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1.
J Clin Apher ; 34(3): 171-354, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31180581

RESUMO

The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating and categorizing indications for the evidence-based use of therapeutic apheresis (TA) in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Eighth Edition of the JCA Special Issue continues to maintain this methodology and rigor in order to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Eighth Edition, like its predecessor, continues to apply the category and grading system definitions in fact sheets. The general layout and concept of a fact sheet that was introduced in the Fourth Edition, has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of TA in a specific disease entity or medical condition. The Eighth Edition comprises 84 fact sheets for relevant diseases and medical conditions, with 157 graded and categorized indications and/or TA modalities. The Eighth Edition of the JCA Special Issue seeks to continue to serve as a key resource that guides the utilization of TA in the treatment of human disease.


Assuntos
Remoção de Componentes Sanguíneos/métodos , Medicina Baseada em Evidências/normas , Humanos , Terapêutica/métodos , Estados Unidos , Redação
2.
Front Neurol ; 10: 556, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31231298

RESUMO

Background: Nearly 20% of US adolescents report at least one lifetime concussion. Pathophysiologic models suggest that traumatic biomechanical forces caused by rotational deceleration lead to shear stress, which triggers a neurometabolic cascade beginning with excitotoxicity and leading to significant energy demands and a period of metabolic crisis for the injured brain. Proton magnetic resonance spectroscopy (1H MRS) offers a means for non-invasive measurement of neurometabolic changes after concussion. Objective: Describe longitudinal changes in metabolites measured in vivo in the brains of adolescent patients with concussion. Methods: We prospectively recruited 9 patients ages 11 to 20 who presented to a pediatric Emergency Department within 24 h of concussion. Patients underwent MRI scanning within 72 h (acute, n = 8), 2 weeks (subacute, n = 7), and at approximately 1 year (chronic, n = 7). Healthy, age and sex-matched controls were recruited and scanned once (n = 9). 1H MRS was used to measure N-acetyl-aspartate, choline, creatine, glutamate + glutamine, and myo-inositol concentrations in six regions of interest: left and right frontal white matter, posterior white matter and thalamus. Results: There was a significant increase in total thalamus glutamate+glutamine/choline at the subacute (p = 0.010) and chronic (p = 0.010) time points, and a significant decrease in total white matter myo-inositol/choline (p = 0.030) at the chronic time point as compared to controls. Conclusion: There are no differences in 1H MRS measurements in the acute concussive period; however, changes in glutamate+glutamine and myo-inositol concentrations detectable by 1H MRS may develop beyond the acute period.

4.
Pediatr Blood Cancer ; 66(7): e27733, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30941859

RESUMO

BACKGROUND: Patients with sickle cell disease (SCD) may require chronic transfusion therapy (CTT) for prevention of stroke or other complications. Limited health literacy (HL) is common and is associated with poor health-related knowledge and outcomes in chronic disease. We sought to assess HL and transfusion knowledge in patients with SCD on CTT and their caregivers. METHODS: A cross-sectional study of patients was conducted in outpatient hematology clinics. Forty-five pairs of adolescent patients and caregivers and 20 caregivers of pre-adolescent patients completed the Newest Vital Sign HL assessment and answered questions assessing SCD and transfusion knowledge. Community-level median income and unemployment rates were estimated from Census data. We computed the correlation of HL with knowledge and compared each to Census variables, payor status, educational attainment, and stroke. RESULTS: HL was inadequate in 22 (34%) caregivers and 31 (69%) adolescents. Adequate caregiver HL was associated with higher educational attainment but not community-level socioeconomics or payor status. Mean knowledge score was lower in adolescents than in caregivers and correlated with age in adolescents (r = 0.42, P = .004). HL correlated with knowledge (r = 0.46, P < .0001). There were no significant correlations of HL or knowledge between adolescents and their caregivers. Neither HL nor knowledge was associated with prior stroke. The greatest knowledge was demonstrated for iron overload and SCD genotype, whereas knowledge gaps existed in alloimmunization, indication for CTT, and SCD curative therapy. CONCLUSIONS: Enhanced educational resources in transfusion therapy, alloimmunization, and curative therapy are needed for patients with SCD and caregivers of all HL levels.


Assuntos
Anemia Falciforme/terapia , Transfusão de Sangue , Cuidadores , Alfabetização em Saúde , Acidente Vascular Cerebral/prevenção & controle , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
J Perinat Neonatal Nurs ; 33(4): 291-300, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30741751

RESUMO

Social media has been influential in decision making regarding a number of health concerns. However, comparatively little has been examined with regard to its effects on pregnant women. The goal of this scoping review was to examine the literature and identify the role of social media in intrapartum decision making. A scoping review of the literature published between January 1990 and June 2018 was performed using PubMed, CINAHL, EMBASE, PsychINFO, Web of Science, and Cochrane databases. Of the initial 1951 records reviewed, 5 met inclusion criteria. Two of the 5 were quantitative in design, 1 was qualitative, and 2 used mixed methods. Internationally widespread, studies largely took place in developed nations including the United States, the United Kingdom, Canada, Australia, New Zealand, and Finland. Women are using the Internet, including social media, consistently as a source of pregnancy information, for example, 97% of 2400 participates in 1 exploratory study. This knowledge seeking was found to increase women's confidence and self-assurance in making decision during labor and birth. Studies identified issues surrounding women's ability to appraise available information. While it is clear that social media has an influence on women's intrapartum decision making, it is not clear exactly how. Further studies are needed to determine the content of the social media being appraised, the accuracy of the information, and the resulting decision as it affects the intrapartum experience. In addition, efforts should be made to open lines of communication between patients and care providers. This may foster a greater clinical understanding of social media consumption and its influences.

6.
Am J Clin Pathol ; 151(1): 116-121, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30239572

RESUMO

Objectives: Knowledge of transfusion medicine by medical students is limited. Transfusion medicine physicians developed, implemented, and evaluated a half-day elective on transfusion medicine for fourth-year medical students. Methods: The course included a didactic lecture with integrated audience response questions and role-playing, as well as a "Jeopardy"-style game to review the material. The same 10-question knowledge quiz was administered before and after the elective. Results: Both knowledge quizzes were taken by 102 students. An average score of 3.3 was obtained on the initial quiz, with only three (3%) students having a passing score (≥6 correct questions). The average score after the elective was 6.6, with 83 (81%) students having a passing score. Students found the elective was informative (62 students, 60.8%), very useful (56, 54.9%), and practical (51, 50%), although some thought it was challenging (22, 21.6%). Conclusions: A short course for medical students that allowed repetition of concepts using several teaching modalities improved their knowledge in transfusion medicine.


Assuntos
Bancos de Sangue , Currículo , Educação Médica , Medicina Transfusional/educação , Humanos , Faculdades de Medicina , Estudantes de Medicina
7.
Transfus Med Rev ; 33(1): 12-23, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30122266

RESUMO

Red blood cells (RBC) transfusion is critical in managing acute and chronic complications in sickle cell disease (SCD); however, it is complicated by RBC alloimmunization, iron overload, transfusion reactions and infection. Several reports documented an increased incidence of alloantibodies in transfused individuals with SCD, especially for Rh and Kell antigens. As a result, the National Institutes of Health Expert Panel and British Society for Haematology guidelines recommend primary matching for C/c, E/e and K antigens in addition to ABO/RhD for RBC transfusions. However, the evidence supporting these recommendations was cited as limited and understanding of alloimmunization in SCD is evolving. To examine the limitations of the evidence, we undertook a systematic review of evidence behind recommendations for limited and extended serologic and genotypic RBC antigen matching to reduce alloimmunization, autoimmunization and transfusion reactions. Searches of PubMed, Embase, Cochrane, and Web of Science databases using MeSH index and free text terms between 1976 through October 2015 and papers and captured through July 2016 through review references in papers, word of mouth, and ongoing Google Scholar and Medline Alerts identified 303 unique articles. Nineteen articles met inclusion criteria and were classified by the Oxford Centre Evidence Based levels of evidence. Strengthening the Reporting of Observational Studies in Epidemiology checklists were completed for 18 of the 19 studies. There were no prospective randomized controlled trials. Sixteen of the articles were cohort studies, two were cross-sectional studies, and one decision tree model examining costs. Low-quality evidence from observational cohort studies supports that alloimmunization prevalence can be decreased by extending serological RBC antigen matching. Transfusion reactions are generally poorly and inconsistently reported. There was no evidence reporting the effect prophylactic genotypic matching has on alloimmunization, autoimmunization or transfusion reactions. There were no studies comparing prophylactic genotypic matching to serologic matching. High-quality evidence was lacking to support clinical decision making regarding best transfusion practices. Multicenter prospective randomized clinical trials are needed to determine best strategies for reducing the rate of alloimmunization using serologic and genotypic matching.


Assuntos
Anemia Falciforme/complicações , Anemia Falciforme/terapia , Transfusão de Sangue , Isoanticorpos/sangue , Reação Transfusional/etiologia , Sistema do Grupo Sanguíneo ABO , Incompatibilidade de Grupos Sanguíneos/imunologia , Tipagem e Reações Cruzadas Sanguíneas , Estudos Transversais , Transfusão de Eritrócitos/efeitos adversos , Eritrócitos/imunologia , Genótipo , Humanos , Estudos Observacionais como Assunto , Estudos Prospectivos , Sistema do Grupo Sanguíneo Rh-Hr , Reação Transfusional/complicações
8.
ASAIO J ; 64(3): 382-388, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28863043

RESUMO

The epidemiology, safety, and efficacy of pediatric multiple tandem extracorporeal therapies are not well understood. We conducted a retrospective chart review of therapeutic apheresis (TA) from January 1, 2012 to October 31, 2015. We collected procedural/clinical demographics, American Society for Apheresis (ASFA) indication, complications, and mortality. One hundred eighty tandem TA procedures were performed in 53 patients. Median age was 9 years (range: 2 months to 21 years) with a median weight of 28 kg (range: 6-170.3 kg) with nine patients weighing < 10 kg. Forty-five percent of patients were in tandem with continuous veno-venous hemofiltration (CVVH), 21% cardiopulmonary bypass (CPB), 4% extracorporeal membrane oxygenation (ECMO), and 11% had multiple extracorporeal therapies (CVVH and ECMO). Common indications were solid organ transplant (50% cardiac, 13% renal) and sepsis-induced thrombocytopenia-associated multiple organ failure (26%). Equipment (4%) and patient (4%) complications occurred, with rare failure (1%) and no procedure-related mortality. Tandem procedures are used in critically ill pediatric patients with higher morbidity and mortality (21%) than typical TA patients. The high percentage of patients outside of category I or II (83%) underscores the emerging nature of tandem extracorporeal therapies and need for further investigation.


Assuntos
Remoção de Componentes Sanguíneos/efeitos adversos , Remoção de Componentes Sanguíneos/métodos , Adolescente , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/métodos , Criança , Pré-Escolar , Estado Terminal , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Hemofiltração/efeitos adversos , Hemofiltração/métodos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
9.
World Neurosurg ; 111: 6-15, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29223518

RESUMO

BACKGROUND: Atypical teratoid/rhabdoid tumor (AT/RT) of the central nervous system (CNS) with synchronous or metachronous extra-CNS disease is a rare childhood malignancy with a dismal prognosis. CASE DESCRIPTION: We report a 7-week-old female with metastatic AT/RT and synchronous malignant rhabdoid tumor of the kidney who received an intensive multimodal approach combining surgical resection, intrathecal chemotherapy, and high-dose chemotherapy with autologous peripheral blood stem cell transplant (PBSCT). She is currently 24 months old without any evidence of disease. In addition, we completed an extensive literature review of cases with CNS AT/RT and synchronous or metachronous extra-CNS primary tumors. To date, 31 pediatric cases have been reported, and the median overall-survival was 6 months after diagnosis. The only 3 survivors received autologous PBSCT, and 2 of these patients had complete resection of their CNS tumor. CONCLUSIONS: The rarity of CNS AT/RT with extra-CNS primary disease and the lack of standard treatment contribute to its reported dismal prognosis. We report a case of a long-term survivor with metastatic AT/RT and synchronous extra-CNS primary tumor. Maximal surgical resection, intrathecal chemotherapy, and consolidative autologous PBSCT may improve prognosis and avoid radiation.


Assuntos
Neoplasias do Sistema Nervoso Central/cirurgia , Neoplasias Renais/cirurgia , Tumor Rabdoide/cirurgia , Teratoma/cirurgia , Adrenalectomia , Terapia Combinada , Feminino , Humanos , Lactente , Neoplasias Infratentoriais/cirurgia , Nefrectomia , Transplante de Células-Tronco de Sangue Periférico , Sobreviventes , Resultado do Tratamento
10.
J Clin Apher ; 33(3): 297-302, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29139162

RESUMO

INTRODUCTION: Therapeutic apheresis (TA) is used inconsistently in pediatric populations. We seek to define our multidisciplinary institutional practice. METHODS: We conducted a retrospective chart review of patients receiving TA from January 1, 2012 through October 31, 2015. Data collected included demographics, American Society of Apheresis (ASFA) indication, complications, and mortality. RESULTS: Over 46 months, 1198 TA procedures were conducted on 289 patients ranging in age from 5 months to 21 years with weights ranging from 4.76 to 170.3 kg (16 procedures in patients <10 kg). The procedures were 86% therapeutic plasma exchange, 10% red blood cell exchange, 4% extracorporeal photopheresis, and 5 leukocytapheresis procedures. TA was initiated in different clinical environments: 41% outpatient, 37% intensive care, 15% general inpatient, and 7% operating room. The ASFA category (6th edition) indications for the 1198 procedures included: 44% category I, 25% category II, 23% category III, a single category IV procedure, and the remainder (8%) uncategorized by ASFA. The rate of procedure failure and procedure-related mortality are 1 and 0%, respectively. Case mortality rate was 4%. CONCLUSION: At a large volume pediatric hospital, TA is commonly used and can be performed safely in a variety of settings by a multidisciplinary team. This demographic review catalogs the number and type of procedures performed as a second-line therapy or on the basis of limited evidence. Additional collaborative investigation is needed to evaluate unique implications of TA in pediatrics to maximize efficacy while preserving safety.


Assuntos
Remoção de Componentes Sanguíneos/métodos , Adolescente , Remoção de Componentes Sanguíneos/mortalidade , Criança , Pré-Escolar , Transfusão de Eritrócitos , Humanos , Lactente , Leucaférese , Masculino , Fotoferese , Troca Plasmática , Estudos Retrospectivos , Adulto Jovem
11.
Transfusion ; 57(3): 525-532, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28164304

RESUMO

BACKGROUND: Red blood cell (RBC) antigen matching policies to prevent alloimmunization in females of childbearing potential (FCP) vary between centers. To inform transfusion centers responsible for making decisions about matching policies for FCPs, the causal stimulus of the antibodies implicated in severe hemolytic disease of the fetus and newborn (HDFN) must be determined. STUDY DESIGN AND METHODS: We conducted a multinational retrospective study of women with offspring affected by severe HDFN requiring neonatal exchange transfusion and/or intrauterine transfusion. Mothers treated at centers that provide extended antigen-negative RBCs (MATCH, five centers) and those that do not (NoMATCH, nine centers) were compared. RESULTS: A total of 293 mothers had at least one affected pregnancy: 179 at MATCH centers and 114 at NoMATCH centers. Most alloimmunization (83%) was attributed to previous pregnancy: 3% to transfusion (two cases at MATCH, six at NoMATCH centers) and 14% undetermined (both antecedent transfusion and pregnancy). Only 50 mothers had received transfusions; 13 had HDFN due to anti-K at MATCH and four at NoMATCH centers. Most (12/13, 92%) of the anti-K HDFN cases at MATCH centers had K+ paternal antigen status. Mothers at the MATCH centers do not appear to be protected from HDFN due to K, C, c, and E antibodies, although the low number of FCPs who received transfusions precluded drawing firm conclusions. CONCLUSION: The causal stimulus of antibodies that cause HDFN is predominantly from previous pregnancy. Although extended RBC matching for FCPs may impart some protection from allosensitization, we were unable to show a positive effect, possibly because matching policies are not uniform and there was a small number of mothers who previously received transfusions.


Assuntos
Antígenos de Grupos Sanguíneos/sangue , Tipagem e Reações Cruzadas Sanguíneas , Transfusão Feto-Materna , Isoanticorpos/sangue , Adulto , Eritroblastose Fetal/sangue , Eritroblastose Fetal/epidemiologia , Feminino , Transfusão Feto-Materna/sangue , Transfusão Feto-Materna/epidemiologia , Humanos , Gravidez , Estudos Retrospectivos
12.
Neurosurgery ; 80(2): 193-200, 2017 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-28173590

RESUMO

Background: Using diffusion tensor imaging (DTI) in neurosurgical planning allows identification of white matter tracts and has been associated with a reduction in postoperative functional deficits. Objective: This study explores the relationship between the lesion-to-tract distance (LTD) and postoperative morbidity and mortality in patients with brain tumors in order to evaluate the role of DTI in predicting postoperative outcomes. Methods: Adult patients with brain tumors (n = 60) underwent preoperative DTI. Three major white matter pathways (superior longitudinal fasciculi [SLF], cingulum, and corticospinal tract) were identified using DTI images, and the shortest LTD was measured for each tract. Postoperative morbidity and mortality information was collected from electronic medical records. Results: The ipsilesional corticospinal tract LTD and left SLF LTD were significantly associated with the occurrence rate of total postoperative motor (P = .018) and language (P < .001) deficits, respectively. The left SLF LTD was also significantly associated with the occurrence rate of new postoperative language deficits (P = .003), and the LTD threshold that best predicted this occurrence was 1 cm (P < .001). Kaplan­Meier log-rank survival analyses in patients having high-grade tumors demonstrated a significantly higher mortality for patients with a left SLF LTD <1 cm (P = .01). Conclusion: Measuring tumor proximity to major white matter tracts using DTI can inform clinicians of the likelihood of postoperative functional deficits. A distance of 1 cm or less from eloquent white matter structures most significantly predicts the occurrence of new deficits with current surgical and imaging techniques.


Assuntos
Neoplasias Encefálicas , Imagem de Tensor de Difusão , Substância Branca , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/patologia , Humanos , Morbidade , Estudos Retrospectivos , Substância Branca/diagnóstico por imagem , Substância Branca/patologia
13.
Arch Pathol Lab Med ; 141(3): 329-340, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28234571

RESUMO

Current genotyping methodologies for transplantation and transfusion management employ multiplex systems that allow for simultaneous detection of multiple HLA antigens, human platelet antigens, and red blood cell (RBC) antigens. The development of high-resolution, molecular HLA typing has led to improved outcomes in unrelated hematopoietic stem cell transplants by better identifying compatible alleles of the HLA-A, B, C, DRB1, and DQB1 antigens. In solid organ transplantation, the combination of high-resolution HLA typing with solid-phase antibody identification has proven of value for highly sensitized patients and has significantly reduced incompatible crossmatches at the time of organ allocation. This database-driven, combined HLA antigen/antibody testing has enabled routine implementation of "virtual crossmatching" and may even obviate the need for physical crossmatching. In addition, DNA-based testing for RBC antigens provides an alternative typing method that mitigates many of the limitations of hemagglutination-based phenotyping. Although RBC genotyping has utility in various transfusion settings, it has arguably been most useful for minimizing alloimmunization in the management of transfusion-dependent patients with sickle cell disease or thalassemia. The availability of high-throughput RBC genotyping for both individuals and large populations of donors, along with coordinated informatics systems to compare patients' antigen profiles with available antigen-negative and/or rare blood-typed donors, holds promise for improving the efficiency, reliability, and extent of RBC matching for this population.


Assuntos
Tipagem e Reações Cruzadas Sanguíneas/métodos , Técnicas de Genotipagem/métodos , Transfusão de Sangue/métodos , Humanos , Transplante de Órgãos/métodos , Transfusão de Plaquetas/métodos
14.
Transfus Med Rev ; 30(4): 217-22, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27555064

RESUMO

Apheresis technology has progressed significantly over the last 50-60 years from a predominately blood donation-based procedure to one that now includes a variety of therapeutic modalities. The last 25 years also has seen an increase in the number of diseases treated by therapeutic apheresis (TA) modalities. Because of ethical considerations, therapeutic modalities are often vetted first in adult populations before establishing utility in pediatric patients. TA is no different. The majority of published studies involve adult patients. Pediatric apheresis studies are traditionally retrospective, single-center experiences, single case reports, or case series. To confirm this, we evaluated the peer-reviewed published literature to assess the level of evidence of clinical pediatric apheresis studies published in the last 21 years. Adverse events experienced by pediatric patients undergoing TA procedures and procedural modifications necessary to accommodate pediatric patients receiving TA were also explored. Consideration was given to differences in disease outcomes in pediatric vs adult patients and evolution of TA treatment indications. A systematic search of the literature yielded >1000 pediatric apheresis publications. Only 370 articles specifically assessed TA in the treatment of a pediatric disease. Of those, the majority (98%) were single-center experiences, single case reports, or case series. The remaining 2% were prospective cohort studies or randomized controlled trials. This first formal assessment of the pediatric apheresis literature confirms the findings of previous anecdotal reports and expert opinion.


Assuntos
Remoção de Componentes Sanguíneos/efeitos adversos , Remoção de Componentes Sanguíneos/métodos , Medicina Baseada em Evidências , Hematologia/métodos , Adolescente , Doadores de Sangue , Criança , Pré-Escolar , Hematologia/tendências , Humanos , Lactente , Recém-Nascido , Pediatria/métodos , Estudos Prospectivos , Projetos de Pesquisa , Estudos Retrospectivos
15.
Transfus Med Rev ; 30(4): 165-73, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27424006

RESUMO

Red blood cell (RBC) transfusion is a common and lifesaving therapy for anemic neonates and infants, particularly among those born prematurely or undergoing surgery. However, evidence-based indications for when to administer RBCs and adverse effects of RBC transfusion on important outcomes including necrotizing enterocolitis, survival, and long-term neurodevelopmental impairment remain uncertain. In addition, blood-banking practices for preterm and term neonates and infants have been largely developed using studies from older children and adults. Use of and refinements in emerging technologies and advances in biomarker discovery and neonatal-specific RBC transfusion databases may allow clinicians to better define and tailor RBC transfusion needs and practices to individual neonates. Decreasing the need for RBC transfusion and developing neonatal-specific approaches in the preparation of donor RBCs have potential for reducing resource utilization and cost, improving outcomes, and assuring blood safety. Finally, large donor-recipient-linked cohort studies can provide data to better understand the balance of the risks and benefits of RBC transfusion in neonates. These studies may also guide the translation of new research into best practices that can rapidly be integrated into routine care. This review highlights key opportunities in transfusion medicine and neonatology for improving the preparation and transfusion of RBCs into neonates and infants. We focus on timely, currently addressable knowledge gaps that can increase the safety and efficacy of preterm and term neonatal and infant RBC transfusion practices.


Assuntos
Anemia/terapia , Transfusão de Eritrócitos/efeitos adversos , Transfusão de Eritrócitos/métodos , Fatores Etários , Peso ao Nascer , Bancos de Sangue , Ensaios Clínicos como Assunto , Eritrócitos , Eritropoetina/sangue , Hematologia/métodos , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Projetos de Pesquisa , Fatores de Tempo , Resultado do Tratamento
16.
J Trauma Acute Care Surg ; 81(1): 178-83, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27032003

RESUMO

BACKGROUND: Recognizing the increasing age and comorbid conditions of patients admitted to our trauma service, we embedded a hospitalist on the trauma service at our Level I trauma center.This program was initiated in January 2013. This study was designed to investigate differences in outcomes between trauma patients who received care from the trauma hospitalist (THOSP) program and similarly medically complex trauma patients who did not receive THOSP care. METHODS: There were 566 patients comanaged with THOSP between December 2013 and November 2014. These patients were matched (1:2) with propensity scores to a contemporaneous control group based on age, Injury Severity Score (ISS), and comorbid conditions. Outcomes examined included mortality, trauma-related readmissions, upgrades to the intensive care unit, hospital length of stay, the development of in-hospital complications, and the frequency of obtaining medical subspecialist consultation. Differences in outcomes were compared with Mann-Whitney U-test or χ test as appropriate. RESULTS: High-quality matching resulted in the loss of 97 THOSP patients for the final analysis. Table 1 shows the balance between the two groups after matching. While there was a 1-day increase in hospital length of stay and an increase in upgrades to the intensive care unit, there was a reduction in mortality, trauma-related readmissions, and the development of renal failure after implementation of the THOSP program (Table 2). Implementation of this program made no significant difference in the frequency of cardiology, nephrology, neurology, or endocrinology consultations. There was also no difference in the development of the complications of venous thromboembolism, pneumonia, stroke, urinary tract infection, bacteremia, or alcohol withdrawal. CONCLUSION: Our study provides evidence that embedding a hospitalist on the trauma service reduces mortality and trauma-related readmissions. A reason for these improved outcomes may be related to THOSP "vigilance." LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.


Assuntos
Mortalidade Hospitalar , Médicos Hospitalares , Equipe de Assistência ao Paciente/organização & administração , Readmissão do Paciente/estatística & dados numéricos , Centros de Traumatologia , Idoso , Comorbidade , Delaware , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Recursos Humanos
17.
Transfusion ; 56(1): 107-14, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26509333

RESUMO

BACKGROUND: Although red blood cell (RBC) transfusion represents an integral component of sickle cell disease (SCD) care, transfusion support for some patients can result in alloimmunization to RBC antigens. Alloimmunized patients with SCD appear to experience worse survival compared to nonalloimmunized patients. While this difference in mortality may in part be due to underlying immunologic differences related to disease severity, it may also reflect direct clinical consequences of RBC alloimmunization. Alloimmunized patients have an increased risk of serious hemolytic transfusion reactions (HTRs) and may not receive adequate RBC transfusion support due to lack of compatible RBC units. CASE REPORT: This study reports on five RBC alloimmunized patients with SCD who died, to illustrate the concept that RBC alloimmunization itself contributes to premature death. RESULTS: The clinical course for each of the reported patients provides insight into the direct and indirect consequences of RBC alloimmunization, where patients experienced delayed HTRs or did not receive needed RBC transfusions. CONCLUSION: Future work examining the clinical impact of RBC alloimmunization should not only consider HTRs but should also address the potential consequences associated with difficulties in obtaining compatible blood.


Assuntos
Anemia Falciforme/mortalidade , Transfusão de Eritrócitos/efeitos adversos , Eritrócitos/imunologia , Isoanticorpos/sangue , Reação Transfusional/mortalidade , Adolescente , Adulto , Anemia Falciforme/sangue , Anemia Falciforme/imunologia , Anemia Falciforme/terapia , Biomarcadores/sangue , Feminino , Humanos , Masculino , Reação Transfusional/sangue , Reação Transfusional/diagnóstico , Reação Transfusional/imunologia , Adulto Jovem
18.
Bioessays ; 37(12): 1327-37, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26577077

RESUMO

Adaptive immunity provides the unique ability to respond to a nearly infinite range of antigenic determinants. Given the inherent plasticity of the adaptive immune system, a series of tolerance mechanisms exist to reduce reactivity toward self. While this reduces the probability of autoimmunity, it also creates an important gap in adaptive immunity: the ability to recognize microbes that look like self. As a variety of microbes decorate themselves in self-like carbohydrate antigens and tolerance reduces the ability of adaptive immunity to react with self-like structures, protection against molecular mimicry likely resides within the innate arm of immunity. In this review, we will explore the potential consequences of microbial molecular mimicry, including factors within innate immunity that appear to specifically target microbes expressing self-like antigens, and therefore provide protection against molecular mimicry.


Assuntos
Anti-Infecciosos/imunologia , Galectinas/imunologia , Imunidade Inata/imunologia , Mimetismo Molecular/imunologia , Imunidade Adaptativa/imunologia , Animais , Autoimunidade/imunologia , Humanos
19.
Am J Hematol ; 90(12): 1135-41, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26361243

RESUMO

Alloimmunization against red blood cell (RBC) antigens is a cause of morbidity and mortality in transfused patients with sickle cell disease (SCD). To investigate distinguishing characteristics of patients who develop RBC alloantibodies after transfusion (responders) versus those who do not (non-responders), a cross-sectional study of 90 children with SCD on chronic RBC transfusion therapy at a single institution was conducted in which 18 immune parameters (including T and B cell subsets) were tested via flow cytometry, and medical records were reviewed. RBC alloimmunization was present in 26/90 (29%) patients, with anti-E, K, and C among the most commonly detected alloantibodies despite prophylactic matching for these antigens at the study institution. In addition, RBC autoantibodies had been detected in 18/26 (69%) of alloimmunized versus 7/64 (11%) of non-alloimmunized patients (P < 0.0001). Alloimmunized patients were significantly older (median 13.0 years vs. 10.7 years, P = 0.010) and had more RBC unit exposures (median 148 U vs. 82 U, P = 0.020) than non-alloimmunized patients. Sex, age at initiation of chronic transfusion, splenectomy, stroke, and transfusion outside of the study institution were not significantly associated with RBC alloimmunization. Alloimmunized patients had a significantly increased percentage of CD4+ T memory cells compared to non-alloimmunized patients (57% vs. 49%, P = 0.0047), with no other significant differences in immune cell subsets or laboratory values detected between these groups. Additional research of RBC alloimmunization is needed to optimize transfusion therapy and to develop strategies to prevent alloimmunization.


Assuntos
Anemia Falciforme/sangue , Transfusão de Eritrócitos/métodos , Imunofenotipagem/métodos , Isoanticorpos/imunologia , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Adulto Jovem
20.
Transfusion ; 55(4): 791-5, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25444310

RESUMO

BACKGROUND: AABB Standard 5.27 requires transfusion services to have a process for urgent release of blood before completion of compatibility testing. Our institution endorses a policy for the emergency release of group O, D+ red blood cells (RBC; O+ RBC) to males and females at least 50 years of age. Our emergency department (ED) stocks 4 O- RBC units. To determine if O+ RBCs can replace ED O- RBCs, we performed a retrospective review. STUDY DESIGN AND METHODS: Patients admitted to the ED between January 2001 and August 2011 and transfused emergency-release O- RBCs were identified. Data were collected on sex, age, length of stay, clinical status, ABO/Rh, RBC transfusions, and RBC antibody screen results. RESULTS: A total of 498 ED O- RBC units were transfused to 268 patients (168 male, 100 female). A total of 322 units were transfused to males and 114 to females at least 50 years of age. Thirty-nine (14%) were D- with 18 receiving O+ RBCs. A total of 109 had follow-up antibody screens; one D- patient developed alloanti-D. CONCLUSIONS: The findings support the placement of O+ RBCs in the ED. The majority of ED O- RBCs (88%) went to patients who qualified for O+ RBCs; a minority (1.5%) of patients were D- females less than 50 years of age. The rate of alloimmunization was low.


Assuntos
Incompatibilidade de Grupos Sanguíneos/prevenção & controle , Serviço Hospitalar de Emergência , Transfusão de Eritrócitos , Sistema do Grupo Sanguíneo Rh-Hr/imunologia , Centros de Traumatologia , Sistema do Grupo Sanguíneo ABO/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Incompatibilidade de Grupos Sanguíneos/sangue , Incompatibilidade de Grupos Sanguíneos/imunologia , Tipagem e Reações Cruzadas Sanguíneas , Emergências , Transfusão de Eritrócitos/efeitos adversos , Feminino , Hemorragia/etiologia , Hemorragia/terapia , Mortalidade Hospitalar , Humanos , Isoanticorpos/sangue , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sistema do Grupo Sanguíneo Rh-Hr/análise , Ferimentos e Lesões/complicações , Ferimentos e Lesões/mortalidade
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