Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 8.833
Filtrar
1.
Rev Med Suisse ; 16(680): 260-263, 2020 Feb 05.
Artigo em Francês | MEDLINE | ID: mdl-32022490

RESUMO

International guidelines suggest that a liberal transfusion policy is not only unnecessary but can also prove harmful in certain situations. Blood transfusion is a costly act involving risks of infection, allergic and hemodynamic. Optimizing the use of this scarce and expensive resource becomes necessary. The case report depicts perfectly the potential complications of a transfusion policy considered too liberal, while emphasizing the importance of clinical judgment in each situation.


Assuntos
Transfusão de Eritrócitos/efeitos adversos , Transfusão de Eritrócitos/normas , Transfusão de Eritrócitos/métodos , Humanos
2.
N Engl J Med ; 382(2): 140-151, 2020 01 09.
Artigo em Inglês | MEDLINE | ID: mdl-31914241

RESUMO

BACKGROUND: Patients with anemia and lower-risk myelodysplastic syndromes in whom erythropoiesis-stimulating agent therapy is not effective generally become dependent on red-cell transfusions. Luspatercept, a recombinant fusion protein that binds transforming growth factor ß superfamily ligands to reduce SMAD2 and SMAD3 signaling, showed promising results in a phase 2 study. METHODS: In a double-blind, placebo-controlled, phase 3 trial, we randomly assigned patients with very-low-risk, low-risk, or intermediate-risk myelodysplastic syndromes (defined according to the Revised International Prognostic Scoring System) with ring sideroblasts who had been receiving regular red-cell transfusions to receive either luspatercept (at a dose of 1.0 up to 1.75 mg per kilogram of body weight) or placebo, administered subcutaneously every 3 weeks. The primary end point was transfusion independence for 8 weeks or longer during weeks 1 through 24, and the key secondary end point was transfusion independence for 12 weeks or longer, assessed during both weeks 1 through 24 and weeks 1 through 48. RESULTS: Of the 229 patients enrolled, 153 were randomly assigned to receive luspatercept and 76 to receive placebo; the baseline characteristics of the patients were balanced. Transfusion independence for 8 weeks or longer was observed in 38% of the patients in the luspatercept group, as compared with 13% of those in the placebo group (P<0.001). A higher percentage of patients in the luspatercept group than in the placebo group met the key secondary end point (28% vs. 8% for weeks 1 through 24, and 33% vs. 12% for weeks 1 through 48; P<0.001 for both comparisons). The most common luspatercept-associated adverse events (of any grade) included fatigue, diarrhea, asthenia, nausea, and dizziness. The incidence of adverse events decreased over time. CONCLUSIONS: Luspatercept reduced the severity of anemia in patients with lower-risk myelodysplastic syndromes with ring sideroblasts who had been receiving regular red-cell transfusions and who had disease that was refractory to or unlikely to respond to erythropoiesis-stimulating agents or who had discontinued such agents owing to an adverse event. (Funded by Celgene and Acceleron Pharma; MEDALIST ClinicalTrials.gov number, NCT02631070; EudraCT number, 2015-003454-41.).


Assuntos
Receptores de Activinas Tipo II/uso terapêutico , Anemia Sideroblástica/tratamento farmacológico , Transfusão de Eritrócitos , Hematínicos/uso terapêutico , Fragmentos Fc das Imunoglobulinas/uso terapêutico , Síndromes Mielodisplásicas/tratamento farmacológico , Proteínas Recombinantes de Fusão/uso terapêutico , Receptores de Activinas Tipo II/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia Sideroblástica/terapia , Método Duplo-Cego , Feminino , Hematínicos/efeitos adversos , Hemoglobinas/análise , Humanos , Fragmentos Fc das Imunoglobulinas/efeitos adversos , Infusões Subcutâneas , Masculino , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/terapia , Proteínas Recombinantes de Fusão/efeitos adversos
3.
Medicine (Baltimore) ; 99(4): e18951, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977912

RESUMO

RATIONALE: An amniotic fluid embolism (AFE) is a rare, lethal syndrome that is commonly associated with disseminated intravascular coagulation (DIC). Anticoagulation therapy is the most important strategy to inhibit excessive activation of the coagulation cascade in patients with AFE and DIC. At present, treatment of AFE with rivaroxaban has not been reported. PATIENT CONCERNS: We report a 37-year-old woman (gravida 2, para 1) at 39 weeks' gestation with irregular contractions of the uterus was admitted to the obstetrical department. Ten minutes after the spontaneous rupture of the membranes, the patient complained of dyspnea and dysphoria and exhibited cyanosis of her lips. The patient's blood pressure decreased and heart rate increased rapidly, and 2100 mL of unclotted blood flowed from her vagina within 1 hour. Her platelet count dropped to 21 × 10/L, and the results from routine coagulation tests, and D-dimer and fibrin degradation product tests were obviously abnormal. DIAGNOSES: According to the current research consensus, AFE with DIC should be considered immediately when sudden cardiovascular collapse occurs around the time of labor and delivery, followed by the development of coagulopathy and hemorrhage. INTERVENTIONS: In addition, the variety of supportive treatments, rivaroxaban was used in anticoagulant therapy. OUTCOMES: At follow-up 30 and 60 days, there were no complaints of discomfort or abnormal laboratory assays. The patient recovered completely. LESSONS: This case highlights that rivaroxaban, as a direct inhibitor of activated factor Xa, demonstrates a good therapeutic efficacy for treating AFE with DIC.


Assuntos
Coagulação Intravascular Disseminada/tratamento farmacológico , Embolia Amniótica/tratamento farmacológico , Inibidores do Fator Xa/administração & dosagem , Rivaroxabana/administração & dosagem , Adulto , Transfusão de Eritrócitos , Feminino , Humanos , Gravidez , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(2): e18739, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914091

RESUMO

Autoimmune hemolytic anemia (AIHA) is a rare disease in which autoantibodies target red blood cells (RBCs), leading to anemia that ranges from no symptoms to severe life-threatening hemolysis. Little is known about the severity of anemia, blood transfusion efficiency and risk of transfusion-related reactions among hospitalized AIHA patients, especially in those with incompatible RBC transfusions.A retrospective study was conducted among hospitalized AIHA patients from January 2009 to December 2015 in a large tertiary care medical center in southwest China.A total of 450 AIHA hospitalized patients were recruited, of whom 97.3% had warm AIHA, 30.3% had primary AIHA, and 90.7% were treated with corticosteroids. On admission, approximately 3% of patients had an hemoglobin (Hb) <30 g/L, 34% had an Hb between 30 and 59.9 g/L, and 46% had an Hb ranging from 60 to 89.9 g/L. A total of 2509.5 U RBCs were transfused to AIHA patients, and 14 transfusion-related adverse reactions were recorded, without any hemolytic transfusion reactions. With an average transfusion trigger of 52.0 ±â€Š9.3 g/L, 59.7% of the patients received RBCs, and 55.8% of the transfusions were viewed as effective. Least incompatible RBCs were given in 39% of the transfusions, but the transfusion efficiency did not significantly decrease with these incompatible blood transfusions (P = .253). Primary AIHA patients with a nadir Hb of approximately 40 to 50 g/L during their hospital stay had the highest rate of remission and did not require a different total number of RBC transfusions (P = .068) or length of hospitalization (P = .194) compared to other groups with nadir Hb values <30 g/L, ≥30 and <40 g/L, ≥50 and <60 g/L, and ≥60 g/L.One-third of AIHA patients suffered from severe anemia during hospitalization, and transfusions, even with incompatible RBCs, were safe and efficient. However, transfusion triggers between 40 and 50 g/L seemed to benefit the most patients by alleviating the RBC destruction caused by autoantibodies, and a restrictive transfusion strategy was beneficial in AIHA patients.


Assuntos
Corticosteroides/uso terapêutico , Anemia Hemolítica Autoimune/fisiopatologia , Anemia Hemolítica Autoimune/terapia , Transfusão de Eritrócitos/métodos , Corticosteroides/administração & dosagem , Corticosteroides/efeitos adversos , Adulto , Anemia Hemolítica Autoimune/epidemiologia , Transfusão de Eritrócitos/efeitos adversos , Feminino , Hemoglobinas , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Reação Transfusional/epidemiologia
5.
Br J Anaesth ; 124(1): 35-43, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31607387

RESUMO

BACKGROUND: Bleeding and transfusions affect mortality in aortic surgery. Although tranexamic acid significantly reduced bleeding in multiple settings, its role in major vascular surgery was never studied. The aim of this study was to determine if tranexamic acid reduces blood loss in open abdominal aortic aneurysm (AAA) surgery. METHODS: A total of 100 patients undergoing elective open AAA repair were randomised to receive tranexamic acid (a loading dose of 500 mg and a continuous infusion of 250 mg h-1) or placebo. The primary outcome was intraoperative blood loss, and the secondary outcomes were the number of patients receiving red blood cells, occurrence of thromboembolic events, and mortality. Data were analysed using the intention-to-treat principle. RESULTS: Fifty patients were randomised into each group. Median (inter-quartile range) intraoperative blood loss was 400 (300-1050) ml in the tranexamic acid group vs 500 (360-1000) ml in the placebo group (P=0.44). Transfusion rate was seven/50 (14%) in the tranexamic group vs 12/50 (24%) in the placebo group (P=0.20). No thrombosis was recorded. In a post hoc analysis, postoperative blood loss was reduced in the tranexamic group both at 4 h (60 [40-80] ml vs 100 [60-140] ml, P<0.001) and 24 h (180 [120-275] vs 275 [190-395] ml, P=0.003) after surgery. At 1 yr, three patients were dead, all in the placebo group (P=0.24) and all after 28 days. CONCLUSIONS: Tranexamic acid did not reduce intraoperative blood loss or blood transfusions in open AAA repair, although it may reduce postoperative blood loss without increasing adverse effects. CLINICAL TRIAL REGISTRATION: NCT02335359.


Assuntos
Antifibrinolíticos/uso terapêutico , Aneurisma Aórtico/cirurgia , Perda Sanguínea Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/métodos , Ácido Tranexâmico/uso terapêutico , Idoso , Antifibrinolíticos/efeitos adversos , Aneurisma Aórtico/mortalidade , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Transfusão de Sangue/estatística & dados numéricos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Método Duplo-Cego , Transfusão de Eritrócitos , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Tromboembolia/epidemiologia , Tromboembolia/prevenção & controle , Ácido Tranexâmico/efeitos adversos
8.
JAMA ; 322(22): 2179-2190, 2019 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-31821429

RESUMO

Importance: The clinical consequences of red blood cell storage age for critically ill pediatric patients have not been examined in a large, randomized clinical trial. Objective: To determine if the transfusion of fresh red blood cells (stored ≤7 days) reduced new or progressive multiple organ dysfunction syndrome compared with the use of standard-issue red blood cells in critically ill children. Design, Setting, and Participants: The Age of Transfused Blood in Critically-Ill Children trial was an international, multicenter, blinded, randomized clinical trial, performed between February 2014 and November 2018 in 50 tertiary care centers. Pediatric patients between the ages of 3 days and 16 years were eligible if the first red blood cell transfusion was administered within 7 days of intensive care unit admission. A total of 15 568 patients were screened, and 13 308 were excluded. Interventions: Patients were randomized to receive either fresh or standard-issue red blood cells. A total of 1538 patients were randomized with 768 patients in the fresh red blood cell group and 770 in the standard-issue group. Main Outcomes and Measures: The primary outcome measure was new or progressive multiple organ dysfunction syndrome, measured for 28 days or to discharge or death. Results: Among 1538 patients who were randomized, 1461 patients (95%) were included in the primary analysis (median age, 1.8 years; 47.3% girls), in which there were 728 patients randomized to the fresh red blood cell group and 733 to the standard-issue group. The median storage duration was 5 days (interquartile range [IQR], 4-6 days) in the fresh group vs 18 days (IQR, 12-25 days) in the standard-issue group (P < .001). There were no significant differences in new or progressive multiple organ dysfunction syndrome between fresh (147 of 728 [20.2%]) and standard-issue red blood cell groups (133 of 732 [18.2%]), with an unadjusted absolute risk difference of 2.0% (95% CI, -2.0% to 6.1%; P = .33). The prevalence of sepsis was 25.8% (160 of 619) in the fresh group and 25.3% (154 of 608) in the standard-issue group. The prevalence of acute respiratory distress syndrome was 6.6% (41 of 619) in the fresh group and 4.8% (29 of 608) in the standard-issue group. Intensive care unit mortality was 4.5% (33 of 728) in the fresh group vs 3.5 % (26 of 732) in the standard-issue group (P = .34). Conclusions and Relevance: Among critically ill pediatric patients, the use of fresh red blood cells did not reduce the incidence of new or progressive multiple organ dysfunction syndrome (including mortality) compared with standard-issue red blood cells. Trial Registration: ClinicalTrials.gov Identifier: NCT01977547.


Assuntos
Preservação de Sangue , Estado Terminal/terapia , Transfusão de Eritrócitos , Insuficiência de Múltiplos Órgãos/prevenção & controle , Adolescente , Criança , Pré-Escolar , Estado Terminal/mortalidade , Progressão da Doença , Transfusão de Eritrócitos/efeitos adversos , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica , Estimativa de Kaplan-Meier , Masculino , Insuficiência de Múltiplos Órgãos/mortalidade , Gravidade do Paciente , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Sepse/etiologia
9.
Am Surg ; 85(11): 1246-1252, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775966

RESUMO

When endoscopy is performed for acute GI bleeding, therapeutic endoscopic procedures are infrequently required (only 6% of cases). We sought to determine the natural history of GI hemorrhage in patients who have undergone therapeutic endoscopy. We queried our hospital database for inpatients with acute GI bleeding who underwent therapeutic endoscopy between 2015 and 2017. The primary endpoints were recurrence of bleeding and the subsequent need for repeated endoscopic interventions, angioembolization, or surgery. Demographic information was collected. We reviewed 205 hospitalized patients: mean age was 70 years, 58 per cent were male, and mean hemoglobin was 9 g/dL. Patients had medical conditions predisposing them to bleeding in 59 per cent and history of previous GI bleeding in 37 per cent of cases. Sixty per cent were on antiplatelet/anticoagulation medications, and 10 per cent were receiving nonsteroidal anti-inflammatory medications. Blood transfusions were given to 78 per cent of patients, with an average of 2.3 units of packed red blood cells transfused per patient before intervention. Recurrence of hemorrhage after therapeutic endoscopy was seen in 9 per cent of patients. Only 2 per cent underwent a second therapeutic endoscopic procedure, and 5 per cent had surgery or angioembolization (half of these patients then had a further recurrence of bleeding). In total, seven patients died (3%). Recurrence of GI bleeding after therapeutic endoscopies is uncommon (9%). Surgery and angioembolization are not commonly necessary, but when used are only successful in 50 per cent of cases.


Assuntos
Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia/métodos , Anticoagulantes/uso terapêutico , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Hemorragia Gastrointestinal/sangue , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Hemoglobina A/análise , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Recidiva , Retratamento , Estudos Retrospectivos , Adulto Jovem
10.
J Surg Oncol ; 120(8): 1379-1385, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31691290

RESUMO

BACKGROUND: Open surgery for hilar cholangiocarcinoma (HCCA) has already been widely reported and analyzed. However, the laparoscopic technique for treating HCCA remains controversial because of the lack of radicality and poor assessment of the resectability of hilar structures without direct palpation. The aim of this study was to provide detailed surgical procedures and photographs of this technically demanding operation, describe our experience in assessing resectability before and during surgery, and confirm the radicality of laparoscopic resection of Bismuth type III and IV HCCA. METHODS: From November 2016 to November 2018, nine patients received laparoscopic resection of Bismuth type III or IV HCCA in our department. RESULTS: Laparoscopic right hepatectomy was performed in four patients, and laparoscopic left hepatectomy was performed in five patients. Negative margins were achieved in all patients. Complications were found in two (22.22%) patients, with bile leakage and hepatic insufficiency each in one patient. The patient developing hepatic insufficiency had persistent and ongoing liver failure and finally expired. CONCLUSION: The radicality of laparoscopic resection for Bismuth type III and IV HCCA can be technically improved through extended lymphadenectomy, visual assessment of hilar structures, and frozen section techniques.


Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Hepatectomia/métodos , Tumor de Klatskin/cirurgia , Laparoscopia/métodos , Perda Sanguínea Cirúrgica , Transfusão de Sangue , Transfusão de Eritrócitos , Feminino , Humanos , Tumor de Klatskin/patologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Seleção de Pacientes , Complicações Pós-Operatórias
11.
Pan Afr Med J ; 33: 262, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692740

RESUMO

Hyperbilirubinemia is one of the most widely seen cause of neonatal morbidity. Besides ABO and Rh isoimmunization, minor blood incompatibilities have been also been identified as the other causes of severe newborn jaundice. We report a newborn with indirect hyperbilirubinemia caused by minor blood group incompatibilities (P1, M, N, s and Duffy) whose hemolysis was successfully managed with intravenous immunoglobulin therapy. A thirty-two gestational weeks of preterm male baby became severely icteric on postnatal day 11, with a total bilirubin level of 14.66 mg/dl. Antibody screening tests revealed incompatibility on different minor groups (P1, M, N, s and Duffy (Fya ve Fyb)). On postnatal day thirteen, the level of bilirubin increased to 20.66 mg/dl although baby was under intensive phototherapy. After the administration of intravenous immunoglobulin and red blood cell transfusion, hemoglobin and total bilirubin levels became stabilised. Minor blood incompatibilities should be kept in mind during differential diagnosis of hemolytic anemia of the newborn. They share the same treatment algorithm with the other types hemolytic anemia. New studies revealed that intravenous immunoglobulin treatment in hemolytic anemia have some attractive and glamorous results. It should be seriously taken into consideration for treatment of minor blood incompatibilities.


Assuntos
Anemia Hemolítica/etiologia , Bilirrubina/metabolismo , Hiperbilirrubinemia/etiologia , Imunoglobulinas Intravenosas/administração & dosagem , Anemia Hemolítica/diagnóstico , Incompatibilidade de Grupos Sanguíneos/complicações , Diagnóstico Diferencial , Transfusão de Eritrócitos/métodos , Hemoglobinas/metabolismo , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Icterícia Neonatal/etiologia , Masculino
12.
Am Surg ; 85(9): 973-977, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638509

RESUMO

Failure to rescue (FTR), defined as death after a major complication in surgical patients, is being used to measure outcomes for quality improvement. Major complications frequently occur in patients undergoing damage control laparotomy (DCL). No previous FTR studies have looked specifically into DCL patients. The aim of this study was to examine risk factors of FTR and identify potential areas for targeted quality improvement in DCL patients. A 10-year retrospective review of all consecutive adult trauma patients who underwent DCL at a Level I trauma center was performed. Demographic and clinical variables were examined for association with FTR. Multivariate regression analysis was performed to identify risk factors of FTR in DCL patients. A total of 199 DCL patients were analyzed. Overall DCL mortality observed was 11.1 per cent (n = 22/199) and overall FTR for the cohort was n = 16/199. FTR represented 72 per cent (n = 16/22) of the total mortality. The significantly increased risk of FTR was associated with older age (P = 0.027), lower initial Glasgow Coma Scale score (P = 0.037), more units of packed red blood cells (P = 0.028), and respiratory complications (P = 0.035). Renal and infectious complications did not significantly increase the risk of FTR in this population. FTR is an important benchmark of quality for trauma patients. This study elucidates potential initial characteristics and complications related to FTR in DCL patients. Efforts in achieving zero death from FTR can potentially improve overall mortality in this subset of patients. Future quality interventions to help minimize FTR should target these specific areas.


Assuntos
Falha da Terapia de Resgate , Laparotomia/efeitos adversos , Laparotomia/normas , Melhoria de Qualidade , Ferimentos e Lesões/cirurgia , Adulto , Fatores Etários , Transfusão de Eritrócitos , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Complicações Pós-Operatórias , Transtornos Respiratórios , Estudos Retrospectivos , Fatores de Risco , Centros de Traumatologia/normas , Estados Unidos
13.
Heart Surg Forum ; 22(5): E396-E400, 2019 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-31596719

RESUMO

BACKGROUND: Cardiovascular surgery is associated with substantial risk for postoperative bleeding with increased patient morbidity and mortality. Numerous intraoperative techniques have been utilized to reduce this risk. This study was to assess postoperative bleeding-related parameters following Bentall procedures and to examine the impact of intraoperative surgical sealant application. METHOD: The medical/surgical records of 100 consecutive Bentall procedure cases were examined retrospectively for perioperative surgical sealant use and postoperative bleeding-related outcomes. RESULTS: Of the 100 patient cases, three died during the postoperative period, and 97 were evaluable. Surgical sealant was utilized in 56 patient cases (57.8%). The utilization versus no utilization of surgical sealant was associated with significant reductions in most postoperative bleeding-related parameters, including less drainage (P = .028), resternotomy for hemorrhage (P = .036), transfusion of red blood cells (P = .022 at 48 hours; P = .027 total in-hospital), transfusion of fresh frozen plasma (P = .04 at 48 hours; P = .004 total in-hospital), and a higher percentage of cases not needing blood transfusion (P = .002). The surgical sealant group had longer cardiopulmonary bypass circuit (P = .016) and aortic cross-clamp time (P = .001), with no significant between-group differences in intubation time (P = .636) or intensive care unit duration (P = .294). When excluding urgent cases or Stanford type A aortic dissections, intensive care unit duration significantly was shorter in the surgical sealant group (P = .017). Surgical sealant use was not associated with any adverse events. CONCLUSION: The application of surgical sealant to the anastomosis suture line in Bentall procedures reduces postoperative drainage, bleeding, and transfusion utilization. Further studies are warranted to investigate these benefits in prospective, randomized clinical trials.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Adesivo Tecidual de Fibrina/uso terapêutico , Hemorragia Pós-Operatória/prevenção & controle , Adesivos Teciduais/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Estudos de Coortes , Unidades de Cuidados Coronarianos/estatística & dados numéricos , Drenagem/estatística & dados numéricos , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Plasma , Reoperação , Estudos Retrospectivos , Esternotomia , Resultado do Tratamento
14.
Medicine (Baltimore) ; 98(39): e17337, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574871

RESUMO

RATIONALE: Diamond-Blackfan anemia (DBA) is a rare inherited marrow disorder, characterized by erythrocyte aplasia and is associated with congenital anomalies and a susceptibility to cancer. Although congenital abnormalities have been observed in ∼50% of DBA patients, the occurrence of an associated congenital diaphragmatic hernia (CDH) has rarely been reported. PATIENT CONCERNS: A 19-month-old male child was referred to our pediatric hematology-oncology outpatient clinic with anemic appearance. He presented to us with recurrent anemia, short stature, and developmental delay. DIAGNOSIS: On bone marrow examination, only erythropoietic cells were markedly decreased in number, whereas other cell lines were unaffected. An abdominal computed tomography scan revealed a Bochdalek type of CDH. A genetic analysis revealed heterozygous mutation of RPS19; therefore, he was diagnosed as having DBA with CDH. INTERVENTIONS: The patient received an initial packed red blood cell transfusion, followed by an administration of oral prednisone. OUTCOMES: The patient is maintained on oral prednisone administered at a dose of 0.3 mg/kg every alternate day and has since a hemoglobin level of >9.0 g/dL without further RBC transfusions. LESSONS: We learned that a Bochdalek type of CDH can manifest in a DBA patient with RPS19 gene mutation. Therefore, patients diagnosed with the latter disorder should also be screened for an early detection of potential CDHs.


Assuntos
Anemia de Diamond-Blackfan , Células da Medula Óssea/patologia , Transfusão de Eritrócitos/métodos , Hérnias Diafragmáticas Congênitas/diagnóstico , Prednisona/administração & dosagem , Proteínas Ribossômicas/genética , Anemia de Diamond-Blackfan/genética , Anemia de Diamond-Blackfan/fisiopatologia , Exame de Medula Óssea/métodos , Glucocorticoides/administração & dosagem , Humanos , Masculino , Mutação , Radioterapia Assistida por Computador/métodos , Resultado do Tratamento , Adulto Jovem
15.
Blood ; 134(13): 995-996, 2019 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-31558553
17.
J Extra Corpor Technol ; 51(3): 140-146, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31548735

RESUMO

Pre-bypass acute autologous donation (PAAD) is a method of blood conservation that reduces exposure of blood to the cardiopulmonary bypass (CPB) circuit and may prevent the contact activation of platelets and clotting factors. The purpose of this study was to evaluate the impact of PAAD on product transfusion rates in cardiac surgical patients. This is a retrospective study of patients undergoing cardiac surgery between 2015 and 2017 for either a coronary artery bypass (CABG), valve replacement, or a combined valve/CABG procedure. PAAD was performed by removing blood from the venous line of the bypass circuit immediately before the institution of CPB. The amount of PAAD volume was determined during the surgical time-out. This was based on patient size, baseline hemoglobin, and type of case. Poisson logistic regression was used to determine whether PAAD was a significant predictor for blood product transfusion. After obtaining institutional review board approval, we reviewed 236 records on (n = 154, 65.3%) who received PAAD and (n = 82, 34.7%) with no blood withdrawal before CPB. The median PAAD volume in the PAAD group was 750 mL. Patients undergoing PAAD had a 14.3% red blood cell (RBC) transfusion rate (.27 ± .91 units), and without PAAD, the RBC transfusion rate was 62.2% (1.56 ± 1.79 units). The significant (p < .05) odds ratios (ORs) for RBC transfusion were as follows: baseline hemoglobin .617 (.530-.719), PAAD .998 (.997-.999), CPB time 1.009 (1.003-1.015), age 1.034 (1.013-1.055), and BSA odds ratio (OR) .326 (.124-.857). PAAD could not be used in all patients. However, using the OR in the Poisson logistic regression model, a one-unit reduction in RBC transfusion is predicted for each 500 mL of PAAD. PAAD was also associated with a significant reduction in fresh frozen plasma and platelet transfusion.


Assuntos
Transfusão de Sangue , Procedimentos Cirúrgicos Cardíacos , Transfusão de Sangue Autóloga , Ponte Cardiopulmonar , Ponte de Artéria Coronária , Transfusão de Eritrócitos , Feminino , Humanos , Masculino , Estudos Retrospectivos
18.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 41(4): 541-547, 2019 Aug 30.
Artigo em Chinês | MEDLINE | ID: mdl-31484619

RESUMO

Perioperative restrictive red blood cell(RBC)transfusion strategy,in which a trigger of hemoglobin(Hb)<7 g/dl is used,is of great benefits to save blood storage and reduce transfusion-related adverse events including infections,immunologic risks,and circulatory overload.Human body can display a series of compensatory mechanisms to acute anemia,including increased cardiac output,favored oxyhemoglobin dissociation,and lung vascular dilation.Therefore,moderate Hb decrease does not necessarily lead to hypoxemia.Patients undergoing hip surgery or suffering from septic shock and/or upper gastrointestinal bleeding can benefit from restrictive RBC transfusion;however,restrictive transfusion may be associated with adverse outcomes in patients with coronary heart disease or undergoing cardiac surgery.Restrictive RBC transfusion strategies have been included in described in many different guidelines.Most of them recommended Hb<7 g/dl to be a trigger for allogeneic RBC transfusion.For patients with an Hb of 7-10 g/dl,the application of restrictive RBC transfusion should be based on the expected blood loss,compensatory ability,and metabolic rate.


Assuntos
Transfusão de Eritrócitos , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Hemoglobinas/análise , Humanos , Assistência Perioperatória
19.
Scand Cardiovasc J ; 53(6): 355-360, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31476919

RESUMO

Objectives: Protamine reduces platelet aggregation after cardiopulmonary bypass (CPB). We studied the inhibitory effect of a reduced protamine dose, the duration of impaired platelet function and the possible correlation to postoperative bleeding. Design: Platelet function was assessed by impedance aggregometry in 30 patients undergoing cardiac surgery with CPB at baseline, before protamine administration, after 70% and 100% of the calculated protamine dose, after 20 minutes and at arrival to the intensive care unit. Adenosine diphosphate (ADP), thrombin receptor activating peptide-6 (TRAP), arachidonic acid (AA) and collagen (COL) were used as activators. Blood loss was measured during operation and three hours after surgery. Results are presented as median (25th-75th percentile). Results: Platelet aggregation decreased markedly after the initial dose of protamine (70%) with all activators; ADP 89 (71-110) to 54 (35-78), TRAP 143 (116-167) to 109 (77-136), both p < .01; AA 25 (16-49) to 17 (12-24) and COL 92 (47-103) to 60 (38-81) U, both p < .05. No further decrease was seen after 100% protamine. The effect was transient and after twenty minutes platelet aggregation had started to recover; ADP 76 (54-106), TRAP 138 (95-158), AA 20 (10-35), COL 70 (51-93) U. Blood loss during operation correlated to aggregometry measured at baseline and after protaminization. Conclusions: Protamine after CPB induces a marked decrease in platelet aggregation already at a protamine-heparin ratio of 0.7:1. The impairment seems to be transient and recovery had started after 20 minutes.


Assuntos
Ponte de Artéria Coronária , Implante de Prótese de Valva Cardíaca , Antagonistas de Heparina/efeitos adversos , Agregação Plaquetária/efeitos dos fármacos , Protaminas/efeitos adversos , Idoso , Perda Sanguínea Cirúrgica/prevenção & controle , Ponte Cardiopulmonar , Ponte de Artéria Coronária/efeitos adversos , Relação Dose-Resposta a Droga , Transfusão de Eritrócitos , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Antagonistas de Heparina/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Testes de Função Plaquetária , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia , Protaminas/administração & dosagem , Fatores de Tempo , Resultado do Tratamento
20.
Bone Joint J ; 101-B(9): 1122-1128, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474150

RESUMO

AIMS: Low haemoglobin (Hb) at admission has been identified as a risk factor for mortality for elderly patients with hip fractures in some studies. However, this remains controversial. This study aims to analyze the association between Hb level at admission and mortality in elderly patients with hip fracture undergoing surgery. PATIENTS AND METHODS: All consecutive patients (prospective database) admitted with hip fracture operated in a tertiary hospital between 2012 and 2016 were analyzed. We collected patient characteristics, time to surgery, duration and type of surgery, comorbidities, Hb at admission, nadir of Hb after surgery, the use and amount of red blood cells (RBCs) transfusion products, postoperative complications, and death. The main outcome measures were mortality at 30 days, 90 days, 180 days, and one year after surgery. RESULTS: We included 829 patients; the mean age was 81 years (sd 11). Mortality at 30 days, 90 days, 180 days, and one year was 5.7%, 12.3%, 18.1%, and 23.5%, respectively. The highest mortality was observed in patients aged over 80 years (162/557, 29%) and in male patients (85/267, 32%). Survival at 90 days, 180 days, and one year after surgery was significantly lower in patients with a Hb level below 120 g/l at admission. In multivariate analysis, Hb level below 120 g/l at admission was found to be an independent factor associated with mortality (adjusted hazard ratio (aHR) 1.68 (95% confidence interval (CI) 1.22 to 2.31); p = 0.001), along with age (aHR 1.06 (95% CI 1.04 to 1.06); p < 0.001), male sex (aHR 2.19 (95% CI 1.61 to 2.96); p < 0.001), and need for RBC transfusions (aHR 1.10 (95% CI 1.02 to 1.19); p = 0.01). CONCLUSION: Our results suggest that low Hb at admission along with age and RBC transfusions is significantly associated with short- and long-term mortality after hip fracture surgery, independently of comorbidity confounders. Further studies should be performed to understand how preoperative Hb could be taken into account in perioperative management. Cite this article: Bone Joint J 2019;101-B:1122-1128.


Assuntos
Anemia/sangue , Anemia/mortalidade , Hemoglobinas/análise , Fraturas do Quadril/mortalidade , Fraturas por Osteoporose/mortalidade , Idoso , Idoso de 80 Anos ou mais , Anemia/complicações , Anemia/terapia , Comorbidade , Transfusão de Eritrócitos/mortalidade , Feminino , Fraturas do Quadril/complicações , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Hospitalização , Humanos , Estimativa de Kaplan-Meier , Masculino , Fraturas por Osteoporose/complicações , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/cirurgia , Prognóstico , Estudos Retrospectivos , Fatores de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA