Apheresis-inducible cytokine pattern change in children with homozygous familial hypercholesterolemia.

Familial hypercholesterolemia is a genetic disorder that leads to severe atherosclerosis related cardiovascular complications in young adults. Extracorporeal elimination is a method of LDL-lowering procedures effective in patients with homozygous or severe heterozygous FH utilized in cases. The recruitment of leucocytes into the arterial intima is dependent on a cascade of events mediated through a diverse family of adhesion molecules. Several pro-inflammatory adhesion molecules are cleared by various lipid apheresis methods. This study showed that, LDL-apheresis led to several changes in circulating inflammatory factors which induced antiinflammatory and antiatherogenic changes in the plasma profile in homozygous familial hypercholesterolemic patients.

Severe childhood amitriptyline intoxication and plasmapheresis: a case report.

Tricyclic antidepressant intoxication is one of the most frequently encountered and life-threatening causes of intoxication among referrals to emergency departments due to drug intoxication. There is no known antidote against any of the tricyclic antidepressants. The American Society for Apheresis (ASFA) recommends plasmapheresis to support primary treatment in this type of drug poisoning, which does not respond to certain and traditional treatments. We present a 15-year-old girl who ingested amitriptyline with suicidal intent. On admission, she was in a comatose state (Glasgow Coma Scale score: 5), with no spontaneous respiration and presence of pathological reflexes. Due to the intake history of lethal doses and the severe clinical picture, plasmapheresis was performed. She was discharged on her fifth day of hospitalization.Due to the high plasma protein binding property of amitriptyline, plasma exchange therapy should be considered in cases of severe amitriptyline intoxication as a life-saving therapeutic modality.

Trends in hepatitis B and hepatitis C virus seropositivity among blood donors over 15 years screened in the blood bank of a university hospital.

Blood transfusion carries well defined risks including hepatitis B and hepatitis C virus transmission. In this study, records of blood donation candidates between the years 1996-2010 were retrospectively reviewed. A total of 220 841 apparently healthy adult donors were screened for hepatitis B surface antigen, anti-HCV with enzyme linked immunosorbent assay (ELISA) method. The overall prevalence of HbsAg and HCV were 1.07% and 0.39%, respectively. HBV seroprevelance decreased through years 1996-2010 but HCV seroprevelance showed a fluctuant course decreasing from 1996 to 2002. In order to decrease transfusion transmitted infections there should be centralized blood collection systems having qualified staff, equipment and non-remunerated voluntary blood donations must be strongly encouraged.

Hematopoietic stem cell transplantation in a very high risk group of patients with the support of granulocyte transfusion.

High risk patients with active fungal infection who had undergone hematopoietic stem cell transplantation (HSCT) with the support of granulocyte transfusions (GTX) as an adjunct to antifungal agents are reviewed retrospectively. Patients requiring immediate allogeneic HSCT for their primary hematological disorders (two severe aplastic anemia, one T cell acute lymphoblastic leukemia (ALL) in second complete remission, one acute myeloid leukemia (AML)-in first complete remission, one T-ALL in refractory relapse) but were denied by other transplant programs due to active invasive fungal infections had undergone HSCT with the support of GTX at the stem cell transplantation unit of Gazi University. Five patients who had undergone six transplants were included in the study and received a total of 38 (3-13) granulocyte transfusions during these six transplants. The median granulocyte concentration was 3.4 × 10(11) per apheresis bag. Full clinical and radiological recovery was achieved in three of the five high risk patients with active invasive fungal infection with the combination of antifungal agents and GTX. Even a very high risk patient with aplastic anemia who had undergone two consecutive transplants due to secondary graft failure was also cured of his primary disease despite the presence of multiple pulmonary fungus balls. Three of the five patients with very high risk features due to the underlying hematological disease and the associated active fungal infection were rescued with allogeneic HSCT performed with the support of GTX combined with antifungal agents. Despite the limitations of this report due to its retrospective nature, it suggests that GTX might be an alternative in patients with active fungal infections who otherwise are denied by the transplant programs. However, prospective randomized studies are required to draw a solid conclusion regarding the role of GTX in HSCT recipients in desperate situations such as active fungal infections.

[Investigation of West Nile virus seroprevalence in healthy blood donors]. / Saglikli kan vericilerinde Bati Nil virusu seroprevalansinin arastirilmasi

West Nile virus (WNV) which is a flavivirus transmitted by mosquitos, may lead to asymptomatic infection, mild febrile illness or encephalitis. Many sporadic cases and major outbreaks of West Nile fever have been reported worldwide, however, WNV infections have not been well documented in Turkey. The aim of the present study was to determine the prevalence of past WNV infections in a population of blood donors. Blood samples were collected from donors with their informed consent. Samples were processed and tested for WNV IgG by enzyme-linked immunosorbent assay (ELISA) (Euroimmun, Germany) according to the manufacturer's guidelines. Demographic data of the donors were recorded. A total of 2821 serum samples were tested. Among them, 28 samples were found to be WNV IgG positive (0.9%) and 41 of them were indeterminate (1.4%). Thus a total of 69 objects were considered to have encountered WNV (2.4%). All of the IgG positive samples (n= 69) and randomly-selected negative samples (n= 60) were re-analysed for the presence of viral RNA by a commercial real-time reverse transcriptase PCR (LightMix® Kit West Nile Virus, TIBMolbiol, Germany). West Nile virus RNA was not found in any of the samples. In conclusion, our data have supported the results of other studies indicating the presence of WNV infection in Turkey. Further larger scale studies are necessary to evaluate the possible risks of WNV infections in our country in terms of blood banking.

A case report of amitriptyline poisoning successfully treated with the application of plasma exchange.

Amitriptyline is a very frequently prescribed antidepressant agent and is very often involved in attempted suicides. Amitriptyline intoxication necessitates primary therapeutic approaches that include gastric irrigation and recurrent administration of activated charcoal. In the case of pronounced anticholinergic findings, physostigmine is of proven benefit and hypertonic sodium bicarbonate can be used to shorten the QRS duration and AV interval. In cases of a comatosed state, hemoperfusion and plasma exchange can be used. In this case report we present a case of severe amitriptyline poisoning that we successfully managed with plasma exchange. We confirmed a 59.5% reduction in the amitriptyline plasma level in our patient after a single plasma exchange session. She was discharged by the third day of admission without any complications. According to current literature, our patient is the fifth patient treated with plasma exchange to be the subject of a publication.

Lipid apheresis applications in childhood: experience in the University Hospital of Gazi.

The most commonly encountered complications in familial hypercholesterolemia (FH) are mainly cardiovascular in origin and the majority of cases unfortunately die due to this problem. LDL-apheresis is a proven therapeutic method in lowering this mortal risk. In this study we aimed to demonstrate the efficiency of LDL-apheresis performed by DALI or Cascade filtration on four pediatric patients with the diagnosis of homozygous FH. Applied LDL-apheresis techniques, side effects, laboratory results and cardiovascular follow-up are discussed in the light of current literature. Our study has shown once again that lipid apheresis treatment in children with homozygous FH is the most effective treatment. The number of childhood subjects in whom lipid apheresis is performed is quite insufficient. There are no studies that compare DALI with cascade filtration in childhood subjects in our knowledge. The view of this aspect, this study will contribute to literature.

BT-online: an innovated and promising computer assisted transfusion system.

BACKGROUND: Errors in the transfusion process are common. These errors encompass a spectrum of events ranging from incorrect transfusion to administration of infected blood products. To overcome these complications, we developed a new blood management software system - the BT-Online system - to decrease erroneous transfusions that are mostly human based. MATERIAL/METHODS: Like previously developed transfusion safety systems, this program uses handheld devices to improve the safety of bedside practices. The BT-online system consists of 3 main structures: (1) the personal digital assistant, (2) the equipment and software (user interface), and (3) the relational database and a web service providing communication of a security-layered database with other personal digital assistants. RESULTS: This system has many features including the ability at the bedside to check the complete patient history and requested tests and blood products, the ability to conduct simultaneous multiple procedures, the ability to transmit results to the database, the ability to gather restrictions and warnings regarding the transfusion and request sections, the ability to provide constant and secure data transfer, a user-friendly design, the ability to gather warnings during measurements that alert the user to potential errors, the ability to enter complications and symptoms and retrieve relevant information and suggestions, the ability to enter transfusion complications, and the ability to check test results and create statistical data for future use. CONCLUSIONS: This system can contribute to blood banks and health care facilities via the above-mentioned specifications. We recommend this system to health care facilities with a significant patient turnover.

Reduction of hepatitis B seroprevalence in blood banking units by combined utilization of self-exclusion forms and clinical evaluation of blood donation candidates in Turkey.

In this retrospectively designed study, we evaluate the influence of the permanence and qualifications of health-care professionals on blood disposal rates due to hepatitis seropositivity. We observed a decrease of 44.2% in the number of blood units being rejected due to the donor's hepatitis B seropositivity in the second study period in which self-exclusion forms and where blood donation candidates were evaluated by a family physician. However, a similar decrease of the disposal rate due to hepatitis C seropositivity was not observed. This is especially important in countries which cannot afford many of the expensive modern laboratory tests. A comprehensive evaluation of self-exclusion forms and a brief examination prior to donation will greatly increase transfusion safety. Unfortunately, there are blood banks in Turkey which employ no physicians at all.