transfusions

European Journal of Haematology — Sun, 29 May 2011 23:00:00 +0100

Conclusions: In elderly anaemic MDS patients, an increment in haemoglobin is associated with improved QoL, whether induced by growth factor treatment or transfusion therapy. (Source: European Journal of Haematology)

Transfusion Therapy: Clinical Principles and Practice

Vox Sanguinis — Tue, 24 May 2011 17:37:18 +0100

(Source: Vox Sanguinis)

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Micropolygyria in an infant born to a patient with severe anorexia nervosa: A case report

International Journal of Eating Disorders — Wed, 13 Apr 2011 23:00:00 +0100

We report the case of an anorexia nervosa (AN) patient with extremely low body weight who became pregnant following ovulation induction and subsequently delivered an infant with micropolygyria. To the best of our knowledge, no previous report has described live birth for a patient with such low body weight. The patient underwent hMG‐hCG therapy for ovulation induction. Despite becoming pregnant, weight loss continued with extreme anemia occurring during the pregnancy. However, blood transfusion therapy was used for successful treatment. Despite the therapeutic and protective measures instituted, the child was born with micropolygyria. Pregnancy in an AN patient with extremely low body weight needs therapeutic intervention during early pregnancy with aggressive precautionary measures, par...

Hemotherapeutic practice in Brazilian nursing: an integrative review

Acta Paulista de Enfermagem — Tue, 22 Mar 2011 20:19:20 +0100

CONCLUSION: There was a small volume of scientific output, which can be justified because this is a relatively new specialty within Brazilian nursingOBJETIVO: Analizar el conocimiento producido por enfermeros respecto a la hemoterápica. MÉTODOS: Se realizó una revisión integrativa de la literatura en las bases de datos LILACS, SciELO y MEDLINE en el período de 2005 a 2009. La muestra contó con nueve estudios que abordan las actividades de enfermería con donadores y receptores de sangre. RESULTADOS: Los resultados evidencian que los enfermeros ejercen un papel fundamental en la seguridad de la transfusión, necesitando de una formación adecuada para asumir esta responsabilidad. CONCLUSIÓN: Se verificó una reducida producción científica, hecho que puede ser justificado por ser é...

Immature erythroblasts with extensive ex vivo self-renewal capacity emerge from the early mammalian fetus

Blood — Thu, 03 Mar 2011 00:00:00 +0100

In the hematopoietic hierarchy, only stem cells are thought to be capable of long-term self-renewal. Erythroid progenitors derived from fetal or adult mammalian hematopoietic tissues are capable of short-term, or restricted (102- to 105-fold), ex vivo expansion in the presence of erythropoietin, stem cell factor, and dexamethasone. Here, we report that primary erythroid precursors derived from early mouse embryos are capable of extensive (106- to 1060-fold) ex vivo proliferation. These cells morphologically, immunophenotypically, and functionally resemble proerythroblasts, maintaining both cytokine dependence and the potential, despite prolonged culture, to generate enucleated erythrocytes after 3-4 maturational cell divisions. This capacity for extensive erythroblast self-renewal is tempo...

Origins of Platelet Transfusion Therapy

Transfusion Medicine Reviews — Thu, 03 Mar 2011 00:00:00 +0100

In 1955, animal studies suggested that thrombocytopenia was not the initiating cause of hemorrhage. Coagulation studies in vitro revealed the correction of coagulation by fresh platelets. Platelets, freshly collected with use of nonwettable surfaces, corrected thrombocytopenia, controlled associated hemorrhage, and prevented death from bleeding. Thus, in vitro and animal studies can be misleading (bench to bedside). Careful clinical observations, elaborated by in vitro studies, which create hypotheses testable in the clinic, lead to therapeutic advances (bedside to bench and back). Platelet replacement for thrombocytopenia prevents the hemorrhagic diathesis and has been universally practiced for over 50 years. (Source: Transfusion Medicine Reviews)

The impact of the 2009 H1N1 influenza pandemic on pediatric patients with sickle cell disease

Pediatric Blood and Cancer — Fri, 25 Feb 2011 00:00:00 +0100

ConclusionsOur results indicate that that in general the impact of the H1N1 influenza pandemic on patients with SCD was mild but that past clinical history correlated with the severity of illness. Additionally, effective hydroxyurea therapy and chronic transfusion therapy appeared to be protective against the incidence of ACS. Our results suggest guidelines for the management of patients with SCD during future influenza pandemics as well as during seasonal influenza epidemics. Pediatr Blood Cancer © 2011 Wiley‐Liss, Inc. (Source: Pediatric Blood and Cancer)

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Renal dysfunction in patients with thalassaemia

British Journal of Haematology — Tue, 22 Feb 2011 17:33:17 +0100

SummaryLittle is known about the effects of thalassaemia on the kidney. Characterization of underlying renal function abnormalities in thalassaemia is timely because the newer iron chelator, deferasirox, can be nephrotoxic. We aimed to determine the prevalence and correlates of renal abnormalities in thalassaemia patients, treated before deferasirox was widely available, using 24‐h collections of urine. We calculated creatinine clearance and urine calcium‐to‐creatinine ratio and measured urinary β2‐microglobulin, albumin, and protein. We used multivariate modelling to identify clinical, therapeutic, and laboratory predictors of renal dysfunction. One‐third of thalassaemia patients who were not regularly transfused had abnormally high creatinine clearance. Regular transfusions we...

Protective role of hemoglobin and fetal hemoglobin in early kidney disease for children with sickle cell anemia

American Journal of Hematology — Tue, 08 Feb 2011 00:00:00 +0100

AbstractPatients with sickle cell anemia are at risk for organ damage including kidney disease. Microalbuminuria may be an early marker of disease progression. This retrospective review analyzed laboratory and clinical findings in children with sickle cell anemia according to the presence or absence of microalbuminuria during well clinic sickle cell visits. Results were analyzed in sum as well as by therapeutic intervention (not on therapy, hydroxyurea therapy, or chronic transfusion therapy). Thirty two of 144 (22%) children had microalbuminuria, including 20 of 82 (24%) children not on a therapeutic intervention (chronic transfusion or hydroxyurea). In children not on therapy, low hemoglobin, low fetal hemoglobin and high LDH were associated with microalbuminuria. Frequency of positive s...

Long‐term results using hydroxyurea/phlebotomy for reducing secondary stroke risk in children with sickle cell anemia and iron overload

American Journal of Hematology — Thu, 27 Jan 2011 00:00:00 +0100

AbstractChildren with sickle cell anemia (SCA) and a primary overt stroke are at high risk of recurrent (secondary) stroke. Chronic transfusion therapy dramatically reduces but does not eliminate this high risk, and inevitably results in transfusion‐related hemosiderosis. We previously reported the use of hydroxyurea/phlebotomy as an alternative to transfusions to reduce the risk of secondary stroke and improve management of iron overload in 35 children with SCA. To report long‐term results, we retrospectively reviewed clinical and laboratory data through October 2008. With a median of 5.6 years and total of 219 patient‐years of follow‐up, 10 of 35 patients (29%) had recurrent stroke after switching to hydroxyurea; 7 were previously reported and 3 new strokes occurred during extend...

Optimal management of β thalassaemia intermedia

British Journal of Haematology — Thu, 20 Jan 2011 00:00:00 +0100

SummaryOur understanding of the molecular and pathophysiological mechanisms underlying the disease process in patients with β thalassaemia intermedia (TI) has substantially increased over the past decade. The hallmark of disease process in patients with TI includes ineffective erythropoiesis, chronic haemolytic anaemia, and iron overload. There are a number of options currently available for managing patients with TI including splenectomy, transfusion therapy, iron chelation therapy, modulation of fetal haemoglobin production, and several other agents targeting specific clinical complications. Limited studies assessed the efficacy and safety of these modalities; hence, there are currently no clear guidelines for managing patients with TI. Until solid evidence‐based guidelines are availa...

Silent cerebral infarcts occur despite regular blood transfusion therapy after first strokes in children with sickle cell disease

Blood — Thu, 20 Jan 2011 00:00:00 +0100

Children with sickle cell disease (SCD) and strokes receive blood transfusion therapy for secondary stroke prevention; despite this, approximately 20% experience second overt strokes. Given this rate of second overt strokes and the clinical significance of silent cerebral infarcts, we tested the hypothesis that silent cerebral infarcts occur among children with SCD being transfused for secondary stroke prevention. A prospective cohort enrolled children with SCD and overt strokes at 7 academic centers. Magnetic resonance imaging and magnetic resonance angiography of the brain were scheduled approximately every 1 to 2 years; studies were reviewed by a panel of neuroradiologists. Eligibility criteria included regularly scheduled blood transfusion therapy. Forty children were included; mean pr...

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Hemostatic resuscitation for acute traumatic coagulopathy

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine — Mon, 10 Jan 2011 00:00:00 +0100

Trauma resuscitation paradigms have changed considerably over the last twenty years. Originally, the goal was to normalize a blood pressure as quickly as possible. Large volume crystalloid resuscitation was used to accomplish this. Standard therapy was that any patient with suspected bleeding received a two liter crystalloid bolus as initial therapy. It was often repeated and blood transfusion therapy was used relatively late. Fresh frozen plasma and platelets were also used relatively late, often after patients had received ten units of red cells. Dilutional anemia was relatively common. Patients with large volume blood loss often died from what was termed, "the bloody vicious cycle," of hypothermia, acidosis and coagulopathy. (Source: Scandinavian Journal of Trauma, Resuscitation and Eme...

Sickle cell nephropathy: challenging the conventional wisdom

Pediatric Nephrology — Tue, 04 Jan 2011 07:39:23 +0100

Abstract This review explores the current model of sickle cell nephropathy and the limitations of the model. Renal abnormalities are common complications of sickle cell disease (SCD). Beginning in childhood, patients with SCD develop a urinary concentrating defect resulting in polyuria and a predisposition to nocturnal enuresis and dehydration. The current model of sickle cell nephropathy suggests that destruction of the renal medulla induces production of renal vasodilating substances that feedback to the glomerulus causing hyperfiltration. Hyperfiltration leads to glomerulosclerosis and proteinuria, with eventual reduction in kidney function. The crucial steps of vasodilating substance production and hyperfiltration in children with SCD have not been proven. Treatment of...

[Innovative education: introduction of clinical simulation-based training at the Faculty of Health Sciences, Semmelweis University, Hungary.]

Orvosi Hetilap — Sat, 01 Jan 2011 00:00:00 +0100

Authors: Csóka M, Deutsch T In Hungary, Faculty of Health Sciences at Semmelweis University was the first institution to introduce patient simulation-based practical training of non-physician professionals. Before introducing this novel educational methodology, students could only practice particular examinations and interventions on demonstration tools. Using the simulator they can also follow and analyze the effects of the interventions that have been made. The high fidelity, adult Human Patients Emergency Care Simulator (HPS-ECS, Medical Education Technologies Incorporation, Sarasota, Florida, USA) is particularly suitable for acquiring skills related to the management of various emergency situations. The 180 cm and 34 kg mannequin which can operate in lying and sitting positions h...

Transfusion therapy in the peri-operative period.

Blood Transfusion — Sat, 01 Jan 2011 00:00:00 +0100

Authors: Aprili G, Velati C, Liumbruno GM PMID: 21235850 [PubMed - in process] (Source: Blood Transfusion)

Effect of transfusion therapy on transcranial doppler ultrasonography velocities in children with sickle cell disease

Pediatric Blood and Cancer — Thu, 23 Dec 2010 00:00:00 +0100

ConclusionYounger children with higher pre‐transfusion hemoglobin levels and lower abnormal TCD velocities are most likely to have rapid normalization of TCD on transfusions. Long‐term follow‐up of children with persistently abnormal exams or worsening velocities on transfusion is needed to determine if these children are at higher risk of stroke. Pediatr Blood Cancer © 2010 Wiley‐Liss, Inc. (Source: Pediatric Blood and Cancer)

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Transfusion Therapy: Clinical Principles and Practice

Karger Publishers — Fri, 10 Dec 2010 15:37:22 +0100

ISBN: 978-3-8055-9696-1 (Source: Karger Publishers)

Two Studies Provide Insight Into Stroke Risk And Prevention In Young Sickle Cell Anemia Patients

Health News from Medical News Today — Tue, 07 Dec 2010 09:00:00 +0100

Monthly blood transfusions combined with daily medication to remove the resulting excess iron remains the best approach for reducing the risk of recurrent strokes in young patients with sickle cell anemia, according to a preliminary analysis of a multicenter trial that includes St. Jude Children's Research Hospital. The study compared the efficacy of two treatments for the potentially life-threatening problem of iron overload caused by chronic transfusion therapy. The transfusions are used to guard against additional strokes in young sickle cell anemia patients... (Source: Health News from Medical News Today)

Blood product ratio in acute traumatic coagulopathy - effect on mortality in a Scandinavian level 1 trauma centre.

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine — Tue, 07 Dec 2010 00:00:00 +0100

Background: Trauma is the leading cause of loss of life worldwide. In the most seriously injured patients, coagulopathy is present on admission. Therefore, transfusion strategies to increase the ratio of plasma (FFP) and platelets (PLT) to red blood cells (RBC), simulating whole blood, have been introduced. Whether these changes influence mortality is unknown. The aim was to investigate the potential effect of increased FFP and PLT to RBC on mortality in trauma patients. Methods: In a retrospective before and after study, all trauma patients admitted to a level-one Trauma Centre, receiving blood transfusion, in 2001-3 (n=97) and 2005-7 (n=156), were included. In 2001-3, FFP and PLT were administered in accordance with the ASA guidelines whereas in 2005-7, Hemostatic Control Resuscitation (...

Circulatory Risk in the Transfusion of Red Blood Cells With Impaired Flow Properties Induced by Storage

Transfusion Medicine Reviews — Mon, 06 Dec 2010 16:29:34 +0100

Red blood cell (RBC) flow properties (FPs), specifically their deformability, aggregability, and adherence to endothelial cells, play major roles in blood circulation. Their impairment, as occurs under various blood banking conditions, may contribute to circulatory impairment in recipients. Recent studies and meta-analyses show that the transfusion of stored RBCs (stRBCs) may be less beneficial than that of freshly collected units, which may thus adversely affect recipients, especially their circulatory function, thereby pointing to a potential role in the alteration of FPs of stRBCs. In this review, we present an up-to-date summary of the studies on the FP of stRBCs, clearly showing that they may be impaired at an early stage of storage, which may contribute considerably to transfusion-as...

Reversible Fanconi syndrome in a pediatric patient on deferasirox

Pediatric Blood and Cancer — Mon, 06 Dec 2010 00:00:00 +0100

We report one pediatric patient with reversible Fanconi syndrome associated with long‐term deferasirox therapy and one patient with mild proximal tubular dysfunction. Kidney and proximal tubular function should be periodically monitored in patients receiving deferasirox throughout their course of therapy. Pediatr Blood Cancer © 2010 Wiley‐Liss, Inc. (Source: Pediatric Blood and Cancer)

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Studies investigate pediatric sickle cell disease and potential breakthrough in controlling malaria

EurekAlert! - Medicine and Health — Sat, 04 Dec 2010 05:00:00 +0100

(American Society of Hematology) Research will be presented today at the 52nd Annual Meeting of the American Society of Hematology that highlights studies on transfusion therapy alternatives and genetic predictors for sickle cell-related stroke in children, the use of hydroxyurea therapy to reduce mortality in pediatric SCD patients, and a potential breakthrough that may inhibit the transmission of malaria causing viruses. (Source: EurekAlert! - Medicine and Health)

Goal-directed hemostatic resuscitation for massively bleeding patients: The Copenhagen concept

Transfusion and Apheresis Science — Sat, 27 Nov 2010 05:30:09 +0100

Conclusion: The initiative from the blood bank, i.e., transfusion packages for patients with uncontrollable bleeding and based on the thromboelastogram when hemodynamic control is established, has improved the transfusion practice and survival in massively transfused patients at our hospital. (Source: Transfusion and Apheresis Science)

Manual erythroexchange for chronic transfusion therapy in patients with sickle cell syndromes unresponsive to hydroxyurea: A long‐term follow‐up

American Journal of Hematology — Wed, 24 Nov 2010 05:15:22 +0100

(Source: American Journal of Hematology)

Plasma Glial Fibrillary Acidic Protein Levels in a Child with Sickle Cell Disease and Stroke.

Acta Haematologica — Wed, 24 Nov 2010 00:00:00 +0100

Authors: Savage WJ, Everett AD, Casella JF A 12-year-old boy with HbSS sickle cell disease (SCD) was admitted with an acute febrile illness and developed overt stroke 3 days later. Plasma glial fibrillary acidic protein levels were elevated, as compared to pediatric controls, 32 h prior to the clinical diagnosis of stroke, peaked immediately prior to the exchange transfusion, and remained elevated 1 year later despite chronic transfusion therapy. Stroke in SCD can occur in the setting of acute illness, and a biomarker that could predict the onset and triage ill children to therapeutic intervention more quickly would be useful. PMID: 21099215 [PubMed - as supplied by publisher] (Source: Acta Haematologica)

[Blood transfusion in emergency settings: French military health service experience.]

Transfusion Clinique et Biologique — Tue, 02 Nov 2010 00:00:00 +0100

Authors: Sailliol A, Ausset S, Peytel E Blood transfusion is required in a number of emergency settings and the French military health service (FMHS) has issued specific guidelines for the treatment of war casualties. These guidelines take into account European standards and laws, NATO standards, and also public sentiment regarding transfusion. These guidelines reflect a determination to control the process and to avoid the improvisation frequently associated with wartime transfusion. The evolution in warfare (terrorism and bombing more frequent than gunshot) and the wide use of body armor have deeply changed the clinical presentation of war injuries. These now involve the extremities in 80% of cases, with extensive tissue damage and heavy blood loss. The FMHS recommends that war casua...

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Perioperative Monitoring of Thromboelastograph on Blood Protection and Recovery for Severely Cyanotic Patients Undergoing Complex Cardiac Surgery

Artificial Organs — Mon, 01 Nov 2010 00:00:00 +0100

In this study, we assessed the clinical effect of a new transfusion therapy guided by thromboelastograph (TEG) on blood protection. Thirty‐one children with severe cyanosis (hematocrit ≥54%), who were diagnosed as having transposition of the great arteries or double outlet right ventricle with or without pulmonary valve stenosis, and underwent arterial switch operation or double roots transplantation, were involved and were divided into two groups. In group F (n = 17), the transfusion therapy after cardiopulmonary bypass was performed with fibrinogen administration combined with traditional transfusion, guided by TEG. In group C (n = 14), traditional transfusion guided by clinical experiences only was performed. We observed the blood protection effects and recovery conditions o...

Masimo's Continuous Hemoglobin Monitor Helps Reduce Blood Transfusions

Medgadget Anesthesiology — Thu, 21 Oct 2010 20:15:25 +0100

We've reported on Masimo's noninvasive hemoglobin monitor, part of Masimo Rainbow SET, here on Medgadget in the past. The idea of monitoring hemoglobin in real time and without the need to draw blood is very attractive in the OR and ICU settings, but does it work? According to results of a trial released at the annual meeting of the American Society of Anesthesiologists this week, the answer is a resounding yes! In the study, Masimo's device helped reduce blood tranfusions in orthopedic surgery patients by an astounding 86 percent. Patients received either the "standard of care" (using blood draws) or the continuous hemoglobin measurement along with the blood draws to guide transfusion therapy. Of the 327 total patients, seven in the standard group and only one in the Masimo group receive...

Antenatal Rh prophylaxis is unnecessary for "Asia type" DEL women.

Transfusion Clinique et Biologique — Sun, 17 Oct 2010 23:00:00 +0100

CONCLUSION: The data indicate that the "Asia type" DEL variant does not appear at risk of alloimmunization to the D antigen. It strongly suggests that the antenatal Rh immune globulin prophylaxis is unnecessary for DEL women. Furthermore, it implicates that the "Asia type" DEL may be deemed Rh-positive safely for clinical transfusion therapy. PMID: 20961786 [PubMed - as supplied by publisher] (Source: Transfusion Clinique et Biologique)

Massive transfusion and blood product use in the pediatric trauma patient

Seminars in Pediatric Surgery — Tue, 05 Oct 2010 05:24:08 +0100

Hemorrhagic shock in the pediatric trauma patient is an uncommon but fundamental problem for the treating clinician. Current management of hemorrhagic shock involves initial resuscitation with crystalloid fluids followed by infusion of blood components as necessary. In management of the adult trauma patient, many institutions have implemented massive transfusion protocols to guide transfusion in situations requiring or anticipating the use of greater than 10 U of packed red blood cells. In the pediatric population, guidelines for massive transfusion are vague or nonexistent. Adult trauma transfusion protocols can be applied to children until a pediatric protocol is validated. Here, we attempt to identify certain principles of transfusion therapy specific to pediatric trauma and outline a s...

Coagulation factor levels in neurosurgical patients with mild prolongation of prothrombin time: effect on plasma transfusion therapy.

Journal of Neurosurgery — Thu, 02 Sep 2010 23:00:00 +0100

Conclusions Neurosurgical patients with a mild prolongation of INR (up to 1.7) have hemostatically normal levels of important coagulation factors, and the authors recommend that plasma not be transfused to simply correct this abnormal laboratory value. PMID: 20815699 [PubMed - as supplied by publisher] (Source: Journal of Neurosurgery)

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Management of post‐partum haemorrhage

Acta Anaesthesiologica Scandinavica — Tue, 31 Aug 2010 23:00:00 +0100

This article aims at introducing pregnancy‐ and haemorrhage‐induced changes in coagulation and fibrinolysis and their relevant compensatory mechanisms, volume replacement therapy, optimal transfusion of blood products, and coagulation factor concentrates, and briefly cell salvage, management of uterine atony, surgical interventions, and selective arterial embolization. Special attention, respective management, and follow‐up are required in women with bleeding disorders, such as von Willebrand disease, carriers of haemophilia A or B, and rare coagulation factor deficiencies. We also provide a proposal for practical instructions in the treatment of PPH. (Source: Acta Anaesthesiologica Scandinavica)

Predicting pituitary iron and endocrine dysfunction

Annals of the New York Academy of Sciences — Sun, 01 Aug 2010 23:00:00 +0100

This article outlines relevant background studies and methodological details as well as providing preliminary results from our first two aims. (Source: Annals of the New York Academy of Sciences)

Do All Patients With Hematologic Malignancies and Severe Thrombocytopenia Need Prophylactic Platelet Transfusions? Background, Rationale, and Design of a Clinical Trial (Trial of Platelet Prophylaxis) to Assess the Effectiveness of Prophylactic Platelet Transfusions

Transfusion Medicine Reviews — Wed, 30 Jun 2010 23:00:00 +0100

This study has been designed as a 2-stage randomized trial with an interim analysis planned after a minimum of 100 patients had been randomized and had completed their period of observation. Patients have initially been enrolled through 3 United Kingdom hematology centers. The interim analysis has been completed, and the results have confirmed a final sample size of 600 patients. Recruitment is now being extended to other centers in United Kingdom and Australia. Local research nurses are not blinded to treatment allocation, but a number of measures to reduce risk of assessment bias include repeated education around standard operating procedures, common definitions, and duplication of assessments. The expected completion date for the 5-year study is December 2011. (Source: Transfusion Medic...

Donor Blood Filtered To Reduce Heart, Lung Complications

Health News from Medical News Today — Thu, 24 Jun 2010 07:00:00 +0100

Researchers at the University of Rochester Medical Center (URMC) have discovered yet another reason to filter the foreign white cells from donor blood: the resulting blood product is associated with dramatically fewer cardiopulmonary complications for patients who received a transfusion. The study is published online in the journal, Transfusion. It is the latest in a large body of work led by Neil Blumberg, M.D., who for 25 years has been investigating the benefits of filtering or washing blood to create safer, simpler approaches to transfusion therapy... (Source: Health News from Medical News Today)

The association of blood lactate concentration with outcome in dogs with idiopathic immune-mediated hemolytic anemia: 173 cases (2003–2006)

Journal of Veterinary Emergency and Critical Care — Sun, 20 Jun 2010 23:00:00 +0100

To determine the association of blood lactate with outcome and response to transfusion therapy in dogs with idiopathic immune-mediated hemolytic anemia (IMHA). Retrospective study. Urban veterinary small animal emergency hospital. One hundred and seventy-three client-owned dogs with IMHA. None. Serial blood lactate concentration, therapeutic interventions, and outcome were recorded. Nonsurvivors were defined as those that died or were euthanized. One hundred and thirty-three dogs (77%) survived, 35 (20%) were euthanized, and 5 (3%) died. One hundred forty-five dogs (84%; 145/173) had a lactate concentration above the laboratory reference interval [0.46[ndash]2.31 mmol/L] on presentation. Blood lactate at presentation was higher in the nonsurvivors (median 4.8 mmol/L; 0.5[ndash]13.6) compar...

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Relationship between Chronic Transfusion Therapy and Body Composition in Subjects with Thalassemia

The Journal of Pediatrics — Sun, 13 Jun 2010 23:00:00 +0100

Conclusion: Although most adult patients with thalassemia had healthy body composition with rare obesity, young non-transfused patients appear at risk for being underweight. Optimizing physical activity and appropriate use of transfusion therapy may improve growth and bone health in these patients who are at-risk for being underweight. (Source: The Journal of Pediatrics)

Optimal timing and dosing of platelet transfusions

ISBT Science Series — Wed, 09 Jun 2010 23:00:00 +0100

Conclusions Although all of these studies further our knowledge to prescribe platelet transfusions, they also raise some interesting questions about the clinical relevance of the outcomes that we are currently using for these studies. The trend over the past decade has been to use bleeding as the primary outcome; however, bleeding is a complex composite outcome (Grades 2, 3 and 4) comprised of some surrogate components (Grades 2 and 3). It is also an outcome that may be difficult to measure and grade in a consistent and reliable manner. The clinical relevance of this outcome is also complex and may vary depending on the perspective from which it is viewed. (Source: ISBT Science Series)

Traditional Transfusion Practices are Changing

Critical Care — Mon, 31 May 2010 23:00:00 +0100

Schochl and co-authors have described a five year retrospective study that outlines a novel, important and controversial transfusion concept in seriously injured trauma patients. Traditionally, clinicians have been taught to use a serial approach, resuscitating hypovolemic trauma patients with a form of crystalloid or colloid, followed by red blood cells (RBCs), then fresh frozen plasma (FFP), and lastly platelets. The data supporting this widely accepted approach is remarkably weak. Conversely, Schochl et al in an innovative, retrospective study describe the use of fibrinogen concentrate, plasma complex concentrate (PCC), RBCs, FFP, and platelets driven by a thromboelastometry based algorithm. Finally, it appears that transfusion therapy is becoming driven by physiology. (Source: Critical...

Alpha-thalassaemia

Orphanet Journal of Rare Diseases — Thu, 27 May 2010 23:00:00 +0100

is inherited as an autosomal recessive disorder characterised by a microcytic hypochromic anaemia, and a clinical phenotype varying from almost asymptomatic to a lethal haemolytic anaemia. It is probably the most common monogenic gene disorder in the world and is especially frequent in Mediterranean countries, South-East Asia, Africa, the Middle East and in the Indian subcontinent. During the last few decades the incidence of alpha thalassaemia in North-European countries and Northern America has increased because of demographic changes. Compound heterozygotes and some homozygotes have a moderate to severe form of alpha thalassaemia called HbH disease. Hb Bart's hydrops foetalis is a lethal form in which no alpha-globin is synthesized. Alpha thalassaemia most frequently results from delet...

Beta-thalassemia

Orphanet Journal of Rare Diseases — Thu, 20 May 2010 23:00:00 +0100

s are a group of hereditary blood disorders characterized by anomalies in the synthesis ofthe beta chains of hemoglobin resulting in variable phenotypes ranging from severe anemia to clinicallyasymptomatic individuals. The total annual incidence of symptomatic individuals is estimated at 1 in100,000 throughout the world and 1 in 10,000 people in the European Union. Three main forms have beendescribed: thalassemia major, thalassemia intermedia and thalassemia minor. Individuals with thalassemiamajor usually present within the first two years of life with severe anemia, requiring regular red blood cell(RBC) transfusions. Findings in untreated or poorly transfused individuals with thalassemia major, as seen insome developing countries, are growth retardation, pallor, jaundice, poor musculatur...

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Inositol hexaphosphate-loaded red blood cells prevent in vitro sickling.

Transfusion — Mon, 03 May 2010 23:00:00 +0100

CONCLUSION: Our results indicate that IHP-RBCs prevent in vitro sickling and suggest that it could improve conventional transfusion therapy in terms of transfused volume, frequency, and efficacy. PMID: 20456710 [PubMed - as supplied by publisher] (Source: Transfusion)

Fatal hyperhemolytic delayed transfusion reaction in sickle cell disease: A case report and literature review

The American Journal of Emergency Medicine — Mon, 03 May 2010 00:00:00 +0100

Patients with sickle cell disease (SCD) may require repeated red blood cells (RBCs) transfusion, putting them at risk for minor blood group alloimmunization and the development of hyperhemolytic delayed transfusion reactions (HDTR). We recently cared for an adolescent with SCD who was admitted to the hospital with a severe HDTR. The patient had been discharged from the hospital five days previously, and had been transfused while hospitalized. The patient continued to hemolyse, despite the use of antigen compatible blood and end-up by disseminated intravascular coagulopathy (DIC), acute kidney injury (AKI) and he went on to develop cardiac arrest and could not be resuscitated. In addition to demonstrating the potential severity of HDTR we are focusing on potential side effects of transfusio...

Transcranial Doppler Ultrasonography and Prophylactic Transfusion Program Is Effective in Preventing Overt Stroke in Children with Sickle Cell Disease

The Journal of Pediatrics — Sun, 02 May 2010 23:00:00 +0100

Conclusions: Our program has been successful in reducing the rate of first overt stroke, but with increased use of transfusion. Additional modifications to screening might further reduce the risk of first stroke, and studies of alternative treatments may be beneficial. (Source: The Journal of Pediatrics)

Sickle cell disease: selected aspects of pathophysiology.

Clinical Hemorheology and Microcirculation — Wed, 07 Apr 2010 21:26:03 +0100

Authors: Alexy T, Sangkatumvong S, Connes P, Pais E, Tripette J, Barthelemy JC, Fisher TC, Meiselman HJ, Khoo MC, Coates TD Sickle cell disease (SCD), a genetically-determined pathology due to an amino acid substitution (i.e., valine for glutamic acid) on the beta-chain of hemoglobin, is characterized by abnormal blood rheology and periods of painful vascular occlusive crises. Sickle cell trait (SCT) is a typically benign variant in which only one beta chain is affected by the mutation. Although both SCD and SCT have been the subject of numerous studies, information related to neurological function and transfusion therapy is still incomplete: an overview of these areas is presented. An initial section provides pertinent background information on the pathology and clinical significance ...

Specificity of 136 patient’s antibodies to human red blood cells in Dr. Max Peralta J Hospital Blood Bank 2004–February 2009

Transfusion and Apheresis Science — Tue, 23 Mar 2010 14:35:43 +0100

Abstract: The development of alloantibodies and erythrocyte autoantibodies complicates transfusion therapy. The antibodies detection of potential clinical significance in 136 samples of Dr. Max Peralta J Hospital Blood Bank patients, Cartago, Costa Rica between 2004 and February, 2009 were evaluated. Transfusion of phenotypically matched blood for Rh and Kell systems proved to be effective in preventing alloimmunization because it been found in this study that there is good evidence that a high proportion of antibodies produced in response to transfusion are Rh and K specificity. (Source: Transfusion and Apheresis Science)

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A randomised clinical trial comparing minimally invasive surgery to conventional approach for endoprosthesis in elderly patients with hip fractures

Injury — Fri, 12 Mar 2010 15:06:26 +0100

Conclusion: Based on the results of the present study, we cannot recommend the use of a minimally invasive approach over a standard approach in the implantation of a cemented endoprosthesis. (Source: Injury)

Controversies related to red blood cell transfusion in critically ill patients

Journal of Veterinary Emergency and Critical Care — Fri, 12 Mar 2010 00:00:00 +0100

To review the evolution of and controversies associated with allogenic blood transfusion in critically ill patients. Veterinary and human literature review. RBC transfusion practices for ICU patients have come under scrutiny in the last 2 decades. Human trials have demonstrated relative tolerance to severe, euvolemic anemia and a significant outcome advantage following implementation of more restricted transfusion therapy. Investigators question the ability of RBCs stored longer than 2 weeks to improve tissue oxygenation, and theorize that both age and proinflammatory or immunomodulating effects of transfused cells may limit efficacy and contribute to increased patient morbidity and mortality. Also controversial is the ability of pre- and post-storage leukoreduction of RBCs to mitigate adv...

Overview on practices in thalassemia intermedia management aiming for lowering complication rates across a region of endemicity: the OPTIMAL CARE study

Blood — Thu, 11 Mar 2010 17:02:02 +0100

This study provides evidence that calls for prospective evaluation of the roles of transfusion, iron chelation, and hydroxyurea therapy in TI patients. (Source: Blood)

Paraspinal extramedullary hematopoiesis in patients with thalassemia intermedia

European Spine Journal — Wed, 10 Mar 2010 18:48:28 +0100

Abstract Ineffective erythropoiesis in patients with thalassemia intermedia drives extramedullary hematopoietic tumor formation in several parts of the body. Paraspinal involvement has received increasing attention due to the associated morbidity secondary to spinal cord compression. Although the history and physical examination may help narrow the differential diagnosis, radiographic imaging remains essential to confirm the existence of hematopoietic tissue. Characteristic appearance has been observed mainly on magnetic resonance imaging. Several treatment options have been described, including transfusion therapy, laminectomy, radiotherapy, and the use of fetal hemoglobin inducing agents that decrease the hematopoietic drive. However, the ideal management scheme remains ...

Establishment of platelet donor registry improves the treatment of platelet transfusion refractoriness in Guangzhou region of China

Transfusion Medicine — Thu, 04 Feb 2010 00:00:00 +0100

In this study, we demonstrated that the establishment of an HLA- and HPA-typed platelet aphaeresis donor registry is useful to improve the treatment outcome of PTR patients and to maintain a long-term platelet transfusion strategy. (Source: Transfusion Medicine)

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Theme section: Current topics in platelet storage and transfusion

Transfusion and Apheresis Science — Mon, 01 Feb 2010 00:00:00 +0100

The current theme section extends and expands upon Volume 41.2’s coverage of platelet transfusion therapy. Five contributions from internationally-renowned Transfusion Medicine experts describe cutting-edge issues in platelet storage, evaluation and unit selection for transfusion. (Source: Transfusion and Apheresis Science)

Clinical consequences of iron overload from chronic red blood cell transfusions, its diagnosis, and its management by chelation therapy.

Transfusion — Fri, 15 Jan 2010 00:00:00 +0100

Authors: Shander A, Sazama K Iron overload from chronic transfusion therapy can be extremely toxic. Excess transfusional iron is deposited in the liver, heart, and other organs as free iron, which can cause organ dysfunction and damage over time. Increased awareness of the risk of iron overload in patients requiring chronic transfusion therapy is needed, and such patients should be screened for hyperferritinemia. Those with serial serum ferritin levels exceeding 1000 ng/mL and a total infused red blood cell volume of 120 mL/kg of body weight or more should be treated with chelation therapy and then monitored to ensure that treatment adequately reduces iron levels. PMID: 20088842 [PubMed - as supplied by publisher] (Source: Transfusion)

Whole blood and component use in resource poor settings.

Tue, 12 Jan 2010 00:00:00 +0100

Authors: Marwaha N Data on blood collection, testing and component preparation has improved worldwide; however, there is limited information on blood utilization from the developing countries. Blood requirement in the Southeast Asia region is 15million units against a collection of 9.3million. There is huge diversity in the management of blood transfusion services, the voluntary blood collection (range 40-100%) and proportion of blood separated into components (10-95%). The major indications for transfusion are for emergency obstetric care, surgery, pediatric and trauma patients. The prevalence of thalassemia in this region is high and in India alone 2million units of packed red cells are required for transfusion to these patients. The Blood Safety Program in India has developed as a c...

Assessment of cardiac iron by MRI susceptometry and R2* in patients with thalassemia

Magnetic Resonance Imaging — Mon, 11 Jan 2010 00:00:00 +0100

Abstract: A magnetic resonance imaging cardiac magnetic susceptometry (MRI-CS) technique for assessing cardiac tissue iron concentration based on phase mapping was developed. Normal control subjects (n=9) and thalassemia patients (n=13) receiving long-term blood transfusion therapy underwent MRI-CS and MRI measurements of the cardiac relaxation rate R2*. Using MRI-CS, subepicardium and subendocardium iron concentrations were quantified exploiting the hemosiderin/ferritin iron specific magnetic susceptibility. The average of subepicardium and subendocardium iron concentrations and R2* of the septum were found to be strongly correlated (r=0.96, P (Source: Magnetic Resonance Imaging)

Quantitative analysis and modelling of hepatic iron stores using stereology and spatial statistics

Journal of Microscopy — Wed, 06 Jan 2010 00:00:00 +0100

Hepatic iron overload is a common clinical problem resulting from hyperabsorption syndromes and from chronic transfusion therapy. Not only does iron loading vary between reticuloendothelial stores and hepatocytes, but iron is heterogeneously distributed within hepatocytes as well. Since the accessibility of iron particles to chelation may depend, in part, on their distribution, we sought to characterize the shape and scale of iron deposition in humans with transfusional iron overload. Toward this end, we performed a histological analysis of iron stores in liver biopsy specimens of 20 patients (1.3[ndash]57.8 mg iron/g dry tissue weight) with aid of electron and light microscopy. We estimated distributions related to variability in siderosomal size, proximity of iron centres and inter-cellu...

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Manual erythro‐exchange for chronic transfusion therapy in patients with sickle cell syndromes unresponsive to hydroxyurea: A long‐term follow‐up

American Journal of Hematology — Fri, 01 Jan 2010 00:00:00 +0100

(Source: American Journal of Hematology)

Effect of chronic red cell transfusion therapy on vasculopathies and silent infarcts in patients with sickle cell disease

American Journal of Hematology — Fri, 01 Jan 2010 00:00:00 +0100

(Source: American Journal of Hematology)

[Karl Landsteiner discovers the blood groups.]

Transfusion Clinique et Biologique — Tue, 29 Dec 2009 00:00:00 +0100

Authors: Lefrère JJ, Berche P The discovery of ABO blood group was a major step in mastering transfusion therapy. Karl Landsteiner (1868-1843) was the author of this discovery. This paper retraces the hard career of this American scientist of Austrian origin, and describes the circumstances that led his research to the discoveries, which were turning points in the history of the immunology. PMID: 20044293 [PubMed - as supplied by publisher] (Source: Transfusion Clinique et Biologique)

Granulocyte transfusion therapy: randomization after all?

Haematologica — Tue, 01 Dec 2009 00:00:00 +0100

Authors: Drewniak A, Kuijpers TW PMID: 19996116 [PubMed - in process] (Source: Haematologica)

Nucleated red blood cells and soluble transferrin receptor in thalassemia syndromes: relationship with global and ineffective erythropoiesis

Clinical Chemistry and Laboratory Medicine — Tue, 24 Nov 2009 17:19:36 +0100

Conclusions: The NRBC count can be useful for better defining ineffective erythropoiesis in patients with thalassemia, and can help optimize transfusion therapy in severe thalassemia syndromes. Clin Chem Lab Med 2009;47:1539–42. (Source: Clinical Chemistry and Laboratory Medicine)

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Hemostatic resuscitation for massive bleeding: the paradigm of plasma and platelets-a review of the current literature.

Transfusion — Thu, 19 Nov 2009 00:00:00 +0100

CONCLUSIONS: High FFP- and PLT-to-RBC ratios seem to improve survival in patients with massive bleeding. Randomized studies evaluating TEG-guided transfusion therapy versus fixed ratios of plasma and PLTs to RBCs in massively bleeding patients is highly warranted. PMID: 19929864 [PubMed - as supplied by publisher] (Source: Transfusion)

Blood transfusion therapy for 41 earthquake casualties

Transfusion and Apheresis Science — Wed, 18 Nov 2009 14:25:07 +0100

Conclusion: Blood transfusion was an effective therapy for the earthquake casualties. (Source: Transfusion and Apheresis Science)

Postop Anemia in High-CV-Risk Patients: No CV Gains From Fixed Hemoglobin Target in Trial

Medscape Medical News Headlines — Wed, 18 Nov 2009 00:38:48 +0100

A randomized trial found no protection from in-hospital cardiovascular events with a strategy of blood transfusions to maintain hemoglobin above 10 g/dL, compared with a more conservative approach to transfusion therapy, in patients with CV disease or risk factors who underwent hip surgery. Heartwire (Source: Medscape Medical News Headlines)

Postop anemia in high-CV-risk patients: No CV gains from fixed hemoglobin target in trial

theHeart.org — Mon, 16 Nov 2009 22:45:01 +0100

Successful management of fresh-frozen plasma transfusion therapy based upon clinical symptoms for total knee arthroplasty in a patient with severe factor V deficiency

Haemophilia — Wed, 11 Nov 2009 00:00:00 +0100

(Source: Haemophilia)

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Red blood cell transfusion in the intensive care setting: controversies amongst evidence

Revista Brasileira de Terapia Intensiva — Fri, 06 Nov 2009 15:36:37 +0100

A anemia é um problema prevalente nas unidades de terapia intensiva. Ela surge nos primeiros dias e pode sustentar-se, ou agravar-se, durante a internação. A etiologia normalmente é multifatorial. A transfusão de hemácias é a intervenção mais comumente utilizada para combatê-la. Aproximadamente 12 milhões de unidades de sangue são utilizadas para transfusões nos Estados Unidos, sendo 25% a 30% dentro das terapias intensivas. A maior segurança com a diminuição das infecções provocadas por transfusões permitiu uma ampliação de indicações clínicas. No entanto, a terapia transfusional está associada a outros efeitos adversos, como infecções nosocomiais, comprometimento imunológico, injúria pulmonar, reações hemolíticas e aumento da incidência de câncer. Alguns...

HLA alloimmunization is associated with RBC antibodies in multiply transfused patients with sickle cell disease

Pediatric Blood and Cancer — Tue, 03 Nov 2009 00:00:00 +0100

Alloimmunization to minor red blood cell (RBC) antigens occurs commonly in sickle cell disease (SCD). Patients with alloimmunization demonstrate increased risk for new alloantibody formation with subsequent transfusion. Alloimmunization to human leukocyte antigens (HLA) can occur with RBC transfusion and may result in graft rejection during stem cell or organ transplantation. The prevalence and risk factors for HLA alloimmunization in multiply transfused pediatric SCD patients are unknown.A cross-sectional study of HLA alloimmunization in SCD patients aged 3-21 years with a history of [ge]3 RBC transfusions was performed to test the hypothesis that HLA alloimmunization is associated with RBC alloimmunization. Antibodies to class I and class II HLA were measured by Flow Panel Reactive Antib...

Asymptomatic brain magnetic resonance imaging abnormalities in splenectomized adults with thalassemia intermedia

Journal of Thrombosis and Haemostasis — Sun, 11 Oct 2009 00:00:00 +0100

Conclusion: WMLs and brain atrophy are a common finding in adult, splenectomized, TI patients. Increasing age and transfusion naivety are associated with a higher incidence and multiplicity of lesions. (Source: Journal of Thrombosis and Haemostasis)

Understanding iron overload: screening, monitoring, and caring for patients with transfusion-dependent anemias.

Clinical Journal of Oncology Nursing — Wed, 30 Sep 2009 23:00:00 +0100

Authors: Ault P, Jones K Patients receiving recurring blood transfusions as supportive therapy to treat chronic anemias, such as myelodysplastic syndromes, thalassemia, and sickle-cell disease, are at risk of iron accumulation. The clinical consequences of iron overload are progressive liver damage, cardiac disease, and endocrine disorders, which can be fatal. Nurses have a vital role in the initial assessment and monitoring of patients undergoing transfusion therapy and their ongoing care. Iron levels may be managed effectively with iron chelation therapy, and treatment guidelines recommend initiation when serum ferritin levels reach more than 1,000 mcg/L. Deferoxamine has been used effectively in clinical practice for more than 40 years. Newer agents, such as deferasirox, have introd...

Consensus and controversies in platelet transfusion

Transfusion and Apheresis Science — Wed, 23 Sep 2009 16:39:08 +0100

This article reviews the current developments and challenges in optimizing platelet transfusion therapy. (Source: Transfusion and Apheresis Science)

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Red cell exchange employing phenotypically matched deglycerolized red blood cells to treat acute sickle cell crisis: A case report

Transfusion and Apheresis Science — Wed, 23 Sep 2009 16:39:08 +0100

Red blood cell (RBC) transfusion in sickle cell patients, especially young recipients, is at high risk for multiple reasons. The high susceptibility to develop alloantibodies, together with haemolytic transfusion reactions that would impair future transfusion therapy imposes the choice of RBC concentrates respecting as much as possible, the patient’s phenotype . Furthermore ethnic difference between donors and RBC recipients is critical to heighten the possibility of alloimmunization against foreign antigens. Sickle cell crisis is a very severe painful condition resulting in tissue infarction of different organs (brain, liver heart, bone, spleen) caused by the precipitation of sickled cells in patients with high level of haemoglobin S (HbS). Red cell exchange (RCE) is a safe and rapid pr...

Granulocyte transfusion therapy in abdominal organ transplant recipients

Journal of Clinical Apheresis — Mon, 14 Sep 2009 23:00:00 +0100

Conclusions: We observed temporal increases in ANC to levels above 1,000/[mu]l in 15/18 (83.3%) courses of GT. We observed a clinical response to infection in 5/12 (42%) patients, the remaining infected patients had no clinical response. Our results suggest that GT therapy in neutropenic solid organ transplant recipients can boost peripheral blood neutrophil counts. Additional studies areneeded to document an independent clinical benefit for GT in this patient population. J. Clin. Apheresis, 2009. © 2009 Wiley-Liss, Inc. (Source: Journal of Clinical Apheresis)

Evaluation of angiogenesis with vascular endothelial growth factor in patients with thalassemia major

Pediatrics International — Mon, 07 Sep 2009 00:00:00 +0100

Conclusion: Early chelating age will negatively influence the VEGF level, which increases angiogenesis, however, early starting transfusion age and regular blood transfusion will positively influence the VEGF level, which decreases angiogenesis in thalassemic patients. (Source: Pediatrics International)

Red Bood Cell Transfusion Therapy and Iron Chelation in Patients With Myelodysplastic Syndromes.

Clinical Lymphoma and Myeloma — Mon, 31 Aug 2009 23:00:00 +0100

Authors: Malcovati L Anemia is the most frequent peripheral cytopenia observed in myelodysplastic syndromes (MDS) and has been recognized among the most important factors affecting the outcome of patients with MDS. In patients who are not candidates for potentially curative approaches, therapeutic options for symptomatic anemia include red blood cell (RBC) transfusion and iron chelation, hematopoietic growth factors, immunosuppression, immune-modulatory drugs, and hypomethylating agents. In about 40% of patients, regular RBC transfusions are the only therapeutic option that can be offered. The onset of a regular transfusion requirement significantly worsens the survival of patients with MDS. Transfusion-dependent patients invariably develop secondary iron overload. Elevated serum ferri...

Prevalence of sickle cell disease in a northeastern region of the Democratic Republic of Congo: what impact on transfusion policy?

Transfusion Medicine — Wed, 26 Aug 2009 23:00:00 +0100

Transfusion therapy may save the lives of patients with sickle cell disease (SCD), but it is also associated with a high risk of transmission of infection. The aims of this study were to determine the prevalence of SCD in a northeastern region of the Democratic Republic of Congo (DRC), and to define ways in which the procedures involved in the security of transfusions should be improved. During a 3-month period in 2006/2007, 520 samples of umbilical cord blood were obtained through neonatal screening in five health centres in Kisangani. The samples were analysed using an isoelectric focusing technique. The estimated prevalence of sickle cell trait and SCD in the population tested was 23·3 and 0·96%, respectively. These numbers will be presented for the attention of the health authorities...

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Prevalence and specificities of red blood cell alloantibodies in transfused Ugandans with different diseases

Vox Sanguinis — Sun, 23 Aug 2009 23:00:00 +0100

Conclusions The prevalence of RBC alloimmunization in transfused Ugandans was 6·1% and was associated with the number of donor exposures. This immunization rate is similar to that observed in transfused Caucasians despite differences in RBC antigen distributions. Patients with malaria were less likely to develop RBC alloantibodies. Alloantibodies were mainly against E and S antigens. We recommend the introduction of pretransfusion antibody tests in Uganda depending on the recipient's diagnosis. (Source: Vox Sanguinis)

The role of religious leaders and faith organisations in haemoglobinopathies - a review

BMC Blood Disorders — Fri, 14 Aug 2009 23:00:00 +0100

Conclusion: Religious leaders and faith organisations have the potential to influence health education, health promotion and positive health outcomes amongst members of their faith community. They also provide potential access to at-risk populations for increasing awareness about SCD, encouraging health service utilization and ethnic blood donor drives. (Source: BMC Blood Disorders)

Iron overload and toxicity: the hidden risk of multiple blood transfusions

Vox Sanguinis — Sun, 02 Aug 2009 23:00:00 +0100

Conclusion Increased awareness of the risks of iron overload from chronic transfusion therapy should result in greater use of interventions such as iron chelation to reduce total body iron and the risk of long-term sequelae. (Source: Vox Sanguinis)

Retrospective analysis of transfusion outcomes in pregnant patients at a tertiary obstetric center

International Journal of Obstetric Anesthesia — Wed, 22 Jul 2009 23:00:00 +0100

Abstract: Background: The decision to use red blood cell transfusion and/or blood products (fresh frozen plasma, platelets, cryoprecipitate) to manage obstetric hemorrhage or treat postpartum anemia is often made empirically by physicians. We performed a retrospective study to review transfusion outcomes in pregnant and postpartum patients at a large obstetric center.Methods: A retrospective, observational study was performed of obstetric in-patients who received red blood cell transfusion and/or blood products over a one-year period. Data abstracted included transfusion data, pre-transfusion hemoglobin (Hb) and lowest recorded (nadir) Hb, and maternal and neonatal outcomes.Results: During the study period, 74 patients received transfusion therapy (1.4%). Pre-transfusion and nadir Hb value...

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Guidelines for Managing Conscientious Objection to Blood Transfusion

Transfusion Medicine Reviews — Thu, 25 Jun 2009 07:44:00 +0100

Parents sometimes deny their children blood transfusion because of their religious beliefs. The Japanese Joint Committee on the Refusal of Blood Transfusion on Religious Grounds asserts that the health and life of every child younger than 15 years should be guarded by the collective efforts of health, welfare, and advocacy institutions when a parent or guardian seeks to withhold transfusion therapy. Patients 18 years or older should receive treatment without transfusion after signing and submitting a “Certificate of Refusal Blood Transfusion and Exemption from Liability.” For a patient younger than 18 years, but 15 years or older, essential transfusion can be performed if the patient or at least one guardian consents. Without patient's or guardian's consent, guidelines for patients 18 ...

Transfusion Therapy: Optimal Use of Blood Products.

ASA Refresher Courses in Anesthesiology — Sun, 14 Jun 2009 23:12:39 +0100

Page: 193Authors: Surgenor, Stephen D M.D. (Source: ASA Refresher Courses in Anesthesiology)

Managing iron overload in patients with myelodysplastic syndromes with oral deferasirox therapy.

The Oncologist — Thu, 30 Apr 2009 23:00:00 +0100

Authors: Jabbour E, Garcia-Manero G, Taher A, Kantarjian HM Patients with myelodysplastic syndromes (MDS) often require chronic RBC transfusions, which can lead to iron overload. Without adequate management, this may cause progressive damage to hepatic, endocrine, and cardiac organs, significantly affecting overall survival. Recent retrospective analyses have suggested that iron chelation provides a survival advantage in iron-overloaded patients with MDS who are given chelation therapy compared with those who are not. Nonetheless, it is evident that iron overload in many patients with MDS is not adequately managed. Clinical evaluation of the once-daily, oral iron chelator deferasirox in MDS populations has indicated that it provides dose-dependent reductions in body iron burden and is ...

Clinical features and molecular analysis in Thai patients with HbH disease

Annals of Hematology — Fri, 24 Apr 2009 06:54:02 +0100

Abstract We studied the α-globin gene abnormalities, the clinical features, hematologic values, growth assessment, transfusion therapy, and serum ferritin levels of patients with hemoglobin H (HbH) disease in southern Thailand. HbH disease in 83 of the 147 patients was the deletional type of HbH. The remaining 64 patients was the nondeletional type of HbH disease. All 83 patients with the deletional type were double heterozygotes of α0-thalassemia and α+-thalassemia. The Southeast Asian type of α0-thalassemia accounted for 98% of the Thai patients with HbH disease and the Thai type of α0-thalassemia made up the rest. A 3.7-kb deletion accounted for 91% of α+-thalassemia, and a 4.2-kb deletion made up the rest of the deletional type. In patients with nondeletional type o...

Utilization of TCD screening for primary stroke prevention in children with sickle cell disease

Neurology — Mon, 13 Apr 2009 04:00:00 +0100

Conclusions: Since the Stroke Prevention Trial in Sickle Cell Anemia, the rate of transcranial Doppler ultrasonography (TCD) screening in sickle cell disease (SCD) has increased sixfold within a large health care plan. Children living farther from a vascular laboratory are less likely to be screened. Increased availability of TCD screening could improve the utilization of this effective primary stroke prevention strategy. (Source: Neurology)

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Transfusion Therapy in Postpartum Hemorrhage

Seminars in Perinatology — Wed, 01 Apr 2009 04:00:00 +0100

Postpartum hemorrhage (PPH) is an obstetric emergency that can occur following vaginal or cesarean delivery. Rapid diagnosis of PPH using laboratory and clinical parameters is an important first step in its management. Traditional blood components, including packed red blood cells, platelets, plasma, and cryoprecipitate, should be used in patients with significant bleeding. Recent studies underline the utility of transfusing these components in defined ratios to prevent dilutional coagulopathy. Disseminated intravascular coagulation (DIC) should be considered in severely bleeding obstetric patients and should be treated aggressively using blood components. Newer hemostatic agents, such as activated factor VII, will play significant roles in patients with bleeding that is refractory to stan...

Right patient, right blood, right care: safe transfusion practice.

British Journal of Nursing — Wed, 11 Mar 2009 20:05:36 +0100

This article examines the key principles and practicalities to be considered in day-to-day practice. Areas covered include legal obligations, appropriate handling of blood components, the different elements of the transfusion process, recognition and management of transfusion reactions and education. A key theme running throughout is the management of clinical risk. PMID: 19273993 [PubMed - as supplied by publisher] (Source: British Journal of Nursing)

Duffy genotyping facilitates transfusion therapy

Clinical and Experimental Medicine — Thu, 19 Feb 2009 14:20:32 +0100

Abstract The Duffy (FY) blood group system is clinically significant in transfusion medicine because FY antibodies are involved in hemolytic transfusion reactions and hemolytic disease of the newborn. The Fya and Fyb antigens are encoded by the FY*A and FY*B alleles which are responsible for the Fy(a+b+), Fy(a+b−) and Fy(a−b+) phenotypes. The Fy(a−b−) phenotype is found in individuals homozygous for a silent FY*B allele, named FY*B ES , which is caused by a mutation in the promoter region of FY*B that result in the loss of FY expression in the erythroid linage. The aim of the present study was to evaluate the role of FY DNA typing as a tool in transfusion compatibility testing. We studied 275 white blood donors from the city of Rosario by serological method and a...

Transfusion medicine and safety.

Thu, 19 Feb 2009 05:00:00 +0100

Authors: Dodd R, Kurt Roth W, Ashford P, Dax EM, Vyas G 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 HBV, HCV, HIV-1/2, and HTLV-I/II infections. Nucleic acid tests (NAT) using enzymatic amplification of viral gene sequences have augmented the risk reduction in "window period" infections that are undetectable by the serological tests. Improved viral safety of transfusion therapy has led...

Patient-specific component requirements: 'right blood, right patient, right time, right place'

ISBT Science Series — Fri, 13 Feb 2009 05:00:00 +0100

Although transfusion therapy may save the patient's life, it also carries the risk of severe complications and is therefore recommended only when all other forms of treatment have proved ineffective. The decision to transfuse should be preceeded by careful evaluation of the clinical condition of each individual patient and not be based exclusively on laboratory results (e.g. hemoglobin concentration). Whenever possible, only such components should be transfused, the lack of which is responsible for the disease symptoms. Most blood is separated into components prior to transfusion which offers several advantages: i) blood resources are conserved therefore several patients can benefit from one donated unit ii) each component is stored in optimal conditions iii) a specific component can be tr...

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Proteomics and blood transfusion

ISBT Science Series — Fri, 13 Feb 2009 05:00:00 +0100

Transfusion medicine is a clinical discipline characterized by one of the most advanced quality management systems, which is structured so as to assure the production of blood components and raw materials, for biopharmaceutical fractionation, that are safe, efficient and effective. During the production, pathogen inactivation and storage processes there is the risk of changes in the integrity of blood components, especially at the protein level. These changes could be the cause of some of the negative effects of transfusion therapy. It is therefore a major challenge to identify significant alterations of these products, and, in this context, proteomics can play a potentially relevant role in transfusion medicine to assess the protein composition of blood-derived therapeutics, particularly ...

Cocaine Abuse Complicating Acute Painful Episodes in Sickle Cell Disease.

Southern Medical Journal — Tue, 06 Jan 2009 06:57:50 +0100

We report clinical outcomes in three patients in which cocaine use preceded a sickle cell pain episode.Page: 87DOI: 10.1097/SMJ.0b013e318188b2abAuthors: Boulmay, Brian MD; Lottenberg, Richard MD (Source: Southern Medical Journal)

Hepatitis B virus reactivation during combined therapy with deferiprone and desferioxamine in a hepatitis B surface antigen thalassemic carrier.

International Journal of Hematology — Thu, 25 Dec 2008 05:00:00 +0100

In this report we firstly describe a case of reactivation of hepatitis B virus (HBV) replication occurred in a patient affected by Thalassemia major which underwent a combined chelation therapy with desferioxamine (DFO) and deferiprone (DFP). Clinical symptom and increase in alanine aminotransferase (ALT) level were detected when the prescription of DFO (30 mg/kg) was increased from 3 to 5 days/week; a raise in HBV-DNA levels of greater than or equal to tenfold compared with baseline was thereafter detected. Diagnosis was troublesome because increasing ALT levels, first suggested toxicity to DFP administration. However, HBV reactivation in our patient cannot be definitively attributed to combined regimen administration: the patient was on regular transfusion therapy and either coincidental...

Does regular blood transfusion prevent progression of cerebrovascular lesions in children with sickle cell disease?

Annals of Hematology — Wed, 24 Dec 2008 08:51:13 +0100

Abstract A retrospective study was conducted to assess changes in cerebrovascular lesions, as assessed by magnetic resonance (MR) imaging and angiography in 18 children with sickle cell disease (SCD) receiving optimised chronic transfusions for primary stroke prevention (abnormal transcranial Doppler flow, nine patients, median follow-up 14.3 months (range, 7.9–48.9)) or secondary stroke prevention (nine patients, median follow-up 59.6 months (range, 11.0–127.9)). An experienced neuroradiologist blinded to patient data reviewed the 41 MR scans (median/patient, three (2–4)). Standard scores were used to evaluate parenchymal and vascular abnormalities at baseline and last follow-up. Within-patient score changes evaluated using Wilcoxon’s paired rank test in...

Blood Transfusion Therapy Data Card

Karger Publishers — Thu, 18 Dec 2008 04:07:15 +0100

Administration of Blood Components (ISBN: 978-3-8055-9107-2) (Source: Karger Publishers)

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Blood Transfusion Therapy: A Physician's Handbook

Karger Publishers — Thu, 18 Dec 2008 04:07:15 +0100

9th edition (ISBN: 978-3-8055-9105-8) (Source: Karger Publishers)

ASH: Stroke in Sickle Cell Children Reduced by Screening

MedPage Today Cardiovascular — Mon, 08 Dec 2008 18:54:50 +0100

SAN FRANCISCO (MedPage Today) -- Screening by transcranial Doppler ultrasound, followed by transfusion therapy, almost eliminated the risk of a stroke among children with sickle cell disease, a researcher said here. (Source: MedPage Today Cardiovascular)

Granulocyte transfusion therapy: a new era?.

Current Opinion in Hematology — Fri, 05 Dec 2008 08:03:07 +0100

Page: 1DOI: 10.1097/MOH.0b013e32831d7953Authors: Dale, David C a; Price, Thomas H b (Source: Current Opinion in Hematology)

Effect of transfusion therapy on cerebral vasculopathy in children with sickle-cell anemia.

Haematologica — Thu, 04 Dec 2008 05:00:00 +0100

Authors: Bader-Meunier B, Verlhac S, Elmaleh-Bergès M, Ithier G, Sellami F, Faid S, Missud F, Ducrocq R, Alberti C, Zaccaria I, Baruchel A, Benkerrou M This retrospective study assessed the long-term effect of transfusional exchange therapy on MRA/MRI abnormalities in 24 homozygous sickle-cell anemia (HbSS) children presenting with abnormal brain MRA. The median time elapsed from baseline to last available MRA was 29 months. Follow-up MRAs showed improvement, stabilization or worsening of cerebrovascular lesions in 11, 6 and 7 patients respectively. Complete normalization of MRA was observed in 6 patients within a mean time of 1.4 years, but stenosis recurred at the same location in the 4 patients in whom transfusion therapy was discontinued. Baseline severe stenosis/occlusion of ...

Successful use of recombinant activated factor VII for postoperative associated haemorrhage: a case report

BioMed Central — Sat, 29 Nov 2008 05:00:00 +0100

Conclusion: Published clinical experiences for the use of rFVIIa in trauma patients are limited to small series and case reports. However, in trauma patients, administration of rFVIIa appears to be effective in addition to prompt surgical intervention as an adjunctive haemostatic measure to control life threatening bleeding in appropriately selected patients. (Source: BioMed Central)

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Pediatric and newborn stroke

Current Treatment Options in Neurology — Tue, 25 Nov 2008 06:58:32 +0100

Opinion statement In children, arterial ischemic stroke is more common than hemorrhage. The clinical presentation differs according to age, stroke type, and location. Seizures are more common with ischemia in children, especially in newborns. The presentation of pediatric ischemic stroke is more complex than in adults, so the clinical phenotype of ischemic stroke is modified. Risk factors for ischemic and hemorrhagic stroke include congenital heart disease, blood disorders, vasculopathies, infections (both current and preceding the stroke), and vascular malformations, but often no discernible etiology is determined. Current treatment is based on consensus rather than large, case-controlled studies. There is no strategy for primary prevention of pediatric or newborn strok...

Efficacy of recombinant activated Factor VII in patients with massive uncontrolled bleeding: a retrospective observational analysis.

Transfusion — Tue, 25 Nov 2008 05:00:00 +0100

CONCLUSION: This study suggests that rFVIIa may play a role in patients with massive uncontrolled blood loss by reducing the amount of RBC and FFP transfusions and by improving the coagulation variables. PMID: 19040498 [PubMed - as supplied by publisher] (Source: Transfusion)

The Sickle Cell Sabbath: a community program increases first-time blood donors in the African American faith community.

Transfusion — Tue, 25 Nov 2008 05:00:00 +0100

CONCLUSION: An educational program that engages the African American faith community more than quadruples the rate of expected first-time blood donors when compared to the general community over this 4-year period. PMID: 19040492 [PubMed - as supplied by publisher] (Source: Transfusion)

Treatment and Prevention of Neonatal Anemia

NeoReviews recent issues — Fri, 31 Oct 2008 04:00:00 +0100

Because red blood cell (RBC) transfusion therapy remains the primary treatment of anemia encountered in early life, the basis for RBC transfusion in the treatment of symptomatic anemia is discussed in this review along with several important aspects of neonatal blood banking practices. Nontransfusion approaches to the prevention and treatment of neonatal anemia also are described. Finally, this review covers the controversy surrounding whether neonatal RBC transfusion therapy should be restrictive or liberal. The evaluation and treatment of uncommon and rare acquired and genetic causes of anemia in newborn infants are beyond the scope of this review. (Source: NeoReviews recent issues)

Transfusion Related Acute Lung Injury presenting with acute dyspnoea: a case report

BioMed Central — Tue, 28 Oct 2008 04:00:00 +0100

Conclusion: The diagnosis of transfusion-related acute lung injury relies on excluding other causes of acute pulmonary edema following transfusion, such as sepsis, volume overload, and cardiogenic pulmonary edema. All plasma containing blood products have been implicated in transfusion-related acute lung injury, with the majority being linked to whole blood, packed red blood cells, platelets, and fresh-frozen plasma. The pathogenesis of transfusion-related acute lung injury may be explained by a "two-hit" hypothesis, involving priming of the inflammatory machinery and then activation of this primed mechanism. Treatment is supportive, with prognosis being substantially better than for most other causes of acute lung injury. (Source: BioMed Central)

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Transfusion Therapy: Optimal Use of Blood Products.

ASA Refresher Courses in Anesthesiology — Fri, 10 Oct 2008 06:24:55 +0100

Page: 193Authors: Surgenor, Stephen D M.D. (Source: ASA Refresher Courses in Anesthesiology)

Designing Property Specifications to Improve the Safety of the Blood Transfusion Process.

Transfusion Medicine Reviews — Wed, 01 Oct 2008 04:00:00 +0100

Authors: Henneman EA, Cobleigh R, Avrunin GS, Clarke LA, Osterweil LJ, Henneman PL Computer scientists use a number of well-established techniques that have the potential to improve the safety of patient care processes. One is the formal definition of a process; the other is the formal definition of the properties of a process. Even highly regulated processes, such as laboratory specimen acquisition and transfusion therapy, use guidelines that may be vague, misunderstood, and hence erratically implemented. Examining processes in a systematic way has led us to appreciate the potential variability in routine health care practice and the impact of this variability on patient safety in the clinical setting. The purpose of this article is to discuss the use of innovative computer science te...

Intraoperative Platelet and Plasma Improves Survival in Patients Operated for a rAAA: A Follow-up Evaluation.

PubMed: Eur J Vasc Endovasc ... — Wed, 04 Jun 2008 04:00:00 +0100

CONCLUSIONS: Early administration of platelets and plasma, together with red blood cells maintained reduced mortality in patients operated for rAAAin a 18 month period. PMID: 18538595 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Treatment of cancer-related anemia.

Collegium Antropologicum — Sun, 01 Jun 2008 04:00:00 +0100

Authors: Badzek S, Curić Z, Krajina Z, Plestina S, Golubić-Cepulić B, Radman I Anemia with consequent tissue hypoxia is common problem in cancer patients. Developed via various patophysiological mechanisms, it has deleterious effect on quality of life and survival of patients with cancer. Recognition of symptoms and timely initiation of treatment improve patients' quality of life, as well as efficacy of oncological treatment. Red blood cells transfusions are well known and efficient way of anemia correction. They are "golden standard" in treatment of cancer-related anemia today, and are unavoidable in almost all patients with hemoglobin concentration below 80 g/L. Newest therapy guidelines in developed countries, supported by recent literature, encourage use of recomb...

Disparity in the management of iron overload between patients with sickle cell disease and thalassemia who received transfusions

Transfusion — Thu, 29 May 2008 13:20:54 +0100

The objective of this study was to evaluate the current standard of care in monitoring iron overload and ... (Source: Transfusion)

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Transfusion therapy for autoimmune hemolytic anemia patients: a laboratory perspective.

Fri, 16 May 2008 17:12:08 +0100

Authors: Drouillard DD Patients presenting with autoimmune hemolytic anemias create inherent challenges to those tasked with providing compatible blood for transfusion therapy. These patients have developed autoantibodies against their own red cell surface antigens. Because these antigens are usually high-incidence, these patients will typically demonstrate panagglutination when their serum is exposed to most commercially procured screening red blood cells. This makes the identification of clinically significant alloantibodies difficult for laboratory personnel. Transfusion history, patient phenotype availability, and previous antibody records all impact the testing methods. The end goal is to identify clinically significant alloantibodies in order to provide antigen negative, compatib...

Distribution of the FYBES and RHCEce(733C>G) alleles in an Argentinean population: implications for transfusion medicine

BioMed Central — Tue, 06 May 2008 04:00:00 +0100

Conclusions: Taken together, the results suggest that admixture events between African slaves and European immigrants at the beginning of the 20th century made the physical characteristics of black Africans to be invisible nowadays. Considering that it was a recent historical event, the FY*BES and RHCE*ce(733C>G) alleles did not have time to become widespread but remain concentrated within families. These findings have considerable impact for typing and transfusion strategy in our population, increasing the pool of compatible units for Fy(b-) individuals requiring chronic transfusion. Possible difficulties in transfusion therapy and in genotyping could be anticipated and appropriately improved strategies devised, allowing a better management of the alloimmunization in the blood bank. (Sour...

Clinical effects of different types of red cell concentrates in patients with thalassemia and sickle cell disease.

Transfusion Clinique et Biologique — Mon, 21 Apr 2008 04:00:00 +0100

Authors: Cabibbo S, Fidone C, Antolino A, Manenti OG, Garozzo G, Travali S, Bennardello F, Di Stefano R, Bonomo P The treatment of thalassemia is still essentially based on continuous transfusion supporting using red cell concentrates (RCC) prepared in different ways. For patients with sickle-cell disorders, either urgent or chronic red blood cell transfusion therapy, is widely used in the management of sickle cell disease (SCD) because it reduces HbS level and generally prevents recurrent vaso-occlusive disease (VOD). Recently, the introduction of prestorage filtration to remove leukocytes and the use of techniques for multicomponent donation have increased the types of blood components available for transfusion purposes. The clinical effects of different types of blood components in ...

Painful Spinal Cord Compression as a Complication of Extramedullary Hematopoiesis Associated with β-Thalassemia Intermedia

Strahlentherapie und Onkologie — Wed, 09 Apr 2008 06:29:36 +0100

Conclusion: Clinical awareness of this phenomenon and knowledge of the available treatment option is essential for successful outcome. In treatment refractory symptoms irradiation could successfully contribute to a rapid therapeutic response. Content Type Journal ArticleCategory Case StudyDOI 10.1007/s00066-008-1794-6Authors Martin Goerner, City Hospital Bielefeld Department of Hematology & Oncology GermanySabine Gerull, City Hospital Bielefeld Department of Hematology & Oncology GermanyErhard Schaefer, City Hospital Bielefeld Department of Hematology & Oncology GermanyMarianne Just, City Hospital Bielefeld Department of Hematology & Oncology GermanyMartin Sure, City Hospital Bielefeld Department of Radiotherapy GermanyPeter Hirnle, City Hospital Bielefeld Department o...

Silent Cerebral Infarct Transfusion (SIT) Trial Imaging Core: Application of Novel Imaging Information Technology for Rapid and Central Review of MRI of the Brain

Journal of Digital Imaging — Wed, 09 Apr 2008 05:59:02 +0100

The objective of this manuscript is to describe the innovative method used to process and adjudicate imaging studies for an international trial with a primary endpoint that includes neuroimaging. Institution investigators at each site were provided with computer hardware and software for transmission of MRI images that allow them to strip the scans of all personal information and add unique study identifiers. Three neuroradiologists at separate academic centers review MRI studies and determine the presence or absence of silent cerebral infarct-like lesions. Their findings are subsequently placed on web-based case report forms and sent to the Statistical Coordinating Center. The average time from imaging center receipt of the MRI study to the radiology committee report back to the loc...

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A Single-Institution Experience With Treatment of Severe Acute Chest Syndrome: Lack of Rebound Pain With Dexamethasone Plus Transfusion Therapy.

Journal of Pediatric Hematology Oncology — Sat, 05 Apr 2008 13:24:11 +0100

Page: 322DOI: 10.1097/MPH.0b013e3181647bb2Authors: Isakoff, Michael S. MD * +; Lillo, J. Alyssa BS +; Hagstrom, J. Nathan MD * + (Source: Journal of Pediatric Hematology Oncology)

Bleeding Disorders in the Neonate

NeoReviews recent issues — Tue, 01 Apr 2008 04:00:00 +0100

Bleeding syndromes in the newborn are rare, but they may be life-threatening and demand immediate attention. Results of an initial coagulation evaluation often can direct the clinician toward diagnostic possibilities, as can the degree of illness manifested by the infant. Among the potential causes of neonatal bleeding are platelet disorders, neonatal hemophilia and other congenital clotting factor deficiencies, vitamin K deficiency syndromes, liver failure, and disseminated intravascular coagulation. Depending on the cause, platelet or protein concentrates may be used for transfusion therapy. (Source: NeoReviews recent issues)

Major obstetric hemorrhage.

Anesthesiology Clinics — Sat, 01 Mar 2008 05:00:00 +0100

Authors: Mercier FJ, Van de Velde M Major obstetric hemorrhage remains the leading cause of maternal mortality and morbidity worldwide, and is associated with a high rate of substandard care. A well-defined and multidisciplinary approach that aims to act quickly and avoid omissions or conflicting strategies is key. The most common etiologies of hemorrhage are abruptio placenta, placenta previa/accreta, uterine rupture in the antepartum period and retained placenta, uterine atony, and genital-tract trauma in the postpartum period. Basic treatment of postpartum hemorrhage relies on manual removal of the placenta or manual exploration of the uterus plus bladder emptying and oxytocin administration. If this does not arrest bleeding, or if there is any suspicion of genital-tract trauma, exa...

Pediatric transfusion therapy: Practical considerations

Indian Journal of Pediatrics — Fri, 29 Feb 2008 09:22:20 +0100

Abstract Over the past decade, safety of blood has increased tremendously because of better donor screening as well as testing of the units for transmissible diseases. Component therapy has allowed more effective and economic use of blood. Whole blood is rarely used; instead, packed red cells, platelets, and fresh frozen plasma (FFP) are the most common components used. These products are further refined using irradiation and microaggregate filters and in the case of FFP, viral inactivation. Irradiation prevents transfusion-associated graft versus host disease, whereas microaggregate filters remove leukocytes, decreasing the rates of alloimmunization, febrile nonhemolytic (FNH) reactions, and cytomegalovirus (CMV) transmission. Autologous donation in older children probabl...