Autologous Blood Transfusion During Elective Surgery in a Candidate for Living Donor Transplantation: A Case Report.

BACKGROUND: Blood transfusions are risk factors for alloimmunization and unfavorable outcomes in solid organ transplant recipients. PURPOSE: We propose the adoption of autologous blood transfusion (ABT) in transplant candidates and recipients referred to elective surgery. METHODS: We present a case of a 45-year-old man with chronic kidney disease stage 5 due to polycystic kidney disease, who was qualified for a native kidney nephrectomy (NKN) before kidney transplantation. Before the scheduled surgery, the patient was referred to a blood donation center for blood collection. RESULTS: During 2 consecutive visits, autologous blood was collected uneventfully, and this allowed for the preparation of 2 units of red blood cell concentrates and a unit of plasma. Pre- and post-donation hemoglobin values were 11.9 and 10.4 g/dL, respectively. The NKN procedure was complicated by intra-abdominal bleeding from an accessory aberrant artery of the kidney. Hemoglobin dropped to 6.8 g/dL and was treated with ABT, followed by artery embolization. This allowed for an increase of hemoglobin to 8.3 mg/dL and avoidance of allotransfusion. Six weeks after NKN, the patient underwent successful kidney transplantation from a living donor. Panel reactive antibodies before transplantation were 0%, and graft function has been excellent during 20 months of observation. CONCLUSION: An autologous blood collection is a feasible option for patients with chronic kidney disease. ABT should be considered the procedure of choice when qualifying potential waiting list candidates and solid organ recipients for elective surgeries.

COVID-19 in unvaccinated patients with inborn errors of immunity-polish experience.

At the beginning of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic, patients with inborn errors of immunity (IEI) appeared to be particularly vulnerable to a severe course of the disease. It quickly turned out that only some IEI groups are associated with a high risk of severe infection. However, data on the course of Coronavirus Disease 2019 (COVID-19) in patients with IEI are still insufficient, especially in children; hence, further analyses are required. The retrospective study included 155 unvaccinated people with IEI: 105 children and 50 adults (67.7% and 32.3%, respectively). Male patients dominated in the study group (94 people, 60.6%). At least two comorbidities were found in 50 patients (32.3%), significantly more often in adults (56% vs. 21%). Adult patients presented significantly more COVID-19 symptoms. Asymptomatic and mildly symptomatic course of COVID-19 was demonstrated in 74.8% of the entire group, significantly more often in children (88.6% vs. 46%). Moderate and severe courses dominated in adults (54% vs. 11.4%). Systemic antibiotic therapy was used the most frequently, especially in adults (60% vs. 14.3%). COVID-19-specific therapy was used almost exclusively in adults. In the whole group, complications occurred in 14.2% of patients, significantly more often in adults (30% vs. 6.7%). In the pediatric group, there were two cases (1.9%) of multisystem inflammatory syndrome in children. Deaths were reported only in the adult population and accounted for 3.9% of the entire study group. The death rate for all adults was 12%, 15.4% for adults diagnosed with common variable immunodeficiency, 12.5% for those with X-linked agammaglobulinemia, and 21.4% for patients with comorbidity. The results of our study imply that vaccinations against COVID-19 should be recommended both for children and adults with IEI. Postexposure prophylaxis and early antiviral and anti-SARS-CoV-2 antibody-based therapies should be considered in adults with IEI, especially in those with severe humoral immune deficiencies and comorbidity.

Difficulties in the treatment of recurring diffuse alveolar hemorrhage accompanying primary antiphospholipid syndrome: a case report and literature review.

Pulmonary embolism is the most common pulmonary manifestation of primary antiphospholipid syndrome (PAPS). However, PAPS may manifest in the respiratory system also due to non-thrombotic processes. In the following paper we present a case of PAPS-related diffuse alveolar hemorrhage (DAH). Because of sparse literature and a lack of randomized controlled trials, there are currently no recommendations regarding the optimal choice of steroid-sparing agent in treating PAPS-related DAH. In our patient, treatment with cyclophosphamide or mycophenolate mofetil along with low dose prednisone was ineffective, partially because of infectious complications, whereas addition of monthly intravenous immunoglobulin to mycophenolate mofetil and prednisone, appears to control the disease.

High serum interleukin-18 concentrations in patients with coronary artery disease and type 2 diabetes mellitus.

AIMS: The aim of our study was to analyse the serum level of interleukin 18 (IL-18) in coronary artery disease (CAD) patients with type 2 diabetes mellitus (DM), and to relate this to clinical findings. METHODS: The IL-18 level was measured by ELISA in serum samples from 130 CAD patients prior to their first, elective, coronary artery bypass surgery. Forty-three of them had been diabetic for several years. A control group consisted of 31 healthy people matched according to age, BMI, lipid and smoking status. RESULTS: The CAD patients with DM were similar to the non-diabetic CAD patients with respect to age, BMI, grade of heart failure, ejection fraction. There were no differences in the duration of CAD, history of myocardial infarction and PTCA or instability of angina. The serum level of IL-18 was higher in the CAD patients than in the control group. The CAD patients with DM had a higher concentration of IL-18 compared to the non-diabetic CAD group. The diabetic patients with triple-vessel disease were characterized by a higher concentration of IL-18 than the non-diabetic patients with the same grade of CAD. Smoking affected the IL-18 concentration, particularly in the diabetic patients. CONCLUSION: Type 2 DM predisposes patients, especially those with multi-vessel CAD who were smokers, to a higher serum level of IL-18, which may help explain their vulnerability to fatal, secondary cardiovascular events. These patients should be in the first line for stringent, secondary cardiovascular prevention.

[Cyclosporine in the treatment of atypical celiac sprue. A case report]. / Zastosowanie cyklosporyny w leczeniu atypowej postaci choroby trzewnej. Opis przypadku.

We present a 45-year-old woman with atypical celiac sprue who was unresponsive to gluten-free diet. Cyclosporine therapy was applied (5 mg/kg body weight daily for 2 months). The patient demonstrated a remarkable clinical and histological response to this drug.