Erythrocyte storage in hypertonic (SAGM) or isotonic (PAGGSM) conservation medium: influence on cell properties.

BACKGROUND AND OBJECTIVES: Prolonged red blood cell (RBC) storage may be associated with increased post-transfusion morbidity and mortality. A contributing factor is RBC storage lesions. We analysed the role of additive conservation solutions, either hypertonic or isotonic, on such cell properties. MATERIALS AND METHODS: After blood donation in citrate-phosphate-dextrose as an anticoagulant, 10 RBC units were stored with saline-adenine-glucose-mannitol (SAGM; 376 mOsm/l) and 10 units with phosphate-adenine-glucose-guanosin-saline-mannitol (PAGGSM; 285 mOsm/l). Measurements were made on days 1 and 42 of storage. RESULTS: The mean cellular volume measured by centrifuged microhaematocrit increased from 87.6 +/- 3.1 fl to 100.7 +/- 4.3 fl in PAGGSM and to 92.2 +/- 2.5 fl in SAGM (P < 0.001) on day 1, after 42 days it was 95.8 +/- 4.0 fl and 93.8 +/- 3.9 fl, respectively. Spontaneous haemolysis and osmotic fragility were lower after storage in PAGGSM. Both additives showed a similar degree of echinocytosis, decreased RBC aggregability and deformability, and increased RBC suspension viscosity after storage. CONCLUSIONS: The isotonic PAGGSM prevented the initial RBC swelling caused by citrate-phosphate-dextrose less than hypertonic SAGM, but reduced the spontaneous haemolysis rate and osmotic fragility after 42 days of storage. All other parameters, such as echinocytosis, decreased RBC deformability and aggregability, and increased blood viscosity was similar for both additive solutions and remained a major problem of blood banking.

A phase 3 randomized placebo-controlled trial of darbepoetin alfa in patients with anemia and lower-risk myelodysplastic syndromes.

The use of darbepoetin alfa to treat anemia in patients with lower-risk myelodysplastic syndromes (MDS) was evaluated in a phase 3 trial. Eligible patients had low/intermediate-1 risk MDS, hemoglobin ⩽10 g/dl, low transfusion burden and serum erythropoietin (EPO) ⩽500 mU/ml. Patients were randomized 2:1 to receive 24 weeks of subcutaneous darbepoetin alfa 500 µg or placebo every 3 weeks (Q3W), followed by 48 weeks of open-label darbepoetin alfa. A total of 147 patients were randomized, with median hemoglobin of 9.3 (Q1:8.8, Q3:9.7) g/dl and median baseline serum EPO of 69 (Q1:36, Q3:158) mU/ml. Transfusion incidence from weeks 5-24 was significantly lower with darbepoetin alfa versus placebo (36.1% (35/97) versus 59.2% (29/49), P=0.008) and erythroid response rates increased significantly with darbepoetin alfa (14.7% (11/75 evaluable) versus 0% (0/35 evaluable), P=0.016). In the 48-week open-label period, dose frequency increased from Q3W to Q2W in 81% (102/126) of patients; this was associated with a higher hematologic improvement-erythroid response rate (34.7% (34/98)). Safety results were consistent with a previous darbepoetin alfa phase 2 MDS trial. In conclusion, 24 weeks of darbepoetin alfa Q3W significantly reduced transfusions and increased rates of erythroid response with no new safety signals in lower-risk MDS (registered as EudraCT#2009-016522-14 and NCT#01362140).

[Anemia in the elderly]. / Anämie im Alter: Wen, wie, warum abklären?

Anemia is common in the elderly and its impact on various important health outcomes has recently been clearly demonstrated. Although a causal relationship has not yet been demonstrated, adequate diagnosis and treatment are important. Because of ongoing changes in demographics an increasing number of anemic elderly patients is to be expected. Despite this, many issues regarding the aetiology and the management of anemia in older persons remain unresolved. The present review will focus on aspects specific to the causes of anemia in the elderly and suggests an algorithm for the management of this very common condition. Clearly evidence based guidelines on anemia in this highest age group need to be developed. Treatment options for patients with myelodysplastic syndromes are also discussed.

The value of white blood cell count in patients with swollen discs.

BACKGROUND: A broad differential diagnosis has to be considered in a patient with swollen discs. Myeloproliferative disorders such as leukemia and lymphoma can in rare cases cause infiltrative optic neuropathy. HISTORY AND SIGNS: Two patients initially presented with slowly progressive severe visual loss. History was unremarkable except for previously noted slightly elevated white blood cell count for which - according to their general physicians - no treatment or work-up was required. At presentation, bilateral disc swelling was present. Magnetic resonance imaging showed enhancement of the entire optic nerves sparing the chiasm. No other intracranial lesion was found. Cerebrospinal fluid contained no malignant cells. THERAPY AND OUTCOME: After bone marrow aspiration the diagnosis of non-Hodgkin's lymphoma and granulocytic leukemia, respectively, was made. Treatment resulted in visual recovery. CONCLUSION: Work-up in a patient with swollen discs should always include white blood cell count. If the result is abnormal further exploration should be pursued. Elevated white blood cell count may be the only hint of optic nerve infiltration caused by a myeloproliferative disorder and its treatment can result in remarkable recovery.