Fresh Blood Transfusion Research Articles

Le fibrome naso-pharyngien. Exérèse sous hémodilution et autotransfusion différée

The surgical treatment of juvenile naso-pharyngeal angiofibroma involved a potential haemorrhagic risk : the average intra-operative blood loss was estimated at between 1,300 and 2,800 ml in many reports. Two cases are reported in which haemodilution and autologous blood transfusion were used. The method consisted in pre-operative repeated phlebotomies (“leapfrog”) and normovolaemic acute haemodilution; thus, 1,700 ml of autologous blood was collected in the first case, and 2,300 ml in the second one. Autotransfusion was carried out and no homologous blood transfusion was used in the peri-operative period. The use of this method, although compelling, had many advantages (financial saving, suppression of adverse reactions with homologous transfusion, transfusion of fresh blood, reduction of postoperative oedema).

特発性血小板減少性紫斑病を有する患者の歯科治療における全身管理

Dental managements in a 17 year old male patient with thrombocytopenia were performed to provide adequate care for post operative bleeding.The patient had been treated with immunosupresive agent therapy and splenectomy, but an elevation of the platete level in the blood did not occur. He had been treated with fresh blood transfusions several times due to spontaneous bleeding from the nasal mucosa and digestive tract.In the present instane, he recieved dental managements for spontaneous oral bleeding. Transfusions of fresh platelet concentrates were carried out intentionally to elevate the count of circulating platelats by at least 50, 000/mm3 for one week after surgical procedures.In the present case, the idiopathic thrombocytopenia patient was reported who sought dental care and who already received splenectomy and prolonged corticosteroid therapy as repoted.It must be considered to produce anti-platelet antibody against fresh platelet concentrates as compared to antibody formations of regular blood transfusion.

Congenital Trypanosomiasis in a Child Born in London

A female infant of 22 months was referred to the Hospital for Sick Children, London, because of delayed psychomotor development. Extensive investigations revealed no cause, but eventually trypanosomiasis was diagnosed. The infant had not been outside the UK, but her mother came from Zaire, where the disease is endemic, but had lived in Kinshasa, where there is no sleeping sickness. It is thought, that the mother may have been asymptomatically infected by a fresh-blood transfusion four years earlier, since no other source of infection was apparent.

Human cytomegalovirus infection: recent developments in diagnosis and epidemiology.

Cytomegalic inclusion disease (CID) is caused by a horizontally or vertically transmitted human herpes virus infection and may persist for life without obvious clinical symptoms. A serious course of horizontal primary and recurrent infections, however, is often observed in immunocompromised persons such as recipients of organ transplants and patients receiving fresh blood transfusions. Vertical infection may cause fetopathies. The human cytomegalovirus (HCMV) is thought to inherit an oncogenic potential as lately discussed for AIDS and M. Kaposi. Laboratory diagnosis of HCMV infection is performed by light microscopy (inclusion bodies), electron microscopy, virus isolation in cell culture, demonstration of viral DNA and antigen in clinical specimens, by histochemical methods (e.g. immunoperoxidase technique) and by DNA and peptide analysis for identification of different isolates and viral finger prints. Evaluation of cell-mediated immunity in HCMV infection is performed quantitatively (assessment of Thelper/Tsuppressor ratios) or qualitatively (specific lymphocyte stimulation by the antigen). In most cases laboratory diagnosis is achieved by serological methods, i.e. demonstration and quantitation of HCMV-specific antibodies. In this context, a number of liquid- and solid-phase immunoassays have been developed, of which immunofluorescence and ELISA are most commonly used, besides complement fixation and passive haemagglutination. These procedures on the one hand allow the use of different antigen preparations as early and late viral proteins, and on the other hand permit a specific determination of different Ig classes and subclasses. A variety of assays has been established especially for determination of virus-specific IgM antibodies, which are predominantly found in active infection. These, however, at least in part may show non-specific results caused by interference of rheumatoid factor or IgG competition. Such problems have now been dealt with and are avoided by IgG precipitation or IgM immunosorption ("mu-capture" technique). These recent methods allow an exact epidemiological identification of risk groups for CMV infection. Results from our laboratory revealed 13% HCMV-IgM positive patients among pregnant women, 16% IgM positive patients among renal transplant recipients, 4% IgM positive cases in patients after cardiosurgery and 1.7% IgM positives among prostitutes. The prevalence of HCMV infection as indicated by specific IgG antibodies was 56%, 90%, 83%, and 90%, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)

DEVELOPMENT OF FATAL BONE MARROW SUPPRESSION DURING D-PENICILLAMINE THERAPY IN THREE PATIENTS WITH RHEUMATOID ARTHRITIS

Three patients with advanced rheumatoid arthritis developed fatal pancytopenia in one case and fatal agranulocytosis in the other two, during the course of D-penicillamine therapy.One patient with classical rheumatoid arthritis experienced fatal pancytopenia after four year treatment of 600mg/day of D-penicillamine which had successfully inhibited acute arthritic episodes during that time. Without any abnormal data suggestive of blood crisis in routine peripharal blood analysis, the patient had begun to complain of palpitation and arrhythmia. The later blood count revealed severe anemia (Hb 6.2g/dl)with leukopenia (2100/mm3) and no platelet. Every effort of suporting therapies including transfusions of fresh blood and platelets, injections of high doses of corticosteroid and protection against life-threatening infections seemed to be of no value for improvement of his pancytopenia and for sequential severe infections. He died from asphyxiation in air way bleeding after two months of hospitalization.The other two patients with classical rheumatoid arthritis experienced sudden catastrophes similar to the condition of sepsis with agranulocytosis. Until the attaks of high fever and acute arthritis, they had been treated with 400mg/day or 200_??_300mg/day of D-penicillamine only for one month with no beneficial effect for their arthritis. They were immediately hospitalized and were found to have leukopenia with little evidence of anemia and thrombocytopenia in their peripheral blood.On the second day in the hospital, agranulocytosis was seen without any changes of platelet and erythrocyte counts and was continued till the sixth day when they died from cerebral bleeding and septic shock respectively.Our three patients were characterized to possess advanced arthritic lesions, severe infections at the time of fatal blood disturbance and relatively heavy doses of anti-rheumatic drugs including corticosteroids, gold and non-steroidal anti-inflammatory drugs before the start of D-penicillamine. These suggest that our patients had been already suppressed hemopoiesis in bone marrow presumably due to several causes including rheumatoid arthritis itself and medications other than D-penicillamine. In addition, adrenal insufficiency caused by long use of steroid may play a role in sudden onset of severe infections which may result in further consumption of leukocytes. As known to have direct cytotoxic effect on bone marrow or to trigger the immunological reactions toward elimination of leukocytes and other cells, D-penicillamine may further suppress the bone marrow functions enough to be realized by routine blood analysis.Althouth our data of three patients are not enough to elucidate the mechanism of marrow suppression or leukopenia by D-penicillamine, learning of rare cases with fatal pancytopenia or agranulocytosis during D-penicillamine therapy may be important for revaluation of the drug and also general clinics of patients with rheumatoid arthritis.

Fresh autologous blood transfusion and platelet counts after cardiopulmonary bypass surgery.

The effect of fresh autologous blood transfusion on platelet count and blood requirement in the early postoperative period is examined in a control group and in patients receiving early and late autologous replacement. Withdrawal of blood in the autologous groups appeared to enhance platelet numbers as the autologous groups had higher mean platelet counts than the control group immediately after bypass, in spite of having lower mean haematocrit. After bypass all groups showed a progressive rise in platelet count with time. A substantial part of the rise was explained by haemoconcentration resulting from fluid shifts but there was also an increase in the total circulating platelet numbers. There was no difference in postoperative blood loss between the three groups. Autologous blood replacement hastens the postoperative rise in platelet count but does not alter the postoperative blood loss.

Improvement of Phagocytosis and Nitroblue Tetrazolium Reduction After Exchange Transfusions in Two Preterm Infants with Severe Septicemia

Vain et al1 have recently reported that the use of the exchange transfusion (ET) with fresh blood in addition to antibiotics and other supportive care therapies, had brought about a decreased mortality in a series of ten newborn infants suffering from severe septicemia with sclerema. They ascribe this effect more to the removal of endotoxins and the improvement of perfusion and tissue oxygenation than to the enhancement of an inflammatory response on the basis of two factors. First, although fresh blood transfusions are postulated to increase humoral immunity depending on the opsonic activity of blood from the donors, many patients had failed to show a significant clinical response after receiving large fresh blood transfusions; but after ET with blood from the same donors a clear improvement had been obtained.

Reversion of the downhill course of active lepromatous leprosy by repeated transfusions of fresh blood, donated by healthy but lepromin positive patients.

Earlier studies of immunologic reconstitution therapy of active lepromatous leprosy patients by repeated infusions of viable allogeneic blood lymphocytes indicated a beneficial effect. In order to avoid cell separation and its associated risks, we attempted to transfer immunity passively into seven seriously ill lepromatous patients by repeated transfusions of fresh blood donated by healthy, but tuberculin and lepromin positive, subjects. The results showed clinical improvement in some cases with the elimination of Mycobacterium leprae, histological reversion and return of immunologic responsiveness.

Effect of age and 2,3-DPG content of transfused blood on serum erythropoietin.

Serum erythropoietin has been measured before and after transfusion of blood stored in acid citrate dextrose for varying periods of time. A greater fall in erythropoietin was found following the transfusion of fresh blood than after an equal amount of stored blood in which 2,3-diphosphoglycerate concentrations were depleted. This confirms that expectations that in vivo tissue oxygenation is influenced by the oxygen affinity of transfused blood.

Deliberate donor-specific blood transfusions prior to living related renal transplantation. A new approach.

In order to select MLC incompatible one-haplotype related donor-recipient pairs that would achieve better graft survival and in an effort to alter the recipient immune response, 45 patients received three fresh blood transfuions from their prospective kidney donors. Recipient sensitization was evaluated by cross-match testing weekly sera obtained during and after the blood transfusions against donor T- and B-lymphocytes at 5 C (cold) and 37 C (warm). Thirteen (29%) of the 45 potential related recipients developed a positive warm T-cell cross-match or a persistent warm B-cell cross-match to their blood donor and related transplantation was not performed. Thirty-two (71%) patients had an appropriate negative cross-match to their blood donor. Thirty of these patients subsequently received kidneys from their blood donor. Ninety-seven per cent of the kidneys are functioning from one to 25 months with a single graft failure due to a patient discontinuing immunosuppressive medication. In addition to the excellent graft survival there was an unusually low incidence of rejection episodes in the recipients of kidneys from their blood donor so that the posttransplant course paralleled that of HLA-identical siblings. This approach may have future application with two-haplotype mismatched donor-recipient pairs, both related and unrelated.

Effect of Age and 2,3-DPG Content of Transfused Blood on Serum Erythropoietin

Serum erythropoietin has been measured before and after transfusion of blood stored in acid citrate dextrose for varying periods of time. A greater fall in erythropoietin was found following the transfusion of fresh blood than after an equal amount of stored blood in which 2,3-diphosphoglycerate concentrations were depleted. This confirms the expectations that in vivo tissue oxygenation is influenced by the oxygen affinity of transfused blood.

Discussion of 8 cases (10 pregnancies) complicated with aplastic anemia during pregnancy and labor

We experienced 8 cases (10 pregnancies) complicated with aplastic anemia during pregnancy and labor for last 10 years and analysed haemorrhagic, obstetrical problems of these cases.Three cases occurred during pregnancy, 1 case after abortion, 4 cases independent of pregnancy. Anemia became worse in all cases during pregnancy and fresh blood transfusions were required. According to our experiences, minimum RBC counts in patients who had livebirths was 120×104/mm3 (Hb; 3.5g/dl). Platelets counts was also decreased during pregnancy and haemorrhagic tedency appeared, so some cases received platelets transfusions. WBC counts was not almost influenced by pregnancy, but 1 case had fever in puerperium. At delivery the amount of bleeding was various, but in all cases either fresh blood or platelets transfusions were required.Aplastic anemia becomes more serious during pregnancy but becomes better after delivery. Problems of aplastic anemia with pregnancy are severe anemia, haemorrhagic tendency, danger of infection. So, pregnancy must be interrupted during the early stage of pregnancy, and during the last stage fresh blood or platelets transfusions are required. Vaginal delivery without laceration is the absolute principle, because uterine bleeding can be easily ceased by the biological ligation of uterine muscle. Prudent follow-up and contraception are necessary after delivery.

Effects of stored and fresh blood transfusions on postoperative pulmonary function. A clinical study on patients following extracorporeal circulation in association with aortic valve surgery.

The effects on postoperative pulmonary function of fresh versus stored blood when priming the heart-lung machine were studied in 49 patients subjected to aortic valvular replacement. The onset of extracorporeal circulation was considered to mimic the conditions of massive blood transfusion. The patients receiving heparinized fresh blood required more oxygen in the respirator than those receiving stored blood, but still had a significantly lower arterial oxygen tension during the first and second postoperative days. The fresh blood patients also showed a tendency to require a larger amount of diuretics to maintain adequate urine output. Pre- and postoperative bleeding and changes in postoperative hematological variables did not differ in the two groups. The results imply that stored blood should be preferable when substituting blood losses.

Effect of blood transfusion in low birthweight infants.

143 fresh blood transfusions were given to 32 low birthweight babies, 28 of whom had hyaline membrane disease. The arterial or central venous pressure was raised by a blood transfusion if before transfusion the mean arterial pressure was less than 35 mmHg or if the diastolic central venous pressure was less than -- 0-5 mmHg. There was no effect of blood transfusion on pH. It therefore appears either that metabolic acidosis in hyaline membrane disease is not caused by poor peripheral perfusion or that blood transfusion does not increase peripheral blood flow in this condition. The safety of the procedure is assessed.

Cytomegalovirus Infection Associated with Severe Encephalitis

A previously healthy 37-year-old woman had a 5-week febrile disease starting 10 days after delivery, which was complicated by disseminated intravascular coagulation and treated with fresh blood transfusions. She developed severe encephalitis with coma. She also had signs of perimyocarditis and enlargement of liver and lymph nodes. The encephalitis was completely reversible. There was a 16-fold rise in complement-fixing antibodies against cytomegalovirus.

RESUSCITATION OF PRETERM INFANTS WITH EARLY POSTNATAL CARDIOVASCULAR SHOCK

This study was designed to evaluate the vascular compartment of infants born in the presence of maternal vaginal bleeding, and to describe one regimen for fluid and pharmacologic resuscitation. Eleven infants born to mothers with abruptio placentae exhibiting tachycardia (HR>150) and hypotension at 1 hr. age received empiric infusions of 20 ml/kg lactated Ringers solution (LR) and 20 ml/kg fresh blood. Blood volume (BV) determinations using the 51Cr RBC dilution technique were completed and BV deficits were then corrected by rapid transfusions of fresh blood. BV determinations were repeated and infants were given 1 μg/kg per min. continuous infusion of Dopamine if BV was normal and hypotension persisted.Eleven infants were studied and BV were markedly deficient as reflected in the mean red cell volume of 35 ml/kg (nl = 64), and mean total BV of 67 ml/kg (nl = 108). Two infants were infected (Group B strep, E. coli), and 2 infants remained hypotensive following BV restoration with a second transfusion. The infant with Strep infection and 1 infant given Dopamine expired.We conclude that preterm infants with hypotension resulting from abruptio placentae are markedly volume deficient and that proper management of these babies required BV determinations. Although early resuscitation with LR is efficacious (survival = 82%), treatment with Dopamine requires further evaluation.

ROLE OF ANTIBODY AND THE CLASSICAL AND ALTERNATIVE COMPLEMENT PATHWAYS ON THE OPSONIZATION OF GROUP B STREPTOCOCCI

In previous studies we have shown that neonates who develop Group B streptococcal sepsis usually lack opsonins to their infecting strain. This investigation was designed to determine the role of antibody and complement in opsonization of these organisms. We also evaluated the effects of fresh blood transfusions on serum opsonic activity in neonates. Group B streptococcal opsonins were determined by a chemiluminescence procedure previously described (JCI 58:1379, 1976). Opsonic activity for types Ia and II was significantly depressed by heating and by inactivation of the classical pathway with Mg++ EGTA. Similar treatment of fresh serum containing type III antibody did not alter opsonic activity for this strain. In the absence of heat stable antibody, fresh serum demonstrated no alternative pathway opsonic activity for group B streptococcal strains; factor B was not activated by electrophoretic analysis; and C3 was not deposited on the cell surface. Comparison of pre and post transfusion sera from 19 neonates showed a rise in opsonic activity only when heat stable antibody was present in donor serum. These results confirm the importance of heat stable antibody and the classical pathway in opsonization of Group B streptococci but do not indicate a major role for the alternative pathway. Therapy aimed at supplying passive immunity to infected neonates will require the presence of heat stable opsonins.

Cytomegalovirus hepatitis in an artificial kidney unit

Serum hepatitis is a dreaded risk in connection with regular dialysis treatment (RDT). Liver damage, however, can be cuased by other diseases, such as infection with cytomegalovirus (CMV). Two cases in our artificial kidney unit revealed signs of liver damage with increased liver enzyme activity. Case 1, a woman, was on RDT after an unsuccessful renal transplantation, and Case 2, a man, belonged to the staff. Serum hepatitis was initially suspected in both cases, but repeated examinations of the sera revealed no hepatitis B antigen or antibodies (HbAg and HbAb). Later on, both showed a significant increase in antibodies in complement fixations reaction (CF) to CMV-antigen. CMV could be isolated from urine in Case 2. Case 1 had been bilaterally nephrectomized. The symptoms (tiredness, muscle pain and headache) and the course of the disease were mild in both cases and liver enzymes became normal within 1-2 weeks. Twenty out of 31 examined patients and staff had antibodies in CF to CMV-antigen, but in none was there any significant increase. The source of infection may have been transfusion of fresh blood in Case 1, but in Case 2 no particular source could be suspected. Thus, in liver damage CMV-infection may be an etiological alternative. In routine work at artficial kidney unite patients and personnel are regularly examined in respect of bilirubin, liver enzymes, HbAg and HbAb in serum. We recommend also examination of serum for antibodies in CF to CMV-antigen. Until a firm differential diagnosis has been established the patient should be isolated and the dialysis equipments used only by that patient.

The treatment of malaria.

At least four doses of quinine followed by a single dose of mefloquine or by a single dose of sulfadoxine-pyrimethamine are two highly effective regimens for chloroquine-resistant falciparum malaria. Mefloquine alone is valuable in ambulant patients. Chloroquine-sensitive falciparum malaria can be treated with a course of chloroquine. Vivax and all other types of malaria should be treated with sequential chloroquine and primaquine. Quinine, by intravenous infusion, is the most effective drug for severe falciparum malaria. The optimum intravenous dose varies between 5 mg/kg and 10 mg/kg administered over four hours. Intravenous or oral quinine should be administered about every 12 hours and the total daily dose of quinine should rarely exceed 20 mg/kg. Intravenous fluid input should be controlled in falciparum malaria to prevent pulmonary oedema. Established renal failure is best treated by dialysis. The value of adrenocortical steroids for falciparum coma has not been established. Fresh blood transfusion may be helpful in small doses for severe anaemia and to replace clotting factors. Anticoagulants, such as heparin, should not be used in falciparum malaria.

Fréquence des hépatites après circulation extra-corporelle

In cardio-vascular surgery the risk that the hepatitis-B (H.B.) virus be transmitted was measured in 3 groups of patients (Professor Ch. Dubost), before and since systematic screening for HBS antigen in donors' blood. The same questionnaire was sent to each patient in each group 6 months after extra-corporeal-circulation (ECC), in order to determine the efficiency of HB virus screening tests. The present study gives the following results: --in the first group (no screening for HBS antigen in donors' blood), the frequency of icteric hepatitis was 6.7% (26 cases of jaundice, probably due to hepatitis viruses, out of 386 ECC); --in the second group (screening for HBS antigen in donors' blood by immuno-diffusion (often made after transfusion of fresh blood) the frequency of icteric hepatitis after transfusion of HBS antigen positive blood); --in the third groups, icteric hepatitis was less frequent (4.6%) since systematic screening for HBS antigen by counter-electrophoresis and complement fixation was performed (29 cas out of 629 ECC). Additionally, viral hepatitis appeared more frequently in men than in women, and among older patients than younger ones. Recovery was generally complete in 2 months; however, the evolution of the disease was severe in 3 cases and fatal in one case. In sum, after ECC, hepatitis still remains a frequent side-effect, compelling blood centers to use th most sensitive screening tests now available for HBS screening: radio-immuno-assay and reverse passive haemagglutination tests. As a consequence of the present study, these 2 techniques are being applied on a daily basis in our laboratory for HBS antigen screening tests are ineffective in preventing the transmission of other strains of viral hepatitis by blood transfusion.