Effect Of Exchange Transfusion Research Articles

Effect of exchange transfusion on mortality in neonates with septicemia

Effect of exchange transfusion on mortality in neonates with septicemia

Effectiveness of Exchange Transfusion in Hyperlipoproteinemia Type 1

Effectiveness of Exchange Transfusion in Hyperlipoproteinemia Type 1

Effect of exchange transfusion on mortality in neonates with septicemia

Effect of exchange transfusion on mortality in neonates with septicemia

Study of changes in the blood levels of copper and zinc following the blood exchange transfusion in neonates with hyperbilirubinemia

<p class="abstract"><strong>Background:</strong> Blood exchange transfusion (EXT) is an essential treatment method in some icteric newborns and causes some changes in trace elements in them. The effects of blood exchange transfusion on zinc (Zn) and copper (Cu) in newborn infants is unknown. This study was conducted to determine the possible effects of EXT on Zn and Cu by comparing the levels of Zn and Cu in jaundiced neonates.</p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">In this study, 30 jaundiced term neonates undergoing EXT for the first time, because of idiopathic unconjugated hyperbilirubinemia, were selected. The Zn and Cu levels of 30 blood bank donors’ samples used for EXT were measured and 30 pairs of umbilical cord blood samples were examined for Zn and Cu before and one hour and five days after exchange transfusion. The serum bilirubin concentration was measured before and after EXT. The collected data in laboratory were analysed by statistical methods using SPSS.19. </span></p><p class="abstract"><strong>Results:</strong> In this study 43% were girls and 56.7% were boys and the average age of the infants was 4.56 days at the time of admission. Before EXT, the average of serum bilirubin was 27.74±2.03 mg/dl, and the average of serum Zn was 48.53±4.94 μg/dl that was lower than serum Zn concentration one hour after EXT (55.98±7.60 μg/dl) and five days after EXT (56.63±10.92 μg/dl). This difference was statistically significant (P=0.001). Furthermore, the average of serum Cu concentration was 59.56±10.92 μg/dl before EXT, 60.48±10.05 μg/dl after EXT and 58.64±8.06 μg/dl five days after EXT that didn't vary significantly from each other.</p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">The results showed that after EXT, the serum Zn concentration was higher than before EXT but the changes in serum Cu concentration was little and negligible. </span></p>

Exchange transfusion in patients with Down syndrome and severe transient leukemia.

Among neonates with Down syndrome (DS) and transient leukemia (TL), hyperleukocytosis (white blood cell [WBC] count >100 × 10(9) /L) is associated with increased blood viscosity, respiratory failure due to pulmonary hypertension, multiorgan failure, and increased risk of early death. There have been no previous studies focusing on the effects of exchange transfusion (ExT) on WBC count, respiratory status, and other parameters in TL patients with hyperleukocytosis. An observational retrospective study was carried out at a single center of all five DS neonates with TL, GATA1 mutations, and hyperleukocytosis, born at a median gestational age of 34 weeks (range, 30-38 weeks) with birthweight 2556 g (range, 1756-3268 g) during a 24 month study period between September 2011 and August 2013. All five neonates underwent ExT at a median age of 2 days (range, 0-5 days) before initiation of other cytoreductive therapy with cytarabine, which was carried out in two patients. All patients required respiratory support before ExT. After ExT, respiration status improved in all five patients: WBC count (mean) decreased by 85% from 143 × 10(9) /L to 21 × 10(9) /L. None developed tumor lysis syndrome. Three survived and two died: one hydrops fetalis neonate born at gestational week 30 died at age 5 days, and another died eventually from acute gastroenteritis 40 days after leaving hospital at the age of 155 days with complete remission. Two of the three surviving neonates developed acute megakaryocytic leukemia at age 90 days and 222 days. ExT was very effective in improving hyperleukocytosis and may have had favorable effects on respiration.

Effects of exchange transfusion on cytokine profiles in necrotizing enterocolitis

To study the effect of exchange transfusion on cytokine profiles in a patient with necrotizing enterocolitis, the levels of 12 cytokines and serum calprotectin were measured among exchange transfusion. A male extremely low birth weight infant was in non-compensated shock and diagnosed stage 3 necrotizing enterocolitis. Exchange transfusion was performed for critical condition, refractory hypotension and disseminated intravascular coagulation. After exchange transfusion, the patient's blood pressure increased and stabilized. Then an enterostomy was performed and revealed necrosis of the ascending colon. Of the cytokines examined, interleukin-8 and serum calprotectin were high before exchange transfusion and decreased after exchange transfusion.

Influence of albumin infusion on curative effect of exchange transfusion in children with hyperbilirubinemia

目的 研究静脉输注白蛋白对重度高胆红素血症换血患儿胆红素换出率的影响.方法 对47例临床达换血标准的患儿随机分为2组进行换血治疗,治疗组22例,换血前1 h予白蛋白1 g/kg静脉输注,对照组25例换血前不予白蛋白.两组换血方法 、步骤、换血量、换血前后各项监护均相同.比较两组换血前、中(换血总量的一半)、后血清胆红素的换出率.结果 治疗组总胆红素与未结合胆红素在换血中、换血后的换出率分别是36.4%、51.0%,37.1%、49.1%;对照组总胆红素与未结合胆红素在换血中、换血后的换出率分别是35.9%、48.9%,37.3%、51.5%;两组间血清胆红素的换出率差异无显著性(P>0.05).两组换血中和换血后血清胆红素水平与换血前比较差异有非常显著性(P<0.01).结论 静脉输注白蛋白对高胆红素血症患儿血清胆红素换出率没有影响,并造成资源浪费。

Effects of exchange transfusion on neonatal thyroid function

Effects of exchange transfusion on neonatal thyroid function

Exchange Transfusion: A Low-Cost Alternative for Severe Childhood Guillain-Barré Syndrome

The high cost and nonavailability of plasmapheresis and intravenous immunoglobulin are prohibitive for the treatment of Guillain-Barré syndrome in resource-poor settings. Exchange transfusion can be an alternative therapy for severe disease in children. The effectiveness of exchange transfusion was evaluated in nine children (median age 6 years) with severe Guillain-Barré syndrome (functional disability score >/= 4). All patients had lower limb weakness for a median duration of 4 days (range 2-16 days). Upper limb weakness (n = 8), respiratory involvement (n = 7), pooling of oral secretions (n = 3), and facial palsy (n = 1) were other motor signs. Four children developed respiratory failure; three were ventilated. Other clinical features included leg pains, meningismus and Lasàgue's sign, backache, excessive sweating, and hemodynamic instability. Two children had albuminocytologic dissociation on cerebrospinal fluid analysis. Nerve conduction velocity testing was done in three patients; two had suggestive findings. One course of exchange transfusion could be performed in seven patients. Six children (86%) responded well with one or more of the following: a halt in progressive motor weakness, improvement in leg pains, meningismus, and straight-leg raising within 24 to 48 hours; one could be weaned off the ventilator by 60 hours. All had improvement in motor power of at least one muscle group by one grade within 3 to 7 days. Two patients died, whereas five (71% of the treatment group) were discharged and could walk independently by 4 months. Two untreated ones had died. Exchange transfusion seems to be a safe and effective alternative for severe Guillain-Barré syndrome. It should be offered whenever intravenous immunoglobulin or plasmapheresis is not available or affordable. Replacement of immunosaturated red cells, removal of activated T cells and monocytes, and transient thrombocytopenia are possible explanations for its effectiveness in addition to removal of pathogenic autoantibodies, immune complexes, cytokines, and complements.

Evaluation of Left Ventricular Systolic Function in Pediatric Sickle Cell Anemia Patients Using the End-Systolic Wall Stress-Velocity of Circumferential Fiber Shortening Relationship

The aim of this work was to evaluate myocardial contractility using the end-systolic wall stress (ESSm)-velocity of circumferential fiber shortening (VCFc) relationship in sickle cell anemia (SCA) patients compared with a similar age group of African-American (AA) control patients. Abnormalities of myocardial function have been documented in SCA patients using load-dependent echocardiographic indexes. Whether the systolic dysfunction results from impaired myocardial contractility or altered loading conditions is unknown because controlled studies using a load-independent measure of contractility have not been performed. Fifty healthy AA patients and 57 SCA patients age 3 months to 18 years were studied. Simultaneous indirect arterial pulse tracing, phonocardiogram, electrocardiogram, and M-mode tracing of the left ventricular (LV) short-axis were recorded. The LV dimensions, corrected ejection time (ETc), percent fractional shortening (%FS), VCFc, and ESSm were determined. The ESSm-VCFc relationship was calculated and compared between groups. Duration and severity of anemia and effects of exchange transfusion on the ESSm-VCFc relationship were determined. The SCA patients had increased LV dimensions in systole and diastole, and increased indexed LV mass. Load-dependent measurements of LV function (ETc, %FS, and VCFc) were lower in SCA patients, and afterload, as measured by ESSm, was increased. The ESSm-VCFc relationship demonstrated reduced contractility in SCA patients compared with control subjects. Degree and duration of anemia along with exchange transfusions did not impact contractility. Sickle cell anemia patients have significant LV dilatation and increased LV mass due to abnormal loading conditions. Contractility, measured by the ESSm-VCFc index, is lower in SCA patients and was not negatively impacted by severity or duration of anemia, or exchange transfusions. The underlying mechanism explaining these findings requires further investigation.

Simvastatin: a new therapeutic approach for Smith-Lemli-Opitz syndrome

The Smith-Lemli-Opitz syndrome (SLOS) is caused by deficient Delta(7)-dehydrocholesterol reductase, which catalyzes the final step of the cholesterol biosynthetic pathway, resulting in low cholesterol and high concentrations of its direct precursors 7-dehydrocholesterol (7DHC) and 8DHC. We hypothesized that i) 7DHC and 8DHC accumulation contributes to the poor outcome of SLOS patients and ii) blood exchange transfusions with hydroxymethylglutaryl (HMG)-CoA reductase inhibition would improve the precursor-to-cholesterol ratio and may improve the clinical outcome of SLO patients. First, an in vitro study was performed to study sterol exchange between plasma and erythrocyte membranes. Second, several exchange transfusions were carried out in vivo in two SLOS patients. Third, simvastatin was given for 23 and 14 months to two patients. The in vitro results illustrated rapid sterol exchange between plasma and erythrocyte membranes. The effect of exchange transfusion was impressive and prompt but the effect on plasma sterol levels lasted only for 3 days. In contrast, simvastatin treatment for several months demonstrated a lasting improvement of the precursor-to-cholesterol ratio in plasma, erythrocyte membranes, and cerebrospinal fluid (CSF). Plasma precursor concentrations decreased to 28 and 33% of the initial level, respectively, whereas the cholesterol concentration normalized by a more than twofold increase. During the follow-up period all morphometric parameters improved. The therapy was well tolerated and no unwanted clinical side effects occurred. This is the first study in which the blood cholesterol level in SLOS patients is normalized with a simultaneous significant decrease in precursor levels. There was a lasting biochemical improvement with encouraging clinical improvement. Statin therapy is a promising novel approach in SLOS that deserves further studies in larger series of patients.

Effect of Exchange Transfusion on Brain Perfusion and Electrocortical Brain Activity in Newborn Lambs

Changes in brain perfusion (using ultrasonic-determined changes in carotid artery blood flow: Q_car) and electrocortical brain activity (ECBA, obtained by a Lectromed cerebral function monitor) were studied during exchange transfusion using the push-pull method in the newborn lamb. Changes in mean arterial blood pressure (MABP), Q_car, heart rate (HR), and ECBA were observed during all exchange transfusions: MABP, Q_car, and ECBA decreased during the withdrawal period and increased during the infusion period, whereas HR showed the opposite phenomenon. Changes in ECBA appeared to be primarily associated with changes in brain perfusion (p < 0.05). These changes in brain perfusion were, however, caused by changes in MABP (p < 0.0001). We concluded that exchange transfusions caused moderate changes in brain perfusion, however changes in ECBA appeared to be very small, and have probably no clinical importance.

Effect of exchange transfusion with a red blood cell substitute on neonatal hemodynamics and organ blood flows

The present study was designed to evaluate the effect of a perfluorocarbon erythrocyte substitute on hemodynamics in the newborn lamb. Isovolumic double volume exchange transfusions were performed with perfluorocarbon emulsion (FC-43) on lambs who were ventilated to maintain normal acid base status. Hematocrit, fluorocrit, viscosity, arterial gas tensions, mean arterial pressure, and heart rate were determined before (control) and after (exchange) exchange transfusion. A radiolabeled microsphere technique was used and cardiac output, organ blood flow, organ vascular resistance, and oxygen delivery were calculated. As the hematocrit and viscosity decreased and the fluorocrit increased, there was a significant increase in PaO2 as well as a significant decrease in A-a gradient and oxygen content. There was no significant change in the acid-base status or the hemodynamic profile (heart rate, stroke volume, cardiac output, and mean arterial pressure). Blood flow to the heart and brain showed a significant increase, whereas flow to the cortex of the kidney showed a significant decrease. There was no significant change in flow to the gastrointestinal tract. Organ vascular resistance in the brain significantly decreased, increased in the kidney, and showed no significant change in the heart and gastrointestinal tract. Oxygen delivery significantly decreased in all organs except the heart. These data suggest that perfluorocarbon emulsions can acutely maintain hemodynamic stability in the newborn lamb and that the intrinsic properties of perfluorocarbons allow for the preservation of adequate oxygenation and acid-base status.

Effects of pyridoxalated hemoglobin polyoxyethylene conjugate on diameter of rat mesenteric arterioles in situ.

The effects of exchange transfusion (ET) with a modified hemoglobin (pyridoxalated hemoglobin polyoxyethylene conjugate, or PHP) on endothelium-dependent relaxation of microvasculature were examined in rat mesenteric arterioles using image-splitter television microscopy. To examine the endothelium-dependent relaxation, we applied acetylcholine (ACh) to arterioles preconstricted with norepinephrine (NE) and measured changes in arteriolar diameter. Topical application of NE (6 x 10(-8) to 6 x 10(-6)M) decreased the diameter of the arterioles dose-dependently to a mean of 45% (SE +/- 4%, n = 6) of the control. Topical application of ACh (7 x 10(-8) to 7 x 10(-6)M) increased the diameter of the arterioles preconstricted with NE in a dose-dependent manner and almost fully reversed the NE-induced decrease in diameter. ET with 6% PHP solution (30 ml/kg) induced an increase in the mean arterial blood pressure (MABP) from 117 +/- 5 to 132 +/- 4 mm Hg (n = 6, p < 0.05), with a concomitant decrease in diameter of arterioles, from 22.6 +/- 2.5 to 19.8 +/- 2.7 microns (p < 0.05). The MABP and arteriolar diameter gradually returned to the control level within 30 min after ET. Arteriolar changes in diameter in response to NE and ACh examined 30 min after ET were similar to those of the control. ET with 6% stroma-free hemoglobin (SFH; 30 ml/kg) did not alter arteriolar changes in diameter in response to NE and ACh. Results suggest that circulating PHP and SFH moieties do not interfere with endothelium-derived relaxing factor(s) induced by ACh in rat mesenteric microvasculatures in situ.

Pyridoxalated hemoglobin polyoxyethylene conjugate (PHP) on the endothelium-dependent relaxation in rat mesenteric arterioles.

Effects of exchange-transfusion with a modified hemoglobin (pyridoxalated hemoglobin polyoxyethylene conjugate; PHP) on diameter of rat mesenteric arterioles responding to various vasoactive substances were examined using the image-splitter television microscopy method. The mesentery of the anesthetized rat was spread over the stage of a microscope and the microvasculature was visualized by transillumination. Exchange-transfusion with a 6%PHP solution (30 ml/kg) was performed and effects of topical application of norepinephrine (NE) and acetylcholine(ACh) on diameter of mesenteric arterioles were examined. By exchange-transfusion with PHP, NE induced a dose-dependent decrease in diameter, while ACh induced a dose-dependent increase in diameter of the arterioles preconstricted by NE. There was no difference in vascular responsiveness to ACh and NE before and after exchange-transfusion with PHP solution. Results suggest that circulating PHP moiety does not exert any action on function of endothelial cell to release endothelium-derived relaxing factor (EDRF) in rat mesenteric microvasculature in situ.

Chloral Hydrate Toxicity in a Term Infant

Chlorate hydrate is commonly used for neonatal sedation, but blood levels are infrequently monitored, reflecting an underemphasis of acute toxic effects. This report describes a case of chloral hydrate toxicity in a term infant with cardiac, renal, neurologic, bladder and gastrointestinal dysfunction. The effects of exchange transfusion are described as well as pharmacokinetics.

Laboratory tests for monitoring prophylactic exchange transfusion in pregnancy complicated by sickle cell disease.

Prophylactic exchange transfusion is of uncertain value in pregnancy complicated by sickle cell disease (SCD), and there is a lack of laboratory tests to monitor its effect and determine the optimal number and frequency of transfusions. In a prospective study of four consecutive pregnancies complicated by SCD, the product of the PCV and percentage of haemoglobin S gave a 'sicklecrit' value that showed a significant (P less than 0.01) improvement following transfusion. Erythrocyte filterability through pores of 5 microns diameter also improved significantly (P less than 0.05) whereas whole blood viscosity did not, owing to the overriding effect of the increase in PCV. Measurement of sicklecrit and erythrocyte filterability, reflecting blood rheology in large and small vessels respectively, may therefore be used to monitor the effects of exchange transfusion in SCD.

Effect of exchange transfusion with Fluosol DA 20% on splenic distribution and immunocompetence of rat lymphocytes.

T- and B-splenic lymphocyte frequency, immune response 4 days after immunization with sheep red blood cells (SRBC), and proliferative response to concanavalin A (Con A) were determined 1, 3, and 5 days after exchange transfusion with Fluosol DA 20% (FDA) in adult, male Sprague-Dawley rats vs sham transfused rats. T-cell, T-helper, T-suppressor, and B-lymphocyte were reduced 1 day after transfusion (P less than or equal to 0.001). T- and B-lymphocyte frequencies were still reduced at day 3 (P = 0.0372). By day 5, there were no significant reductions in T-cell, T-helper, T-suppressor, and B-cell frequencies in the FDA-transfused rats. The frequency of cells with cytoplasmic IgG was reduced (P less than or equal to 0.025) in cells harvested from spleens of FDA-transfused rats and tested fresh. Proliferative response of splenic lymphocytes to Con A was unaffected by transfusion with FDA (P greater than or equal to 0.078). Splenic hemolytic plaques in response to SRBC were unaffected if rats were transfused 3 days after immunization with SRBC and 1 day prior to study (P = 0.941), enhanced if rats were transfused 1 day after SRBC immunization and 3 days prior to study (P = 0.0015), and suppressed if rats were transfused 1 day before SRBC immunization and 5 days before study (P less than 0.0001). Transfusion with FDA causes transient decreases in identifiable T and B lymphocytes, depresses cytoplasmic IgG-positive B cells, does not affect proliferative response to Con A, does not affect an ongoing specific immune response, enhances an early specific immune response, and inhibits the induction of a specific immune response.

Effects of exchange transfusion with perfluorochemical emulsions on hepatic oxygen supply and blood flow in the rat.

Exchange-transfusion to hematocrit 20 with isotonic perfluorochemical (PFC) emulsions containing 3% hydroxyethylstarch (HES) in rats breathing 100% oxygen produced significant reductions of hepatic PO2 and blood flow in comparison to rats hemodiluted with isotonic 3% or 6% HES solution. The results indicate that PFC and/or emulsifiers were associated with adverse effects on liver blood supply.

....Beginning to See the Light

In March 1952, Mollison and Walker1 reported the results of their prospective, randomized, controlled trial on the effect of exchange transfusion v simple transfusion in infants with severe erythroblastosis fetalis. They showed that exchange transfusion led to significantly lower mortality and a much lower incidence of fatal kernicterus. In the interim, numerous published studies have examined the relation between serum bilirubin levels in the neonatal period and the postmortem finding of kernicterus or the presence of later, clinical, bilirubin encephalopathy. With few exceptions, the design of these studies has made interpretation of their results hazardous, if not nugatory.2 We now have a study from the National Institute of Child Health and Human Development (NICHD)3 in which the population is sufficiently large and the study design sufficiently rigorous to permit actual, if tentative, conclusions concerning the effect of a different intervention (phototherapy) upon the immediate and later outcome of jaundiced newborn infants.