Blood Exchange Research Articles

To study the outcome of exchange transfusion in severe neonatal sepsis in neonates admitted in NICU at Dr. Bhim Rao Ambedkar memorial hospital, Raipur, Chhattisgarh, India

Background: Sepsis is one of the most common causes of neonatal mortality and morbidity.Immaturity of the immune system, newborn infants are highly susceptible to systemic infection.Blood exchange transfusion in severe neonatal sepsis remove bacteria, bacterial toxins, andcirculating pro-inflammatory cytokines, improve perfusion and tissue oxygenation, correct theplasma coagulation system and enhance immunological defence mechanisms. Material andmethods: This is a hospital-based, time-bound, analytical observational study conducted fromJanuary 2019 to December 2019 in the NICU of Dr. B.R.A.M. Hospital & Pt. J. N. M. Medical College,Raipur, Chhattisgarh, India. The data was collected in pre-designed proforma, entered in MicrosoftExcel and analysis was done using SSPS v 22.0. Result: About 42 neonates were diagnosed withsevere neonatal severe. Of which 23 (54.76%) were preterm, 42.24% were term neonates.Maximum 22 (52.38%) were VLBW, 4.76% were LBW and 19.05% were with normal birth weight. Inthe study two-third of 28 (66.67%) were outborn and one third were inborn. In the present studymajority of 30 (71.43%) had EOS and 12 (28.57%) had LOS. In our study out of 42 study subjects24 (57.14%) died and 18 (42.86%) were discharged after blood exchange transfusion. Of those whodied 15 (62.5%) were preterm and of those discharged 10 (55.6%) were term neonates (p=0.349).Outborn neonates more died as compare to inborn though this was also not significant (p=0.133).Conclusion: significant reduction of mortality in patients who underwent exchange transfusion,together with the no adverse effects observed, suggest that this procedure should be considered forthe treatment of neonates with severe sepsis.

Retinopathy of prematurity (ROP) in Ardebil (North West of Iran): Prevalence and Risk factors

Background and objective: Retinopathy of prematurity (ROP), which affects the retina of premature infants, is a leading cause of blindness in premature infants worldwide. The aim of this study was to evaluate the frequency and risk factors of retinopathy of prematurity infants referred to Alavi hospital between October 2018 and October 2019. Methods: In the present study, 400 infants with gestational age less than 34 weeks and or birth weight of 2000 g or less were enrolled in the study. Required information including sex, gestational age, maternal age, birth weight, type of delivery, oxygen therapy, septicemia, multiple gestations, family marriage, respiratory problem, and blood exchange were extracted from their hospital records and then included in the data collection form. These infants were also examined for ROP, stage and area of involvement by an experienced ophthalmologist and then classified into two groups including retinopathy and healthy group. Finally, the data were analyzed in SPSS 25 software using chi-square, fisher exact test, t-test, binary logistic regression, and ROC curve analysis. Results: Of the 400 preterm infants studied (57.2% male and 42.8% female), 107 (26.8%) infants had ROP of whom 23 (21.5%) needed treatment (i.e. 5.8% of all infants need treatment). There were 4 (3.7%), 29 (27.1%), and 74 (69.2%) infants with zone I, II, and III, respectively. There were 91 (85%), 11 (10.3%), and 5 (4.7%) infants with stage I, II, and III, respectively. Multivariate logistic regression analysis showed that parental consanguinity (OR=2.263, 95%CI: 1.240-4.130, P=0.008), gestational age less than 32.5 weeks (OR=4.067, 95%CI: 2.340- 7.069, P<0.001), and birth weight less than 1725 g (OR=4.522, 95%CI: 2.677-7.637, P<0.001) were associated with a 2.3-fold, 4.1-fold, and 4.5-fold increased risk of ROP, respectively. ROP had no significant relationship with other variables. Conclusion: In summary, the findings of the present study showed that one quarter of the premature infants had ROP. Furthermore, birth weight less than 1725 g, gestational age less than 32.5 weeks, and parental consanguinity were risk factors for ROP, in addition, one-fifth of the infants with ROP needed treatment. Key Words: Retinopathy, Prematurity, ROP, Newborn.

Hearing Threshold of Auditory Brainstem Response in Term Neonates with Hyperbilirubinemia

Background:Neonatal jaundice is a common cause of premature neonatal hearing loss and is a major cause of childhood deafness, especially in developing countries. The aim of this study was evaluating Hearing threshold of Auditory Brainstem Response (ABR) in term neonates admitted with hyperbilirubinemia at a range of exchange transfusion and near exchange transfusion. Methods: This cross-sectional study was performed on 134 healthy term infants admitted due to hyperbilirubinemia in the neonatal care unit of Besat Hospital in Hamadan from March 2017 to September 2017. All neonates were evaluated by Otoacoustic Emission (OAE) and ABR after admission in neonatal ward and after treatment by intensive phototherapy or blood exchange. Data were collected and analyzed through SPSS software and using Chi-square and Mann-Whitney tests. The significance level was considered at 0.05 for all statistical tests. Results: The mean weight of newborns was 3000 ±350 gr and the mean of gestational age was 39± 2 weeks. Bilirubin concentration of the infants was 36.9±9.2 mg/dL. There was a significant difference between hearing loss on auditory brainstem response in term neonates according to hyperbilirubinemia in blood exchange range (P = 0.001). However, there was no significant difference between hearing loss on auditory brainstem response in term neonates according to the gestational age, sex and phototherapy (P > 0.05). Conclusion: Our findings indicated that high bilirubin levels in the range of exchange transfusion can be an important risk to the auditory system, which without creating kernicterus, can interfere with auditory tests.

Scalp Swelling and Headache in a 12-year-old Boy

1. Kathryn Westphal, MD* 2. Respicius Bakalemwa, MD† 3. Elizabeth Groothuis, MD, MPH* 1. *Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 2. †Department of Pediatrics, Bugando Medical Centre, Mwanza, Tanzania A 12-year-old boy with sickle cell disease (SCD) is admitted to a hospital in Mwanza, Tanzania, with acute onset of periorbital and scalp swelling. Associated symptoms include fever, headache, difficulty breathing, and back pain. Because resources in sub-Saharan Africa are limited, access to comprehensive care for patients with SCD is variable. The general principles of management focus on early diagnosis, parental education, prevention of infection with vaccinations and prophylactic medications, prompt treatment of infection and pain, the use of hydroxyurea for stroke prevention, and blood transfusions for life-threatening anemia. This patient has a known diagnosis of SCD but has infrequent pain episodes and no previous transfusions. He is not receiving hydroxyurea or prophylaxis against bacterial infections or malaria. He has no history of stroke and no known head trauma. On presentation he is afebrile and his heart rate is 120 beats/min, respiratory rate is 40 breaths/min, and blood pressure is 105/75 mm Hg. His oxygen saturation is 92% in room air. Physical examination is significant for pallor, periorbital edema, scalp edema, dyspnea without adventitious lung sounds, and splenomegaly with diffuse abdominal tenderness. His scalp edema is fluctuant and extends posteriorly from the periorbital region, encompassing the entire scalp. Swelling is most prominent in the frontal and parietal areas. The overlying skin is nonerythematous and nontender but is warm to the touch. His neurologic examination has no focal findings, although generally he appears tired. Initial laboratory results demonstrate a white blood cell count of 84,000/μL (84×109/L) with a lymphocytic predominance (57%), a hemoglobin level of …

Vascular Senescence: A Potential Bridge Between Physiological Aging and Neurogenic Decline.

The adult mammalian brain contains distinct neurogenic niches harboring populations of neural stem cells (NSCs) with the capacity to sustain the generation of specific subtypes of neurons during the lifetime. However, their ability to produce new progeny declines with age. The microenvironment of these specialized niches provides multiple cellular and molecular signals that condition NSC behavior and potential. Among the different niche components, vasculature has gained increasing interest over the years due to its undeniable role in NSC regulation and its therapeutic potential for neurogenesis enhancement. NSCs are uniquely positioned to receive both locally secreted factors and adhesion-mediated signals derived from vascular elements. Furthermore, studies of parabiosis indicate that NSCs are also exposed to blood-borne factors, sensing and responding to the systemic circulation. Both structural and functional alterations occur in vasculature with age at the cellular level that can affect the proper extrinsic regulation of NSCs. Additionally, blood exchange experiments in heterochronic parabionts have revealed that age-associated changes in blood composition also contribute to adult neurogenesis impairment in the elderly. Although the mechanisms of vascular- or blood-derived signaling in aging are still not fully understood, a general feature of organismal aging is the accumulation of senescent cells, which act as sources of inflammatory and other detrimental signals that can negatively impact on neighboring cells. This review focuses on the interactions between vascular senescence, circulating pro-senescence factors and the decrease in NSC potential during aging. Understanding the mechanisms of NSC dynamics in the aging brain could lead to new therapeutic approaches, potentially include senolysis, to target age-dependent brain decline.

The Epidemiology Pattern of Human Immunodeficiency Virus/Acquire Immune Deficiency Syndrome, Diagnostic, Transmission and Prevention in Nigeria-Past and Present

Human immune Virus/Acquire immune deficiency syndrome (HIV/AIDS) epidemic is one of the major public health challenges faced by Nigeria. The review present the Epidemiology of Human immune Virus/Acquire immune deficiency syndrome, diagnostic and Prevention in Nigeria. The method use was based on the data obtain in Nigeria. Nigeria’s first two AIDS cases were diagnosed in 1985 in Lagos. Today, Nigeria’s epidemic is characterized as one the most rapidly increased rates of HIV/AIDS cases in West Africa. Nigeria's population of 160 million and estimated HIV prevalence of 3.34% (2011) makes Nigeria the second highest HIV burden worldwide, with 3.2 million people living with HIV (PLHIV). Recently, it is estimated that about 3, 229, 757 people live with HIV in Nigeria and about 220, 393 new HIV infections occurred in 2013 and 210,031 died from AIDS- related causes. As of 2020 in Nigeria, the HIV prevalence rate among adults ages 15–49 was 3.1 percent Nigeria has the second-largest number of people living with HIV. In some states, the epidemic is more concentrated and driven by high-risk behaviors, while other states have more generalized epidemics that are sustained primarily by multiple sexual partnerships in the general population. HIV is spread by sexual contact with an infected person and by blood or body fluid exchange through sharing of contaminated needles or transfusions of infected blood or blood clotting factors. Infants born to HIV-infected women may become infected in gestation, during birth, or through breastfeeding. An antenatal clinic (ANC) HIV seroprevalence sentinel survey has been conducted biennially in Nigeria since 1991 to track the epidemic. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that 3.5 million Nigerian adults and children were living with HIV/AIDS by the end of 2001. Among sex workers in Lagos, HIV prevalence rose from 2 percent in 1988–89 to 12 percent in 1990–91. By 1995–96, up to 70 percent of sex workers tested positive. As a result of the epidemic, the crude death rate in Nigeria was about 20 percent higher in 2000 than in 1990. In 2019, 170,000 adults and children died of AIDS and UNAIDS estimated that 1 million children orphaned by AIDS were living in Nigeria. The main thrust of HIV prevention strategies in Nigeria is based on the following: Information, Education, and Communication; Condom Promotion; Behavior Change; and Vaccine Development.

369 Placental central intralobular lakes: an inversion of pressure differential in relation to fetal capillaries?

Placental central intralobular lakes (CILs) are anechoic areas at lobule centers. Small CILs (largest diameter < 1 cm) are often seen during the third trimester. Although they result from jets of blood from the spiral artery into the lobule’s center, their precise significance is unclear. Conventionally, the pressure in the placental fetal capillaries is expected to be higher than in the intervillous space. However, the spherical shape adopted by the lobule in the presence of CILs (see figure) prompts us to assert that CILs could reflect an inversion of the pressure differential, thereby compressing the fetal capillaries and reducing maternal and fetal blood exchanges. Identifying the clinical and biological factors associated with CIL occurrence warrants investigation to test our hypothesis. Our prospective study included 477 unselected single pregnancies (initial maternal weight 62±12 kg) involved in an enhanced prenatal care program recording extended clinical, biological and ultrasound information. CIL was considered when at least 2 CILs > 5 mm were observed. The case group was defined by CIL occurrence. The remaining cases were assigned to the control group. CIL was detected by ultrasound during the third trimester in 44% of studied pregnancies. When compared to the control group, the maximum maternal systolic arterial pressure (MSAP, mm Hg) was higher during the first trimester (124 ± 13 vs. 122 ± 13; p<0.04) and third trimester (138 ± 14 vs. 135 ±14; p<0.0008). The second trimester one-hour post-load glucose level was higher (1.24 g/l ± 0.3 vs. 1.19 ± 0.3; p<0.002). Lastly, the newborn’s Apgar score was lower at one minute (9.3 ± 1.4 vs. 9.4 ± 1.3; p<0.006). The higher MSAP and lower Apgar score suggest a pressure increase in spiral artery delivery and a reduction in placental efficiency. The insulin resistance we observed supports this interpretation. A better understanding of CIL significance may help to evaluate placental exchanges and detect placental insufficiency.

Home phototherapy for hyperbilirubinemia in term neonates\u2014an unblinded multicentre randomized controlled trial

The aim of this study was to assess whether home phototherapy was feasible and safe in a cohort of otherwise healthy term-born neonates who fulfilled the criteria for in-hospital phototherapy. This was a randomized controlled trial in which term newborns with a total serum bilirubin of 18–24 mg/dL (300–400 μmol) were randomized to either home phototherapy or conventional in-hospital phototherapy. The primary outcome measurements were safety and efficacy, length of stay and the number of failed treatments. The secondary outcomes were the number of blood samples and weight gain during treatment. One hundred forty-seven patients were recruited, 69 patients randomized to conventional phototherapy and 78 to home phototherapy. The results showed that no patients needed blood exchange and only 4% of the patients allocated to home phototherapy were admitted to the hospital. The duration of phototherapy, length of stay, amount of blood tests and weight change showed no statically significant differences.Conclusion: Home phototherapy could be a safe alternative to inpatient phototherapy for otherwise healthy newborns with hyperbilirubinemia if daily checkups and 24/7 telephone support can be provided. The parents should be informed to contact the hospital immediately if they fail to perform the treatment at home.Trial registration: Clinicaltrials.gov NCT03536078What is Known:• Phototherapy in the hospital is a safe and effective treatment without major side effects.• Fibre optic equipment has made the choice of home phototherapy possible.What is New:• This is the first randomized controlled trial comparing home phototherapy with hospital phototherapy.• Results indicate that home phototherapy could be considered as a safe and feasible alternative when performed according to instructions given, to hospital treatment for otherwise healthy term newborns.

Application of blockchain technique to reduce platelet wastage and shortage by forming hospital collaborative networks

Given the short shelf life of blood products and a decrease in donor population, hospitals endeavor to achieve an equilibrium between shortage and outdating. Though collaborating and sharing blood among hospitals will result in a reasonable reduction in surplus and deficit, health regulations strongly discourage blood exchange among hospitals due to traceability issues. With the recent advancement in peer-to-peer networking, blockchains have been used for record transactions in businesses with the advantage of being timestamped. This research is one of the first to address the blood inventory management problem using the blockchain technique by forming a collaborative network of hospitals and exchanging blood in that system, enabling transparency and traceability. A novel clustering technique, called multi-criteria clustering (MCC), using a mixed-integer programming approach, is proposed to form the blockchain network that bases its clustering decisions on a number of conflicting criteria, such as collaboration preference, geographical distribution, hospital size, and operational heterogeneity. Subsequent to this, a mathematical model is developed to identify purchasing strategies for each hospital in a blockchain network, given the opportunity to share blood among other hospitals in that network. This two-phase approach is tested using hospital settings in a neighborhood of a metropolitan city. Sensitivity analysis is performed to evaluate the effectiveness of the blockchain system with respect to change in cost, shelf life, demand distribution, and coefficient of demand variation. Based on the results, it can be concluded that, for all settings, the proposed blockchain network significantly outperforms the current system with independently acting hospitals, in spite of the additional blockchain development and operating expenses that are incurred.

Post-Exchange Transfusion Sodium Change Within a Laboratory Reference Range of Serum in Hospitalized Severe Neonatal Jaundice Cases

Background: Blood exchange transfusion (ECT) therapy is an essential part of the modern health care for high-risk icteric neonates. Objectives: Therefore, this study sought to examine the effectiveness of monitoring sodium disorders and the required interventions indicating the overall state of health of hospitalized jaundiced neonates. Methods: This prospective analytic study was performed on 49 neonates diagnosed with severe jaundice undergoing screened exchange blood transfusion from November 2018 to May 2019. Serum sodium ion concentrations testing was performed before the exchange, then 1 - 3 hours later, and again 24 hours after receiving ECT, using a sensitive ELISA kit in a laboratory. Using the newest version of SPSS 24 software program, the association between different numerical variables was calculated by a repeated-measure ANOVA test. P &lt; 0.05 criterion was set as the threshold of significance. Results: Out of the total 49 neonates, 24 (48.5%) were girls and 25 (51.5%) were boys, of which 93.9% and 6.1% were term and preterm-born neonates, respectively. The average birth weight was 2843 ± 267/510 g and the mean period of hospital stay was 4.55 ± 2.399 days. The various causes of severe neonatal jaundice of all the hospitalized cases were 45% unknown, 43% combined ABO and Rh incompatibility, 10% breastfeeding pattern, and 2% G6PD deficiency. A continual fall in serum sodium was observed following banked blood exchange (P &lt; 0.05). However, these reversible changes were outside the expected normal range. Despite a diminished sodium concentration, the mean sodium levels were within the laboratory reference range of serum (137 - 142 mEq/L) in all the three measured duration times. Moreover, variation in the amount of serum sodium was associated with an unknown underlying cause that led to neonatal jaundice (P = 0.04) and this difference did not reach statistical significance in terms of birth weight, gestational age, and other causes accounting for high bilirubin (P &gt; 0.05). Conclusions: Given these facts, it was concluded that neonatal jaundice was significantly associated with post-exchange serum sodium changes within the laboratory reference range of serum.

Mathematical model for treatment of neonatal hyperbilirubinemia.

Based on the mechanism of neonatal hyperbilirubinemia treatment methods (light, exchange blood and drugs), three types of neonatal hyperbilirubinemia treatment mathematical models are established, and the expressions of the model solutions are given in this paper. By applying clinical test data and numerical approximation algorithm, the relevant parameters in the model can be estimated. According to the standards of "Expert Consensus", two treatment plans are designed, which are 1) the combined transfusion and phototherapy treatment plan and 2) the combined treatment plan of drugs, transfusion and phototherapy. The results of the program operation are numerically simulated and compared with the treatment data of clinical cases. It is found that the coincidence effect is important, which verified the rationality of the model. The model results can track and predict the changes of bilirubin levels in real-time, which provides a theoretical basis for the clinical design of treatment plans.

Productivity, Energy Exchange and Morpho-Biochemical Parameters of Blood under the Influence of a Marl-Serum Additive in Young Pigs When Rearing

Productivity, Energy Exchange and Morpho-Biochemical Parameters of Blood under the Influence of a Marl-Serum Additive in Young Pigs When Rearing

EMTiness in pseudo-malignant behavior of trophoblasts during embryo implantation.

Implantation in humans is a multistep process that involves apposition, adhesion, and invasion of the developing blastocyst into the receptive maternal endometrium. Though significant volume of research in this direction has identified important players orchestrating this delicate process, there are still gaps in our understanding of all the sequence of events during embryo implantation. Also, the early pregnancy-related complications that lead to fetal loss and miscarriage often occur in this critical window of implantation, which is primarily defined as the time when the maternal endometrium is supposed to be most receptive to the free blastocyst that emerges out from the zona pellucida. Studies in humans and rodents have identified several mediators like folliculin, LIF, IL11Ra, splicing factor SC35, etc. to be essential for early implantation. Trophoblasts, that form the outer epithelial layer of the blastocyst, participate in the formation of the placenta. During placentation, invasive extravillous trophoblasts (EVTs), migrate into the endometrium, and a transient epithelial to mesenchymal transition (EMT) and remodel the uterine arteries for blood and nutrient exchange.

Changes in Mineral Blood Exchange in Orthopedically Sick Cows When Using Complex Treatment

This article presents the results of a study of mineral components of the blood of cows suffering from purulent-necrotic ulcers in the area of the sheep during their complex treatment. In orthopedically ill animals, an imbalance in the mineral metabolism system was detected, namely, a tendency to decrease the content of calcium, phosphorus, sodium and magnesium, as well as a tendency to increase the content of potassium. As a result of the undertaken therapy of purulent pododermatitis, the dynamics of the studied indicators in the experimental groups was more pronounced and positive, which may indicate the effectiveness of the measures taken.

Klebsiella Pneumoniae sepsis, clinical features and early outcome among Newborns in neonatal intensive care unit Zawia teaching hospital

Background: Klebsiella pneumonia is one of the most common infections that cause neonatal sepsis globally. It is responsible for a significant proportion of hospital-acquired infections including septicemias, urinary tract infections, pneumonia, and soft tissue infections especially in the immunocompromised hosts such as the neonate. Aim of study: to identify, clinical features and the outcomes associated with K. pneumonia, in all newborn at NICU at Zawia teaching Hospital – Libya. Materials and Methods: Retrospective case series study conducted at neonatal intensive care unit in Zawia teaching hospital /Libya. during one year period (1st of January -30st December 2012). Four hundred and eleven neonates who were admitted to Intensive Care Unit (ICU) in pediatric department were selected. The following data was obtained from the patient’s medical records sex, birth weight, gestational age, mode of delivery, time of admission (Season), blood cultures strain of the isolates, maternal history, clinical diagnosis and features association problems mechanical ventilator, blood exchange, umbilical vein catheterization, respiratory distress syndrome, birth asphyxia, CRP for risk patient, CRP on deterioration, platelets concentrate transfusion and outcome. Result: The study results reported that 13 neonates had positive klebsiella pneumonia.9 (69.2%) preterm,9(69.2%)were males 4(30.8%)were females with 2:1 male to female ratio ,10 (76.9%) had low birth weight ,8(61.5%) were delivered by caesarean section , regarding maternal age 53.8% were between 31-40 years with mean maternal age 32.15 years and 5.5 standard deviation ,61.5% were infected at the second half of the year p value, History of PROM in 6( 46%), pre eclampsia (30.8 %) maternal fever in 1(7.7%),maternal infection (7.7%). 9(69.5%) had respiratory distress,53.8%,7 (53.8%) developed hyperbilirubenmia,4(30%) had necrotizing enterocolities ,1(7%) had acute myocarditis,1patient presented with fever and proved to have UTI with sepsis, mechanical ventilation was needed in8 (61.5%).one patient developed Pnemothorax (7.7%)and drained under water seal by insertion of chest tube. Umbilical vein catheterization inserted only in one patient7.7% Exchange blood transfusion was done in one baby 7.7%. all had negative CRP test on admission 13 (100%) and CRP was positive in all patients (100%) with positive klebsiella pneumoniae (p value 0.0001) when sepsis was suspected.10 (76.9%) of the neonates required platelets transfusion which indicate the higher rate of thrombocytopenia. Regarding neonatal outcome, the result reported that 10(76.9%) of neonates with positive klebsiella pneumonia were alive and only 3 (23.1%) died, Two due to respiratory failure and the 3rd one died due acute myocarditis complicated by heart failure. The mortality rate about 23%. 66.6%were preterm low birth weight .100% were males and due to ESBL producing strains. Conclusion: The main risk factors for the infection was preterm babies, males gender, low birth weight, caesarean section delivery, prolonged pre labor rupture of membrane (PR0M). mostly infected at the second half of the year and hospital stay, The clinical presentations are non specific, Acute myocarditis is a rare presentation with fatal prognosis. CRP is valuable for early detection of klebsiella pneumoniae infection. Thrombocytopenia is very common The mortality rate was relatively high and all deaths were male, due to ESBL producing K.pnemoniae strains which was similar to many studies in other countries.

The variation in the reduced glutathione levels of red blood cells between full-term Libyan newborns with hyperbilirubinemia

Background: Hyperbilirubinemia refers to the yellow coloration of the skin and the sclera of newborn babies that result from the accumulation of bilirubin in the skin and mucous membranes. Newborns with jaundice need to be monitored because bilirubin is potentially toxic to the central nervous system. Aim of the study: To determine the relation of erythrocytic glutathione with hyperbilirubinemia in newborns. Methods: We studied 45 Libyan full-term newborns (23 male and 22 female) with neonatal hyperbilirubinemia aged from day one to day four born in Al- Jomhoriya hospital in Benghazi. We excluded each case with pathological jaundice that needs treatment by phototherapy or blood exchange. All investigations concerning this research carried out on each newborn every 24 hours in a period of four days as follow: day 1 up to day 4, day 2 up to day 5, day 3 up to day 6, day 4 up to day 7. We analyzed the total serum bilirubin (TSB) and the level of reduced glutathione (GSH) in red blood cells directly on fresh blood. Conclusion: Our results show no significant variations in the mean level of erythrocytic glutathione in the jaundiced full-term newborns compared to the control group in the first week of life.

Medical Anthropology in the Time of COVID-19.

Medical Anthropology in the Time of COVID-19.

Plasma dilution improves cognition and attenuates neuroinflammation in old mice

Our recent study has established that young blood factors are not causal, nor necessary, for the systemic rejuvenation of mammalian tissues. Instead, a procedure referred to as neutral blood exchange (NBE) that resets signaling milieu to a pro-regenerative state through dilution of old plasma, enhanced the health and repair of the muscle and liver, and promoted better hippocampal neurogenesis in 2-year-old mice (Mehdipour et al., Aging 12:8790–8819, 2020). Here we expand the rejuvenative phenotypes of NBE, focusing on the brain. Namely, our results demonstrate that old mice perform much better in novel object and novel texture (whisker discrimination) tests after a single NBE, which is accompanied by reduced neuroinflammation (less-activated CD68+ microglia). Evidence against attenuation/dilution of peripheral senescence-associated secretory phenotype (SASP) as the main mechanism behind NBE was that the senolytic ABT 263 had limited effects on neuroinflammation and did not enhance hippocampal neurogenesis in the old mice. Interestingly, peripherally acting ABT 263 and NBE both diminished SA-βGal signal in the old brain, demonstrating that peripheral senescence propagates to the brain, but NBE was more robustly rejuvenative than ABT 263, suggesting that rejuvenation was not simply by reducing senescence. Explaining the mechanism of the positive effects of NBE on the brain, our comparative proteomics analysis demonstrated that dilution of old blood plasma yields an increase in the determinants of brain maintenance and repair in mice and in people. These findings confirm the paradigm of rejuvenation through dilution of age-elevated systemic factors and extrapolate it to brain health and function.

Use of therapeutic plasma exchange for pediatric neurological diseases

Therapeutic plasma exchange is used to treat neurological diseases in the pediatric population. Since its first use in pediatric patients with hepatic coma in the form of manual whole blood exchange, therapeutic plasma exchange has been increasingly used to treat these disorders of the nervous system. This expansion is a result of improved techniques and apheresis instruments suitable for small children, as well as the recognition of its applicability to many diseases in the pediatric population. This review provides a historical overview of the use of therapeutic apheresis in children and highlights the most common applications for therapeutic plasma exchange to treat neurological disorders in children.

Effects of Red Blood Cell Sickling on Right Ventricular Afterload in vivo.

Hemolysis in sickle cell disease (SCD) releases cell free hemoglobin, which scavenges nitric oxide (NO), leading to pulmonary vascular vasoconstriction, increased pulmonary vascular resistance (PVR), and the development of PH. However, PVR is only one component of right ventricular (RV) afterload. Whether sickled red blood cells increase the total RV afterload, including compliance and wave reflections, is unclear. Patients with SCD and pulmonary hypertension (PH) have a significantly increased risk of sudden death compared to patients with SCD alone. Sickled red blood cells (RBCs) are fragile and lyse easily. Here, we sought to determine the acute effects of SCD RBCs and increased cell free hemoglobin on RV afterload. Main pulmonary artery pressures and flows were measured in C57BL6 mice before and after exchanges of whole blood (~200 uL, Hct=45%) with an equal volume of SCD RBCs in plasma (Hct=45%) or cell free hemoglobin (Hb+) in solution. After transfusions, animals were additionally stressed with acute hypoxia (AH; 10% O2). SCD RBCs increased PVR only compared to control RBCs; cell free hemoglobin increased PVR and wave reflections. These increases in RV afterload increased further with AH. The release of cell free hemoglobin from fragile SCD RBCs in vivo increases the total RV afterload and may impair RV function more than the SCD RBCs themselves.