RESUMO
INTRODUCTION: Blood component resuscitation is associated with hypocalcemia (HC) (iCal <0.9 mmol/L) that contributes to coagulopathy and death in trauma patients. It is unknown whether or not whole blood (WB) resuscitation helps mitigate the risk of HC in trauma patients. We hypothesized that calcium homeostasis is maintained and mortality improved in patients who only receive WB. MATERIALS AND METHODS: This is a retrospective review of all adult trauma patients who received WB from July 2018 to December 2020. Variables included transfusions, ionized calcium levels, and calcium replacement. Patients were characterized as follows based on blood products received: WB or WB with other blood components. Groups were compared with respect to HC, correction of HC, 24 h, and inpatient mortality. RESULTS: Two hundred twenty-three patients received WB and met the inclusion criteria. 107 (48%) received WB only. HC occurred in 13% of patients who received more than one WB unit compared to 29% of WB and other blood component patients (P = 0.02). WB patients received less calcium replacement (median 250 mg versus 2000 mg, P < 0.01). HC and total units transfused within 4 h were associated with mortality in the adjusted model. HC significantly increased after 5 units of blood products were transfused, regardless of product type. WB was not protective against HC. CONCLUSIONS: HC and failure to correct HC are significant risk factors for mortality in trauma. Resuscitations with WB only and WB in combination with other blood components are associated with HC especially when more than 5 units of any blood product are transfused. Calcium supplementation should be prioritized in any large volume transfusion, regardless of blood product type.
Assuntos
Transtornos da Coagulação Sanguínea , Hipocalcemia , Ferimentos e Lesões , Adulto , Humanos , Hipocalcemia/etiologia , Hipocalcemia/prevenção & controle , Cálcio , Transfusão de Sangue/métodos , Transfusão de Componentes Sanguíneos/métodos , Ressuscitação/métodos , Estudos Retrospectivos , Ferimentos e Lesões/complicações , Ferimentos e Lesões/terapiaRESUMO
OBJECTIVE: The study evaluated the efficacy of phototherapy and 20% albumin infusion to reduce total serum bilirubin (TSB) in neonates with severe hyperbilirubinemia. The primary outcome was a reduction of TSB at the end of treatment. The secondary outcomes were the need for exchange transfusion, inpatient mortality, neurological outcomes at discharge, and development outcomes at 12-months follow-up. RESULTS: One hundred and eighteen neonates were randomly assigned to phototherapy and 20% albumin (n = 59) and phototherapy and saline (n = 69). The median age at admission was 5 (interquartile range (IQR) 3-6) days, and the median gestation was 36 (IQR 36-38) weeks. No significant differences were found in the change in TSB (Mann-Whitney U =609, p = 0.98) and rate of change in TSB per hour after treatment (Mann-Whitney U = 540, p = 0.39) between the two groups. There were no significant differences between the two groups in the proportion of participants who required exchange transfusion (χ2 (2) = 0.36, p = 0.546); repeat phototherapy (χ2 (2) = 2.37, p = 0.123); and those who died (χ2 (2) = 0.92, p = 0.337). Trial registration The trial was registered in the International Standardized Randomized Controlled Trial Number (ISRCTN); trial registration number ISRCTN89732754.
Assuntos
Albuminas/uso terapêutico , Hiperbilirrubinemia Neonatal/terapia , Fototerapia/métodos , Solução Salina/administração & dosagem , Bilirrubina/sangue , Transfusão de Componentes Sanguíneos/métodos , Feminino , Hospitalização , Humanos , Hiperbilirrubinemia Neonatal/mortalidade , Hiperbilirrubinemia Neonatal/fisiopatologia , Lactente , Mortalidade Infantil , Recém-Nascido , Quênia , MasculinoRESUMO
Objetivo. Existen estudios que declaran la sangre recuperada con el sistema de autotransfusión que está potencialmente heparinizada y mezclada con otros fármacos, lo que puede provocar alteraciones hematológicas en el paciente, a tenor de la evidencia existente. Se planteó comparar los valores hematológicos de los pacientes antes de reinfundir glóbulos rojos procedentes del recuperador celular y 12h después de la reinfusión. Material y métodos. Estudio analítico observacional en el cual se estudiaron 479pacientes intervenidos de cirugía cardíaca donde se utilizó el recuperador celular. Se recogieron variables hematológicas antes de reinfundir y 12h después de haber sido reinfundidos. Resultados. Los valores hematológicos estadísticamente significativos antes de la reinfusión y 12h después de la reinfusión fueron: hemoglobina (9,5 a 12,5g/dl), hematocrito (26 a 38%), plaquetas (214,2 a 164,210
Objective. There are studies that declare blood recovered with the autotransfusion system that is potentially heparinised and mixed with other drugs, can cause haematological alterations in the patient, according to existing evidence. The proposal was to compare the haematological values of the patients before reinfusing red blood cells from the cell saver and 12h after reinfusion. Material and methods. Observational analytical study of 479 patients who underwent cardiac surgery where the cell saver was used. Haematological variables were collected before reinfusion and 12h after reinfusion. Results. Statistically significant haematological values before reinfusion and 12h after reinfusion were: haemoglobin (9.5 to 12.5g/dL), haematocrit (26 to 38%), platelets (214.2 to 164.210
Assuntos
Humanos , Transfusão de Sangue Autóloga/efeitos adversos , Anticoagulantes/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Análise Química do Sangue , Recuperação de Sangue Operatório/métodos , Transfusão de Componentes Sanguíneos/métodosRESUMO
BACKGROUND: Quality of life in chronic idiopathic urticaria is hampered as efficacy of H1-antihistamines is limited. Autologous serum containing tolerance-generating anti-idiotype antibodies is a novel and cost-effective therapy. This study was conducted to evaluate the efficacy of autologous serum therapy (AST) among chronic urticaria patients with autologous skin prick test positive and negative status. METHODS: Untreated 102 patients of chronic urticaria were enrolled in a non-randomized interventional study. Patients were categorized into two groups based on autologous serum skin prick test as test positive (ASST +) and test negative (ASST -). Patients were then treated with intramuscular injection of 0.05ml per kg body weight of autologous serum weekly for 10 weeks. Urticaria activity scoring (UAS) tool was used for quantification of the symptoms. Weekly recording of UAS (range: 0-42) was made before the therapy (baseline) and during the therapy for 10 weeks. RESULTS: Significant improvement with AST in the mean UAS was noted from baseline to 10 weeks in both the group of patients (14.6 ± 6.3 and 10.2 ± 5.1 for ASST+ group ; 16.9 ± 7.8 and 8.6 ± 4.8 for ASST- group; at baseline and 10 weeks, respectively (p-value for both <0.05)). However no statistical significance was found while comparing the efficacy of the therapy against ASST + and ASST - Groups (p-value > 0.05). CONCLUSIONS: Irrespective of autologous skin prick test results, autologous serum therapy showed significant improvement in patients with chornic idiopathic urticaria. AST can, thus, be an effective treatment modality for it.
Assuntos
Anticorpos Anti-Idiotípicos/uso terapêutico , Transfusão de Componentes Sanguíneos/métodos , Transfusão de Sangue Autóloga/métodos , Soro , Urticária/imunologia , Urticária/terapia , Adolescente , Adulto , Doença Crônica , Estudos Transversais , Feminino , Humanos , Masculino , Nepal , Qualidade de Vida , Adulto JovemRESUMO
PURPOSE: Rotator cuff tears are one of the most common causes of shoulder malfunction and pain, which lead to a significant reduction in the quality of life. This present study investigated the effects of subacromial platelet-rich plasma injections [i.e. autologous conditioned plasma (ACP) injections] as compared to standard subacromial cortisone injection therapy in 50 patients with partial rotator cuff tears. METHODS: Before injection, and 6 weeks, 12 weeks and 6 months thereafter, the patients were assessed by the Constant-Murley score (CMS), the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the simple shoulder test (SST) and a pain visual analogue scale (VAS). An MRI was also performed before and 6 months after injection. RESULTS: Both patient groups had statistically significant better shoulder score outcomes over time. ASES, SST and CMS outcomes after 12 versus 6 weeks were better in the ACP group as compared to the cortisone group. VAS, ASES and CMS outcomes after 12 weeks versus baseline in the ACP group were better as compared to the cortisone group. There was a statistically significant difference between ACP group and cortisone group 12 weeks after injection regarding VAS, ASES, SST and CMS in favour of the ACP group. The MRI showed an improvement in grade of tendinopathy in both groups, however, without statistically significant differences between the two groups. CONCLUSION: Compared with cortisone injections, ACP injections show earlier benefit as compared to cortisone injections although a statistically significant difference after 6 months could not be found. Therefore, subacromial ACP injections are a good alternative to subacromial cortisone injections, especially in patients with contraindication to cortisone. LEVEL OF EVIDENCE: Therapeutic study, Level III.
Assuntos
Anti-Inflamatórios/uso terapêutico , Transfusão de Componentes Sanguíneos/métodos , Cortisona/uso terapêutico , Lesões do Manguito Rotador/terapia , Síndrome de Colisão do Ombro/terapia , Adulto , Idoso , Artroscopia , Feminino , Humanos , Injeções , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Medição da Dor , Plasma Rico em Plaquetas , Qualidade de Vida , Manguito Rotador/cirurgia , Tendinopatia/terapia , Resultado do TratamentoRESUMO
By the optimised availability of less expensive and safe red cell packs and other blood products over the last 20 years, numerous surgical interventions have become possible without any demand for comments on the precise need. However, a number of publications indicates that blood transfusion may also induce disadvantageous effects on the postoperative course by immunomodulation, which requires a rather restrictive indication for transfusion. Furthermore, demographic development leads to a decrease in that portion of the population with the potential for blood donation accompanied simultaneously by an increase of the percentage of older patients with more need of blood products during medical treatment. This makes blood-sparing measures necessary. In addition, costs for red cell packs have increased, in particular, for the generally compatible blood group 0 - an extra amount for rhesus negative blood. The present narrative review highlights, therefore, important news from the clinical transfusion medicine, immunohaematology and haemostaseology and their impact on daily transfusion practice. In this context, "blood management" is considered as one of the very effective blood-sparing measures, which focusses especially i) on the substitution of iron in case of depressed preoperative haemoglobin as well as ii) to elucidate disorders of coagulation by structured medical history and, subsequently, to balance possible need by a specific plan for substitution. Simultaneously, prospective studies are initiated to investigate how far the transfusion trigger of a patient can be lowered down to a still appropriate level. As far as consolidated findings are already available, they are described with regard to the single blood components and taking into account the cross-sectional guidelines of the "Bundesärztekammer" (Federal Physicians Chamber). Finally, initial evidence is provided characterising patient- and blood donor-specific, blood group-dependent features of a reasonable haemotherapy.
Assuntos
Transfusão de Componentes Sanguíneos/métodos , Transfusão de Sangue/métodos , Cuidados Intraoperatórios/métodos , Assistência Perioperatória/métodos , Fatores de Coagulação Sanguínea/uso terapêutico , Transfusão de Sangue Autóloga/métodos , Medicina Baseada em Evidências , Humanos , Substitutos do PlasmaRESUMO
Promover en los profesionales de salud una buena práctica clínica en el uso de los componentes sanguíneos, en la baja, mediana y alta complejidad. · Proponer criterios para facilitar la toma decisiones en relación a las indicaciones de transfusión, y de esta manera reducir la variabilidad clínica injustificada. Reducir las complicaciones derivadas de un inadecuado uso de los componentes sanguíneos.
Assuntos
Humanos , Transfusão de Componentes Sanguíneos/métodos , Transfusão de Sangue Autóloga/métodos , Reação Transfusional , Hipotermia/prevenção & controleRESUMO
Plasma obtained via whole blood donation processing or via apheresis technology can either be transfused directly to patients or pooled and fractionated into plasma protein products that are concentrates of 1 or more purified plasma protein. The evidence base supporting clinical efficacy in most of the indications for which plasma is transfused is weak, whereas high-quality evidence supports the efficacy of plasma protein products in at least some of the clinical settings in which they are used. Transfusable plasma utilization remains composed in part of applications that fall outside of clinical practice guidelines. Plasma contains all of the soluble coagulation factors and is frequently transfused in efforts to restore or reinforce patient hemostasis. The biochemical complexities of coagulation have in recent years been rationalized in newer cell-based models that supplement the cascade hypothesis. Efforts to normalize widely used clinical hemostasis screening test values by plasma transfusion are thought to be misplaced, but superior rapid tests have been slow to emerge. The advent of non-vitamin K-dependent oral anticoagulants has brought new challenges to clinical laboratories in plasma testing and to clinicians needing to reverse non-vitamin K-dependent oral anticoagulants urgently. Current plasma-related controversies include prophylactic plasma transfusion before invasive procedures, plasma vs prothrombin complex concentrates for urgent warfarin reversal, and the utility of increased ratios of plasma to red blood cell units transfused in massive transfusion protocols. The first recombinant plasma protein products to reach the clinic were recombinant hemophilia treatment products, and these donor-free equivalents to factors VIII and IX are now being supplemented with novel products whose circulatory half-lives have been increased by chemical modification or genetic fusion. Achieving optimal plasma utilization is an ongoing challenge in the interconnected worlds of transfusable plasma, plasma protein products, and recombinant and engineered replacements.
Assuntos
Transfusão de Componentes Sanguíneos/métodos , Plasma , Preservação de Sangue/métodos , Canadá , Hemofilia A/terapia , Hemorragia/etiologia , Hemorragia/terapia , Hemostasia , Técnicas Hemostáticas , Humanos , Plasma/fisiologiaRESUMO
BACKGROUND: Autologous platelet-rich plasma (aPRP) is widely used with orthopedic patients to help treat injuries to tendons, cartilage, ligaments, and muscle. A comprehensive review of the literature was conducted to evaluate aPRP's efficacy and compare available methods. In addition, the production and administration of aPRP were explored. STUDY DESIGN AND METHODS: A literature search was performed. Randomized controlled clinical trials (RCTs) in orthopedic procedures on adult patients were included and assessed for methodologic quality. The main outcomes were pain relief, increase in function, structural integrity, and "healing" based on various validated scales. RESULTS: Twelve RCTs and one controlled cohort were included (four lateral epicondylitis, two chronic Achilles tendinopathy, two anterior cruciate ligament injury, and five rotator cuff injuries). Four trials reported some benefit from aPRP versus controls while eight trials found no benefit from aPRP applications versus control. One study had too many patients withdraw from the control arm for acceptable data interpretation. All protocols used a different aPRP formulation or method of delivery or application. CONCLUSIONS: Despite its popularity, there are no standardized criteria that define aPRP. Different techniques yield wide variability in terms of platelet count and concentration. These variations make it difficult to compare clinical trials that use aPRP or draw conclusions concerning its clinical efficacy in orthopedic procedures. Blood bankers have experience in the production of standardized blood components. This expertise may be used to develop and implement protocols for the production and administration of aPRP, as well as quality control measures.
Assuntos
Transfusão de Componentes Sanguíneos/métodos , Transfusão de Sangue Autóloga/métodos , Procedimentos Ortopédicos/métodos , Plasma Rico em Plaquetas , Adulto , Transfusão de Componentes Sanguíneos/normas , Transfusão de Sangue Autóloga/normas , Feminino , Humanos , Masculino , Procedimentos Ortopédicos/normasRESUMO
Intravenous fluid administration is a medical intervention performed worldwide on a daily basis. Nevertheless, only a few physicians are aware of the characteristics of intravenous fluids and their possible effects on plasma acid-base equilibrium. According to Stewart's theory, pH is independently regulated by three variables: partial pressure of carbon dioxide, strong ion difference (SID), and total amount of weak acids (ATOT). When fluids are infused, plasma SID and ATOT tend toward the SID and ATOT of the administered fluid. Depending on their composition, fluids can therefore lower, increase, or leave pH unchanged. As a general rule, crystalloids having a SID greater than plasma bicarbonate concentration (HCO3-) cause an increase in plasma pH (alkalosis), those having a SID lower than HCO3- cause a decrease in plasma pH (acidosis), while crystalloids with a SID equal to HCO3- leave pH unchanged, regardless of the extent of the dilution. Colloids and blood components are composed of a crystalloid solution as solvent, and the abovementioned rules partially hold true also for these fluids. The scenario is however complicated by the possible presence of weak anions (albumin, phosphates and gelatins) and their effect on plasma pH. The present manuscript summarises the characteristics of crystalloids, colloids, buffer solutions and blood components and reviews their effect on acid-base equilibrium. Understanding the composition of intravenous fluids, along with the application of simple physicochemical rules best described by Stewart's approach, are pivotal steps to fully elucidate and predict alterations of plasma acid-base equilibrium induced by fluid therapy.
Assuntos
Equilíbrio Ácido-Base/efeitos dos fármacos , Transfusão de Componentes Sanguíneos/efeitos adversos , Transfusão de Componentes Sanguíneos/métodos , Coloides/efeitos adversos , Coloides/uso terapêutico , Soluções Isotônicas/efeitos adversos , Soluções Isotônicas/uso terapêutico , Soluções/efeitos adversos , Soluções/uso terapêutico , Coloides/administração & dosagem , Soluções Cristaloides , Hidratação , Humanos , Infusões Intravenosas , Soluções Isotônicas/administração & dosagem , Soluções/administração & dosagem , Água/metabolismoRESUMO
OBJECTIVE: To evaluate whether autologous conditioned plasma offers any therapeutic advantage over ultrasound-guided dry needling as a stand-alone procedure in the treatment of refractory lateral epicondylitis. MATERIALS AND METHODS: Prospective, randomized pilot study of 28 patients (11 men, 17 women, mean age, 49.1 years) with refractory lateral epicondylitis (mean symptom duration, 19.1 months) who underwent either dry needling (n = 13) or dry needling combined with autologous conditioned plasma (ACP) injection (n = 15). Each patient received two separate injections (0 weeks and 1 month) and analysis of visual analogue pain scores (VAS) and Nirschl scores were performed pre-procedure, at 2 months and final evaluation at 6 months. Successful treatment was defined as more than a 25 % reduction in pain scores without re-intervention. Data was analyzed using the Mann-Whitney test and local research ethics committee approval was obtained. RESULTS: At 2 months, the mean VAS improvement was 0.85 (12.3 %) in the dry needling group compared to 2.19 (27.1 %) in the ACP group (p = 0.76) and there was a 5.83-point and 20.3-point Nirschl score improvement respectively (p = 0.72). At the final follow-up of 6 months, the mean VAS improvement was 2.37 (34 %) in the dry needling group compared to 3.92 (48.5 %) in the ACP group (p = 0.74) and there was a 22.5-point and 40-point Nirschl score improvement, respectively (p = 0.82). CONCLUSIONS: There is a trend to greater clinical improvement in the short term for patients treated with additional ACP, however no significant difference between the two treatment groups was demonstrated at each follow-up interval. A larger, multicenter, randomized controlled trial is required to corroborate the results of this pilot study.
Assuntos
Terapia por Acupuntura/métodos , Artralgia/etiologia , Artralgia/prevenção & controle , Transfusão de Componentes Sanguíneos/métodos , Peptídeos e Proteínas de Sinalização Intercelular/uso terapêutico , Cotovelo de Tenista/complicações , Cotovelo de Tenista/terapia , Terapia por Acupuntura/instrumentação , Artralgia/diagnóstico , Doença Crônica , Terapia Combinada , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Cotovelo de Tenista/diagnóstico , Resultado do TratamentoRESUMO
Transfusion of blood and blood components is a common practice in obstetric wards but it is not without risk. The incidence of transfusion reactions varies from 4 in every hundred transfusions for non-haemolytic reactions to one in every 40,000 for haemolytic transfusion reactions. The physiological basis of blood transfusion is outlined in this article. Most of the donated blood is processed into components: packed red cells (PRBCs), platelets, and fresh frozen plasma (FFP) or cryoprecipitate. Various alternatives to blood transfusion exist and include autotransfusion, pre-autologous blood storage, use of oxygen carrying blood substitutes and intraoperative cell salvage. Despite the risks associated with transfusions, obstetricians are frequently too aggressive in transfusing blood and blood products to their patients. Acute blood loss in obstetrics is usually due to placenta praevia, postpartum blood loss and surgery related. An early involvement of a consultant obstetrician, anaesthetist, haematologist and the blood bank is essential. There are no established criteria for initiating red cell transfusions and the decision is purely based on clinical and haematological parameters, which have been discussed along with the general principles of blood transfusion in obstetrics and some practical guidelines.
Assuntos
Transfusão de Sangue/métodos , Parto Obstétrico/efeitos adversos , Hemorragia/etiologia , Hemorragia/terapia , Transfusão de Componentes Sanguíneos/métodos , Transfusão de Sangue Autóloga/métodos , Feminino , Humanos , Incidência , Guias de Prática Clínica como Assunto , Gravidez , Reação Transfusional/epidemiologiaAssuntos
Transfusão de Sangue/métodos , Administração de Caso , Anemia/terapia , Bancos de Sangue , Transfusão de Componentes Sanguíneos/efeitos adversos , Transfusão de Componentes Sanguíneos/métodos , Transfusão de Sangue Autóloga , Documentação , Humanos , Plasma , Transfusão de Plaquetas , Reação TransfusionalRESUMO
INTRODUCTION: Donor blood supplies are diminishing, becoming more costly and these transfusions lead to higher mortality in cardiac patients. The transfusion risks and the literature highlight the need for an alternative similar to cell salvage to be routinely considered. The Xtra is the first cell saver to be launched since 2001 and will undoubtedly initiate evolution towards the 'next generation' of cell savers. It is also the first to be launched in a new era where the demand for electronic perfusion data management (EPDM) has grown. RESULTS: The user interface (UI) was easy to use. The increased data entry options improved the quality of the recordable data. The integrated data management system (DMS) was comprehensive. Data was easy to manage and enabled central data compilation, which reduces repeated data, the risk of inconsistent data inventory and provides the potential for research and analyses. The haematocrit of the processed blood is a key quality indicator for cell salvage. The comparison of the manufacturer's integrated protocol, Popt, to our team's own protocol showed that Popt delivered a higher haematocrit on its '1st bowl' (59.1% compared to 57.3%) and its 'total process' end product haematocrit was 0.68% higher. The Popt cycle took an average of 330s, whereas our own settings completed in just over 300s. CONCLUSION: The Xtra is a device which will lead the evolution of 'next generation' cell saver technology. The user interface and data management system provide export options and the ability to record the level of data required for good EPDM. This is essential to 'future proof' cell salvage technology. The manufacturer's integrated protocol achieved a higher end product haematocrit than our perfusion team's best practice. The design of the Xtra is contemporary, but the DMS equips this cell saver for the new era that faces both Perfusion and Cardiac Surgery.
Assuntos
Transfusão de Componentes Sanguíneos/instrumentação , Doadores de Sangue , Transfusão de Sangue Autóloga/instrumentação , Armazenamento e Recuperação da Informação/métodos , Interface Usuário-Computador , Transfusão de Componentes Sanguíneos/métodos , Transfusão de Sangue Autóloga/métodos , Estudos de Avaliação como Assunto , Hematócrito/instrumentação , Hematócrito/métodos , HumanosRESUMO
BACKGROUND: Reduced use of allogenic blood components is a key issue in cardiac surgery. Several methods to conserve blood have been used; reinfusion of shed mediastinal blood (RSMB) has found widespread acceptance, but the efficacy and safety are still debated. The purpose of this study was to evaluate the effects of RSMB on the use of allogenic blood components and selected complications. MATERIAL AND METHODS: Six hundred and twenty-three consecutive cardiac surgery patients in three successive periods, of whom patients in the middle period did not receive RSMB due to manufacturer delivery problems, were evaluated. Patients and procedures were characterized by EuroSCORE. Prospective collected data were: units of transfused allogenic blood, fresh frozen plasma (FFP) and platelets, postoperative blood loss and postoperative complications such as dialysis, re-operation due to bleeding, sternal infection and stroke. Length of stay in ICU was used as a general indicator of perioperative complications. RESULTS: The number of patients receiving allogenic blood in periods with RSMB was significantly lower (36.5% versus 54.9%, p<0.005), while no difference was seen in FFP and platelets. The average number of transfused blood units was lower in patients receiving RSMB (2.07 versus 3.41, p=0.029), while FFP (1.34 versus 2.01, p=0.11) and platelets (0.58 versus 0.95, p=0.05) were not statistically significantly different. Postoperative bleeding was lower (759 versus 967 ml, p=0.032) in the periods with RSMB. CONCLUSION: Patients receiving RSMB were less transfused with allogenic blood and had less postoperative drainage, while the frequency of observed postoperative complications was not different from patients who did not receive RSMB.
Assuntos
Transfusão de Sangue Autóloga/métodos , Transfusão de Sangue/métodos , Procedimentos Cirúrgicos Cardíacos , Complicações Pós-Operatórias/etiologia , Idoso , Transfusão de Componentes Sanguíneos/métodos , Perda Sanguínea Cirúrgica , Feminino , Humanos , Masculino , Mediastino/irrigação sanguínea , Pessoa de Meia-Idade , Hemorragia Pós-Operatória , Período Pós-Operatório , Estudos ProspectivosRESUMO
BACKGROUND: We tried to evaluate a putative negative effect on coronary atherosclerosis in patients receiving intracoronary infusion of unfractionated bone marrow mononuclear cells (BMMC) following an acute ST-elevation myocardial infarction. Peripheral blood mononuclear cells or enriched CD133(+) BMMC have been associated with accelerated atherosclerosis of the distal segment of the infarct related artery (IRA). METHODS: Thirty-seven patients with ST-elevation myocardial infarction from the TECAM pilot study underwent intracoronary infusion of autologous BMMC 9 +/- 3.1 days after onset of symptoms. We compared angiographic changes from baseline to 9 months of follow-up in the distal non-stented segment of the IRA, as well as in the contralateral coronary artery, with a matched control group. A subgroup of 15 treated patients underwent additional IVUS within the distal segment of the IRA. RESULTS: No difference between stem cell and control group were found regarding changes in minimum lumen diameter (0.006 +/- 0.42 vs 0.06 +/- 0.41 mm, P = ns) and the percentage of stenosis (-2.68 +/- 12.33% vs -1.78 +/- 8.75%, P = ns) at follow-up. Likewise, no differences were seen regarding changes in the contralateral artery (minimum lumen diameter -0.004 +/- 0.54 mm vs -0.06 +/- 0.35 mm, P = ns). In the intravascular ultrasound substudy, no changes were demonstrated comparing baseline versus follow-up in maximum area stenosis and plaque volume. CONCLUSIONS: In this pilot study, analysis of a subgroup of patients found that intracoronary injection of unfractionated BMMC in patients with acute ST-elevation myocardial infarction was not associated with accelerated atherosclerosis progression at mid term. Prospective, randomised studies in large cohorts with long-term angiographic and intravascular ultrasound follow-up are necessary to determine the safety of this therapy.
Assuntos
Aterosclerose/cirurgia , Transfusão de Componentes Sanguíneos/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Macrófagos/transplante , Infarto do Miocárdio/terapia , Ultrassonografia de Intervenção/métodos , Aterosclerose/complicações , Aterosclerose/diagnóstico , Transfusão de Sangue Autóloga , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Vasos Coronários , Progressão da Doença , Feminino , Seguimentos , Humanos , Infusões Intra-Arteriais , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Projetos Piloto , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVES: This study aimed to determine whether serial autologous infusions of selective high-density lipoprotein (HDL) delipidated plasma are feasible and well tolerated in patients with acute coronary syndrome (ACS). BACKGROUND: Low HDL is associated with increased risk of cardiovascular disease. Plasma selective delipidation converts alphaHDL to prebeta-like HDL, the most effective form of HDL for lipid removal from arterial plaques. METHODS: ACS patients undergoing cardiac catheterization with >or=1 nonobstructive native coronary artery atheroma were randomized to either 7 weekly HDL selective delipidated or control plasma apheresis/reinfusions. Patients underwent intravascular ultrasound (IVUS) evaluation of the target vessel during the catheterization for ACS and up to 14 days following the final apheresis/reinfusion session. 2-D gel electrophoresis of delipidated plasmas established successful conversion of alphaHDL to prebeta-like HDL. The trial was complete with 28 patients randomized. RESULTS: All reinfusion sessions were tolerated well by all patients. The levels of prebeta-like HDL and alphaHDL in the delipidated plasma converted from 5.6% to 79.1% and 92.8% to 20.9%, respectively. The IVUS data demonstrated a numeric trend toward regression in the total atheroma volume of -12.18 +/- 36.75 mm(3) in the delipidated group versus an increase of total atheroma volume of 2.80 +/- 21.25 mm(3) in the control group (p = 0.268). CONCLUSIONS: In ACS patients, serial autologous infusions of selective HDL delipidated plasma are clinically feasible and well tolerated. This therapy may offer a novel adjunct treatment for patients presenting with ACS. Further study will be needed to determine its ability to reduce clinical cardiovascular events.
Assuntos
Síndrome Coronariana Aguda/terapia , Transfusão de Componentes Sanguíneos/métodos , Lipoproteínas HDL/administração & dosagem , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/diagnóstico , Adulto , Idoso , Transfusão de Sangue Autóloga , Eletroforese em Gel Bidimensional , Ensaio de Imunoadsorção Enzimática , Feminino , Seguimentos , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Método Simples-Cego , Resultado do Tratamento , Ultrassonografia de IntervençãoRESUMO
Management of bleeding in the neonate, infant, or child presents its own set of dilemmas and challenges. One of the primary problems is the lack of good scientific evidence regarding the best management strategies for children rather than for adults. The key to success in the predicament is firstly to ensure that the physician has a clear understanding of the underlying normal physiology of the young child's hematologic status. Then by adding knowledge of the abnormal pathology that is being presented, the physician can at least understand what anomalies he or she is facing. Once all the available information concerning the patient's clinical condition and the options available has been well digested, a multidisciplinary approach allows the optimal use of all available resources. Good teamwork, understanding, and communication between all vested parties allows for a synergistic relationship to enhance patient care and give the best available end result.
Assuntos
Anestesia/métodos , Transfusão de Componentes Sanguíneos/métodos , Preservação de Sangue/métodos , Algoritmos , Transfusão de Componentes Sanguíneos/efeitos adversos , Transfusão de Sangue Autóloga/efeitos adversos , Transfusão de Sangue Autóloga/métodos , Criança , Pré-Escolar , Eritropoetina/uso terapêutico , Hemodiluição/efeitos adversos , Hemodiluição/métodos , Humanos , Lactente , Recém-Nascido , Guias de Prática Clínica como Assunto , Proteínas Recombinantes , Fatores de RiscoRESUMO
Blood loss and transfusion tactics were analyzed in 131 patients who had undergone correction of one, two, and three cardiac valves under general balanced anesthesia and extracorporeal circulation. The volume of intraoperative blood loss was 869+/-298 ml with the range of 700 to 2000 ml. Packed red cells (PRC) were transfused to 9% of patients; fresh frozen plasma (FFP) in 10%, PRC and FFP were transfused to 17% patients. Donor blood was not used in 63.5% of patients in order to save the patient's blood. It comprised the preoperative storage of autologous plasma in a quantity of 300-700 ml, the modified intraoperative reservation of autologous blood in a volume of 400-1200 ml, and, in 70% of patients, the use of washed autologous red blood cells. The hemostasis protocol included the use of epsilon-aminocapronic acid, aprotinin (trasilol) not more than 2,000,000 KUE, and packed platelets. For adequate heparin neutralization, after administration of the calculated dose of protamine, it was long administered in a dose of 25 mg/hour for 4-5 hours. The developed and introduced comprehensive program for the patient's blood maintenance and blood loss diminution made it possible to avoid transfusing PRC and FFP in more than 60% of patients with a blood loss volume of as high as 1500 ml; and to maintain adequate oxygen balance and hemostasis in the remaining patients.