Hb Loss Research Articles

A prospective, randomized comparison of a 1940 nm and a 2013 nm thulium: yttrium-aluminum-garnet laser device for Thulium VapoEnucleation of the prostate (ThuVEP): First results.

Introduction:We report the early postoperative results of the first prospective, randomized comparison of two commercially available thulium lasers with different wavelengths for the treatment of benign prostatic obstruction (BPO).Materials and Methods:From January to June 2013, 80 consecutive patients were randomized for Thulium VapoEnucleation of the prostate (ThuVEP) with a 2013 nm (RevoLix®) (n = 39) or a 1940 nm (Vela®XL) (n = 41) thulium laser. Preoperative status, surgical details and the immediate outcome were recorded for each patient. The perioperative complications were assessed and classified according to the modified Clavien classification system.Results:Median operation time, resected tissue, percentage of resected tissue, catheter time, overall operation efficiency and Hb loss differed nonsignificantly between both devices (P > 0.05). At discharge, the median maximum urinary flow rate and postvoiding residual (PVR) urine improved significantly in both groups (P < 0.001). The PVR was lower in the 1940 nm ThuVEP group (P ≤ 0.034). Perioperative complications occurred in 18 (22.5%) patients (Clavien 1: 12.5%; Clavien 2: 5%, Clavien 3b: 2.5%, Clavien 4a: 2.5%), with no differences between the groups (P = 0.5).Conclusions:The 1940 nm and the 2013 nm thulium lasers are both safe and effective for the treatment of BPO with ThuVEP. Both lasers give equivalent and satisfactory immediate micturition improvement with low perioperative morbidity.

Is tranexamic acid clinically effective and safe to prevent blood loss in total knee arthroplasty? A meta-analysis of 34 randomized controlled trials.

Tranexamic acid (TXA) is well established as a versatile intraarticular and intravenous (IV) antifibrinolytic agent that has been successfully used to control bleeding after total knee arthroplasty (TKA). The present meta-analysis aimed at assessing the effectiveness and safety of TXA in reducing blood loss and transfusion in TKA. We searched the PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases from 1966 to December 2013. Only randomized controlled trials (RCTs) were included in the present study. Two independent reviewers identified the eligible studies, assessed their methodological quality, and extracted data. The data were using fixed-effects or random-effects models with standard mean differences and risk ratios for continuous and dichotomous variables, respectively. Subgroup analysis was performed according to the IV or intraarticular administration of TXA. Thirty-four RCTs encompassing 2,594 patients met the inclusion criteria for our meta-analysis. Our meta-analysis indicated that when compared with the control group, the IV or intraarticular use of TXA significantly reduced total blood loss, postoperative blood loss, Hb loss, and transfusion rate as well as blood units transfused per patient after primary TKA, but did not reduce intraoperative blood loss. No significant difference in deep vein thrombosis (DVT), pulmonary embolism, or other adverse events among the study groups. IV or intraarticular use of TXA for patients undergoing TKA is effective and safe for the reduction blood loss and blood transfusion requirements, yet does not increase the risk of postoperative DVT. Level II.

Novel System for Rapid Assessment of Blood Loss in Elective Surgery and Cesarean Delivery

INTRODUCTION: Visual and gravimetric methods of estimating blood loss are severely limited by human error and the presence of large volumes of amniotic fluid, irrigation, or both. The study goal was to assess accuracy of a novel system for intraoperative monitoring of hemoglobin (Hb) loss. METHODS: After institutional review board approval, 50 patients undergoing elective surgery or cesarean delivery contributed laparotomy sponges intraoperatively. The iPad-based Triton system was used to measure Hb loss (g) and blood loss (mL) by scanning sponges exiting the surgical field. Hemoglobin loss measured by the device was compared with a rinsing (reference) method using linear regression and Bland-Altman analysis. The device's measure of estimated blood loss was compared with the gravimetric method (weighing sponges) and with health care providers' visual estimates. RESULTS: A strong positive linear correlation was observed between the device's measures and the reference method (r=0.91, P<.001). Bland-Altman analysis revealed a bias of 3.7 g Hb and narrow limits of agreement (−15.3 to 22.7 g Hb) between the two measures. Gravimetric method demonstrated a positive linear correlation (r=0.87, P<.001) with the reference method, yet overestimated mean estimated blood loss by 422 mL per patient (667 compared with 245 mL, P<.001). Visual estimation was weakly correlated (r=0.30, P<.05) with the reference method. CONCLUSION: This novel device may enhance the ability to rapidly and accurately quantitate ongoing bleeding and may enable health care providers to better manage fluid and blood product replacement in the setting of obstetric hemorrhage.

Peripheral blood stem cell collection in low‐weight children: retrospective comparison of two apheresis devices

Apheresis is a major challenge in peripheral stem cell collection from low-weight children with cancer. Comparisons between the new apheresis device Optia (TerumoBCT) and the earlier COBE Spectra (CaridianBCT) have been performed in adults but not in low-weight children. The objective was to compare the performance of these two devices in small children. In this retrospective study, all patients were reviewed weighing less than 15 kg undergoing stem cell collection using the Optia device between April 2011 and April 2012. They were paired on weight in a 3:1 ratio with patients whose cells had been collected with the COBE Spectra since 2006. Six patients were treated with the Optia and were matched with 18 patients treated with the Spectra. No side effects occurred. Collection efficiency (CE) was similar between the two groups (50% vs. 47%), but CD34 cell blood clearance was lower with the Optia (0.4 mL/min/kg vs. 0.6 mL/min/kg, p < 0.01). Platelet (PLT) loss and hemoglobin (Hb) loss were significantly reduced with the Optia (respectively, 32% vs. 54%, p < 0.01; and 1.4 g/dL vs. 2.9 g/dL, p < 0.01). Apheresis duration was increased with the Optia (159 min vs. 134 min, p < 0.05). The cell product harvested with the Optia had a lower volume and lower hematocrit, but similar white blood cell and PLT content. Compared with the Spectra, the Optia allows similar CE with a reduced PLT and Hb loss but with a longer duration.

Anti-erythropoietin antibody levels and its association with anaemia in different strains of semi-immune mice infected with Plasmodium berghei ANKA

BackgroundMalaria anaemia is still a major public health problem and its pathogenesis still unclear. Interestingly, the progression of anaemia is at relatively low parasitaemia with some mortality in the semi-immune individuals in the endemic areas despite adequate erythropoietin (EPO) synthesis. A recent study has shown that treatment with exogenous anti-erythropoietin (anti-EPO) antibodies (Ab) of infected mice gives protection against malaria infection, suggesting an important role for anti-EPO Ab in malaria. The objective of the study was to evaluate anti-EPO antibody levels in anaemic condition of different strains of semi-immune mice with malaria.MethodologySemi-immune status was attained in four mice strains (Balb/c, B6, CBA and NZW) by repeated infections with 104Plasmodium berghei ANKA, and treatment with chloroquine/pyrimethamine. ELISA was used to measure anti-EPO Ab, transferrin and EPO while inflammatory cytokines measurement was done using bead-based multiplex assay kit.ResultsThe mean anti-EPO Ab levels in the mice strains [Optical Density (OD) values at 450 nm: Balb/c (2.1); B6 (1.3); CBA (1.4) and NZW (1.7)] differed (p = 0.045), and were significantly higher when compared with uninfected controls, p < 0.0001, and mean anti-EPO Ab levels in the mice strains at recovery [OD values at 450 nm: Balb/c (1.8); B6 (1.1); CBA (1.5) and NZW (1.0) also differed (p = 0.0004). Interestingly, EPO levels were significantly high in NZW and low in Balb/c mice (p < 0.05), with those of B6 and CBA of intermediary values. Again, NZW were highly parasitaemic (20.7%) and the other strains (Balb/c, B6 and CBA) ranged between 2.2-2.8% (p = 0.015). Anti-EPO Ab correlated positively with extent of Hb loss (r = 0.5861; p = 0.003). Correlation of anti-EPO antibody with EPO was significant only in Balb/c mice (r = −0.83; p = 0.01). Significant levels of IL6 and IFNγ (p < 0.0001), both known to be associated with erythropoiesis suppression were observed in the Balb/c. Transferrin was significantly lower in Balb/c (p < 0.0001) when compared with the other mice strains (B6, CBA and NZW).ConclusionThis is the first ever report in estimating endogenous anti-EPO antibodies in malaria anaemia. The data presented here suggest that anti-EPO Ab is produced at infection and is associated with Hb loss. Host factors appear to influence anti-EPO antibody levels in the different strains of mice.

2180 COMPARISON OF THULIUM:YTTRIUM-ALUMINUM-GARNET (REVOLIX®) PROSTATECTOMY WITH MORCELLATOR(PIRANHA®) AND WITHOUT MORCELLATOR FOR THE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA

and prostate size of Thulium VapoEnucleation of the prostate (ThuVEP) for symptomatic benign prostatic obstruction (BPO). METHODS: A prospective evaluation of 687 patients was done. ThuVEP was performed using a 2 m Tm:YAG laser; the resected tissue was then morcellated within the bladder. Prostate size was 40g in 196 (group A), 40 to 79g in 336 (group B), and 80g in 155 (group C) patients, respectively. Patient data and the immediate outcomes were analyzed. RESULTS: The mean prostate sizes were 27.94 6.77, 54.38 10.54, and 109.8 28.31 gm for group A, B, and C (p 0.001). Laser energy, operation time, enucleation time, morcellation time, enucleation (resected weight/enucleation time) efficiency, operation efficiency (resected weight/operation time), percentage of resected tissue (resected weight/preoperative prostate volume), and resected weight differed significantly among the groups (p 0.001). Haemoglobin (Hb) loss (g/dL) differed significantly between group A (1.09 1.02), B (1.28 1.27), and C (1.62 1.49) (p 0.001). The overall correlation between Hb loss and prostate size in all patients was however very weak (r 0.13) and was below the level of significance (r 0.2). The median postoperative catheter time was 2 days in all groups. At discharge, peak urinary flow rates and post-voiding residual urine volumes improved significantly (p 0.001) compared to baseline without differences between group A, B, and C. The most relevant complications were acute urinary retention (8%), urinary tract infection (4.66%), secondary apical resection (2.91%), and bleeding requiring transfusions (2.03%). There were no differences in the occurrence of complications between group A, B, and C. The mortality rate for ThuVEP was 0%. CONCLUSIONS: Perioperative morbidity and micturition improvement was not associated with prostate size in ThuVEP. Therefore, ThuVEP is a size-independent treatment modality of BPO.

Simultaneous determination of phagocytosis of Plasmodium falciparum-parasitized and non-parasitized red blood cells by flow cytometry

BackgroundSevere falciparum malaria anaemia (SMA) is a frequent cause of mortality in children and pregnant women. The most important determinant of SMA appears to be the loss of non-parasitized red blood cells (np-RBCs) in excess of loss of parasitized (p-) RBCs at schizogony. Based on data from acute SMA where excretion of haemoglobin in urine and increased plasma haemoglobin represented respectively less than 1% and 0.5% of total Hb loss, phagocytosis appears to be the predominant mechanism of removal of np- and p-RBC.Estimates indicate that np-RBCs are cleared in approximately 10-fold excess compared to p-RBCs. An even larger removal of np-RBCs has been described in vivax malaria anaemia. Estimates were based on two single studies both performed on neurosyphilitic patients who underwent malaria therapy. As the share of np-RBC removal is likely to vary between wide limits, it is important to assess the contribution of both np- and p-RBC populations to overall RBC loss, and disclose the mechanism of such variability. As available methods do not discriminate between the removal of np- vs p-RBCs, the purpose of this study was to set up a system allowing the simultaneous determination of phagocytosis of p- and np-RBC in the same sample.Methods and ResultsPhagocytosis of p- and np-RBCs was quantified in the same sample using double-labelled target cells and the human phagocytic cell-line THP-1, pre-activated by TNF and IFNγ to enhance their phagocytic activity. Target RBCs were double-labelled with fluorescent carboxyfluorescein-succinimidyl ester (CF-SE) and the DNA label ethidium bromide (EB). EB, a DNA label, allowed to discriminate p-RBCs that contain parasitic DNA from the np-RBCs devoid of DNA. FACS analysis of THP-1 cells fed with double-labelled RBCs showed that p- and np-RBCs were phagocytosed in different proportions in relation to parasitaemia.ConclusionsThe assay allowed the analysis of phagocytosis rapidly and with low subjective error, and the differentiation between phagocytosed p- and np-RBCs in the same sample. The presented method may help to analyse the factors or conditions that modulate the share of np-RBC removal in vitro and in vivo and lead to a better understanding of the pathogenesis of SMA.

Custom-fit minimally invasive total knee arthroplasty: effect on blood loss and early clinical outcomes

Recently, new custom-fit pin guides in total knee arthroplasty (TKA) have been introduced. Use of these guides may reduce operating time. Use of the guides combined with the absence of intramedullary alignment jigs may lead to reduced blood loss and improved early outcomes. Our aim was to evaluate blood loss and early clinical outcomes in patients undergoing minimally invasive TKA using custom-fit magnetic resonance imaging (MRI)-based pin guides. A prospective study in 80 patients was carried out. Patients were divided randomly into 2 equal groups. In one group, intramedullary alignment jigs were used. In the second group, custom-fit MRI-based pin guides were used. All patients received the same cemented posterior-stabilized implant through a mini-midvastus approach. The volume in the drain bottles was recorded after 48 h. Hb loss was estimated by subtracting the postoperative from the preoperative Hb level. Transfusion requirements and surgical time were recorded. Outcome measures were Knee Society Scores (KSS), knee flexion, knee swelling and pain. There was lower mean drainage of blood in the custom-fit group (391 ml vs. 603 ml; p < 0.0001). There was no difference in estimated loss of Hb (3.6 g/dl vs. 4.1 g/dl; n.s.) and in transfusion requirements (7.5 % vs. 10 %; n.s.). Surgical time was reduced in the custom-fit group (12 min less; p = 0.001). KSS measured at week 2, 6 and 12 showed no significant difference between groups. Knee flexion measured on days 7, 10 and at week 6, 12 and knee swelling and pain measured on days 1, 3, 10 and at week 6, 12 showed no significant difference between groups. Using custom-fit pin guides reduces blood drainage, but not the estimated Hb loss in minimally invasive TKA and does not affect transfusion rate. Surgical time is reduced. There is no effect on the early clinical outcomes. Therapeutic study, Level I.

A mathematical modeling approach to quantify the role of phlebotomy losses and need for transfusions in neonatal anemia

Very preterm infants commonly develop anemia requiring multiple red blood cell transfusions (RBCTx). This is in part attributable to heavy laboratory phlebotomy loss. Quantification of the extent to which laboratory blood loss contributes to anemia sufficient to prompt RBCTx has not been examined. Twenty-six preterm infants weighing less than 1500 g at birth requiring ventilator support who received one or more RBCTx were intensively studied during the first month of life. Hemoglobin (Hb) loss via laboratory blood loss and RBC senescence and Hb gain from RBCTx were precisely accounted for in a Hb mass balance mathematical model developed to assess the impact of phlebotomy on RBCTx when restrictive RBCTx criteria were applied. Study subjects had a birth weight of 880 ± 240 g (mean ± SD) and a Hb level of 14.4 ± 2.4 g/dL at birth and received 3.81 ± 2.15 RBCTx during the study period. Modeling indicated that even with the total elimination of laboratory phlebotomy loss, a reduction of 41% to 48% in RBCTx was achievable. The present modeling results indicate that while phlebotomy reduction can significantly decrease the number of RBCTx administered to preterm infants, total elimination of all RBCTx will likely require other approaches, for example, stimulation of erythropoiesis with erythropoiesis-stimulating agents.

Effect of a patient blood management programme on preoperative anaemia, transfusion rate, and outcome after primary hip or knee arthroplasty: a quality improvement cycle

There are few data on the associations between anaemia, allogeneic blood transfusion (ABT), patient blood management, and outcome after arthroplasty in the UK. National agencies nevertheless instruct NHS Trusts to implement blood conservation measures including preoperative anaemia management. Internationally, blood management programmes show encouraging results. We retrospectively audited 717 primary hip or knee arthroplasties in a UK general hospital and conducted regression analyses to identify outcome predictors. We used these data to modify previously published algorithms for UK practice and audited its introduction prospectively. The retrospective audit group served as a control. Preoperative haemoglobin (Hb) concentration predicted ABT (odds ratio 0.25 per 1 g dl(-1), P<0.001). It also predicted the length of stay (LOS, effect size -0.7 days per 1 g dl(-1), P=0.004) independently of ABT, including in non-anaemic patients. Patient blood management implementation was associated with lower ABT rates for hip (23-7%, P<0.001) and knee (7-0%, P=0.001) arthroplasty. LOS for total hip replacement and total knee replacement decreased from 6 (5-8) days to 5 (3-7) and 4 (3-6) days, respectively, after algorithm implementation (P<0.001). The all-cause re-admission rate within 90 days decreased from 13.5% (97/717) before to 8.2% (23/281) after algorithm implementation (P=0.02). We conclude that preoperative Hb predicts markers of arthroplasty outcome in UK practice. A systematic approach to optimize Hb mass before arthroplasty and limit Hb loss perioperatively was associated with improved outcome up to 90 days after discharge.

Bipolar tissue sealant device decreases hemoglobin loss in multilevel spine surgery

Traditional techniques for obtaining hemostasis during orthopedic surgery, such as conventional electrocautery and sealants, have limited clinical effectiveness in reducing hemoglobin (Hb) loss and requirement for transfusion. The bipolar tissue sealant device studied in this trial combines radiofrequency energy with saline irrigation to hemostatically seal both cut bone and soft tissue, potentially aiding hemostasis. Sixty patients undergoing multilevel posterior lumbar instrumentation and fusion were randomly assigned to unipolar cautery alone (control group) or unipolar cautery plus use of the bipolar tissue sealant device (treatment group). Hb loss from the surgical field was measured (rather than estimated) and compared between the two groups. The primary hypothesis was that the treatment group would lose significantly less Hb than the control group. The control group experienced a mean Hb loss of 102.4 g while the treatment group showed a significantly lower mean Hb loss of 66.2 g (p = 0.0004). No significant difference was found between groups with respect to secondary endpoints including length of surgery, number of red blood cell units transfused, number of total blood component units transfused, transfusion avoidance, length of stay, or serious adverse events. Use of a bipolar tissue sealant device in addition to unipolar cautery significantly decreased Hb loss during multilevel, posterior lumbar spinal instrumentation and fusion when compared with unipolar cautery alone.

Impact of ribavirin dose reduction during treatment in chronic hepatitis C genotype 1 patients

Impact of ribavirin dose reduction during treatment in chronic hepatitis C genotype 1 patients

Microfluorometric assay for quantification of anti-erythrocytic antibody level in sera of Plasmodium berghei ANKA infected semi-immune mice

A simple, sensitive and reproducible fluorometry method was developed to quantify anti-erythrocytic auto-antibody in the sera of semi-immune mice. The level of anti-erythrocytic auto-antibody measured using fluorometry was significantly higher in sera of Plasmodium bergheiANKA infected mice than the uninfected, p< 0.0001. This result correlates significantly with the standard ELISA assay, p<0.0001, r 2 =0.7766. Both methods show significant correlation with regard to extent of Hb loss, p<0.006 (r 2 =0.33) (fluorometry method) and p< 0.0001, r

Rate of red blood cell destruction varies in different strains of mice infected with Plasmodium berghei-ANKA after chronic exposure

BackgroundSevere malaria anaemia in the semi-immune individuals in the holo-endemic area has been observed to occur at low parasite density with individual variation in the responses. Thus the following has been thought to be involved: auto-immune-mediated mechanisms of uninfected red blood cell destruction, and host genetic factors to explain the differences in individual responses under the same malaria transmission. In this study, the extent of red blood cell (RBC) destruction in different strains of semi-immune mice model at relatively low parasitaemia was studied.MethodologyTo generate semi-immunity, four strains of mice were taken through several cycles of infection and treatment. By means of immunofluorescent assay and ELISA, sera were screened for anti-erythrocyte auto-antibodies, and their relationship with haematological parameters and parasitaemia in the strains of semi-immune mice was investigated.ResultsUpon challenge with Plasmodium berghei ANKA after generating semi-immune status, different mean percentage haemoglobin (Hb) drop was observed in the mice strains (Balb/c = 47.1%; NZW = 30.05%; C57BL/6 = 28.44%; CBA = 25.1%), which occurred on different days for each strain (for Balb/c, mean period = 13.6 days; for C57BL/6, NZW, and CBA mean period = 10.6, 10.8, 10.9 days respectively). Binding of antibody to white ghost RBCs was observed in sera of the four strains of semi-immune mice by immunofluorescence. Mean percentage Hb drop per parasitaemia was highest in Balb/c (73.6), followed by C57BL/6 (8.6), CBA (6.9) and NZW (4.0), p = 0.0005. Consequently, auto-antibodies level to ghost RBC were correlated with degree of anaemia and were highest in Balb/c, when compared with the other strains, p < 0.001.ConclusionThe results presented in this study seem to indicate that anti-RBC auto-antibodies may be involved in the destruction of uninfected RBC in semi-immune mice at relatively low parasite burden. Host genetic factors may also influence the outcome of auto-immune mediated destruction of RBC due to the variation in Hb loss per % parasitaemia and differences in antibody titer for each semi-immune mice strain. However, further studies at the molecular level ought to be carried out to confirm this.

Identification of colorectal adenomas by a quantitative immunochemical faecal occult blood screening test depends on adenoma characteristics, development threshold used and number of tests performed

Faecal occult blood tests (FOBT) are faulted by low sensitivity for advanced adenomatous polyps (AAP). Quantified, immunochemical, haemoglobin (Hb)-specific immunochemical FOBT (I-FOBT) measurements are now used for colorectal screening. To correlate adenoma characteristics to amount of faecal Hb lost and to evaluate sensitivity and specificity for AAP by faecal Hb development threshold used and number of I-FOBTs collected. Three daily I-FOBTs were collected and analysed in 1221 patients scheduled for colonoscopy. Faecal Hb was analysed as ngHb/mL of buffer and the highest result related to colonoscopy findings. In 1204 patients without cancer, colonoscopy identified adenomas in 294, 99 with AAPs. Adenoma patients had elevated faecal Hb increasing with advanced histology, size, pedunculated shape and multiplicity (P < 0.001 for all). At 50 ngHb/mL threshold, sensitivity and specificity for AAPs were 54.5% (95%CI 44.7, 64.7) and 88.1% (95%CI 86.2, 90.1) for three tests. At higher thresholds, sensitivity decreased, but was significantly higher with more samples collected. Conversely, specificity increased at higher thresholds, but decreased with more samples. Faecal Hb loss from adenomas is significantly associated with size, number and advanced features. Sensitivity and specificity for AAPs are determined by test threshold chosen and number of samples collected; these determine the number of colonoscopies needed for positive tests.

Blood use in elective surgery: the Austrian benchmark study

Benchmarking transfusion activity may help to eliminate inappropriate use of blood products. The goal of this study was to measure and to compare the current transfusion practice and to identify predictors of transfusion in public hospitals to develop strategies to optimize transfusion practices. This was a prospective observational study in 18 randomly selected public hospitals from April 2004 to February 2005. Primary outcome measures were the amount of intra- and postoperative blood components transfused and intercenter variability of transfusion rate. Secondary outcome measures were prevalence of preoperative anemia, calculated perioperative blood loss, and lowest measured perioperative hemoglobin (Hb) level. Adult patients undergoing primary unilateral total hip replacement (THR, n = 1401), primary unilateral knee replacement (TKR, n = 1296), hemicolectomy (HECOC, n = 148), and coronary artery bypass graft (CABG) surgery (n = 777) were enrolled. Due to the small number, data of HECOC patients were not fully analyzed. In the remaining procedures, there was a large intercenter variability in the percentage of patients who received transfusions: THR 16 to 85 percent, TKR 12 to 87 percent, and CABG 37 to 63 percent. In the patients who received transfusions, the number of red blood cells (RBC) units transfused varied significantly. There was also a considerable intercenter variability in RBC loss. The prevalence of preoperative anemia was 19 percent and identical in both sexes. The incidence of preoperative anemia was three times higher in patients who received transfusions compared to those who did not. This study demonstrates a high intercenter variability in RBC transfusions and RBC loss in standard surgical procedures. Whereas the variability in blood loss remains largely unexplained, the main predictors for allogeneic RBC transfusions are preoperative and nadir Hb and surgical RBC loss.

Blood loss and postoperative complications associated with transurethral resection of the prostate after pretreatment with dutasteride

To determine whether pretreatment with dutasteride, a dual 5alpha-reductase inhibitor (5ARI), reduces surgical blood loss or postoperative complications in patients with benign prostatic hyperplasia (BPH) who undergo transurethral resection of the prostate (TURP). This double-blind, randomized, placebo-controlled, multicentre study comprised 214 patients with BPH. Placebo was compared with dutasteride 0.5 mg/day 2 weeks before and after TURP, or 4 weeks before and 2 weeks after TURP. Surgical blood loss was measured using a haemoglobin photometer (HemoCue AB, Angelholm, Sweden) and postoperative adverse events were recorded. Microvessel density (MVD) was calculated by immunostaining and light microscopy of the prostatic chips. Although dutasteride reduced serum dihydrotestosterone (DHT) by 86-89% in 2-4 weeks, and intraprostatic DHT was approximately 10 times lower than in the placebo group, the (adjusted) mean haemoglobin (Hb) loss during surgery was 2.15-2.55 g Hb/g resectate with no significant difference in blood loss between the groups either during or after TURP. Clot retention occurred in 6-11% and urinary incontinence in 14-15% of patients during the 14 weeks after TURP, with no difference between the groups. The MVD at TURP was also similar for all groups. There were no significant reductions in blood loss during or after TURP or complications afterward with dutasteride compared with placebo, despite significant suppression of intraprostatic DHT. Blood loss and transfusion rates in the placebo group were lower than those previously reported in studies where there was a beneficial effect of a 5ARI, relative to placebo, on bleeding during TURP.

Oral Administration of PBI-1402 Significantly Reduces Erythropenia and Accelerates Peripheral Blood Recovery in Myeloablated Mice Post Transplantation.

The goal of this study was to determine the potential of PBI-1402, a compound that was shown to provide radio- and chemoprotection, to ameliorate the myeloablative therapy induced cytopenia and/or accelerate blood cell recovery of myeloablated hosts following autologous bone marrow transplantation in mouse model. Mice were exposed to irradiation and transplanted the following day with 5×105 bone marrow cells from syngeneic donors. Following transplantation, mice were divided into two groups that received two different doses of PBI-1402 orally and a control group that received PBS for 14 days post transplantation. The results showed that PBI-1402 treatment significantly diminished post-transplant erythropenia in a dose dependent manner. Similarly, determination of haemoglobin (Hb) demonstrated a significant attenuation of Hb loss and additionally, significantly accelerated post-transplantation recovery with the highest dose of PBI-1402. A significantly higher number of platelets was observed with the highest dose of PBI-1402. In addition, similar results were obtained with analysis of white blood cell (WBC) recovery. To determine if the observed effect of PBI-1402 treatment on red blood cell cytopenia and Hb recovery is the consequence of increased erythrocyte progenitor response to Epo, we performed an Epo dose response experiment on CFU-E bone marrow samples obtained from treated and control mice at different time points post transplantation. The results indicated that erythroid progenitors from treated and control mice responded similarly to Epo. However, PBI-1402 treated mice contained significantly higher number of CFU-E. Interestingly, analysis of more primitive Sca1+ progenitors revealed a significant increase in the number of Sca1+ cells from the bone marrow of mice treated with PBI-1402 (p < 0.05). These results demonstrate that PBI-1402 treatment significantly reduced irradiation induced erythropenia with concomitant acceleration in erythroid and Hb recovery. Additionally, treatment with PBI-1402 accelerated WBC recovery and platelet recovery and increased more primitive Sca1+ progenitors. PBI-1402 may offer protection from myeloabaltive therapy or accelerate recovery from remaining resident or transplanted stem cells.

Perioperative intravenous iron preserves iron stores and may hasten the recovery from post‐operative anaemia after knee replacement surgery

In unilateral total knee replacement (TKR), perioperative blood loss, low transfusion thresholds and short hospital stay result in patients being discharged with low haemoglobin (Hb). We assessed the effects of perioperative administration of intravenous iron, with or without erythropoietin, plus a restrictive transfusion threshold (Hb < 80 g L(-1)) both on transfusion rate and recovery from post-operative anaemia. TRK patients received iron sucrose (2 x 200 mg per 48 h, iv) (Group IVI, n = 129). Patients with admission Hb < 130 g L(-1), also received erythropoietin (1 x 40 000 IU, sc) (Group EPO, n = 19). Perioperative clinical and laboratory data were obtained. Mean Hb loss was 36 g L(-1), but only seven patients were transfused (5%). Pre-operatively, 66 (45%) patients did not have enough stored iron to compensate Hb loss. At post-operative day 30, only 15% were anaemic, 70% of Hb loss and 92% of pre-operative Hb were recovered and ferritin increased by 73 microg L(-1) (P < 0.01), although erythropoietic response was higher in patients receiving erythropoietin (P < 0.05). No adverse effects of iron sucrose or erythropoietin were witnessed. This protocol seems to reduce allogeneic blood transfusion rate and may hasten the recovery from post-operative anaemia in TKR patients, without depleting iron stores. Further studies are needed to ascertain which patients may benefit of extended intravenous iron and/or erythropoietin administration.

Blood loss after total knee replacement

We carried out a prospective randomised study to evaluate the blood loss in 60 patients having a total knee arthroplasty and divided randomly into two equal groups, one having a computer-assisted procedure and the other a standard operation. The surgery was carried out by a single surgeon at one institution using a uniform approach. The only variable in the groups was the use of intramedullary femoral and tibial alignment jigs in the standard group and single tracker pins of the imageless navigation system in the tibia and femur in the navigated group. The mean drainage of blood was 1351 ml (715 to 2890; 95% confidence interval (CI) 1183 to 1518) in the computer-aided group and 1747 ml (1100 to 3030; CI 1581 to 1912) in the conventional group. This difference was statistically significant (p = 0.001). The mean calculated loss of haemoglobin was 36 g/dl in the navigated group versus 53 g/dl in the conventional group; this was significant at p < 0.00001. There was a highly significant reduction in blood drainage and the calculated Hb loss between the computer-assisted and the conventional techniques. This allows the ordering of less blood before the operation, reduces risks at transfusion and gives financial saving. Computer-assisted surgery may also be useful for patients in whom blood products are not acceptable.