Large Amount Of Fresh Blood Research Articles

Development and application of disposable constant volume and negative pressure drainage device

The common negative pressure drainage bottle used in the vacuum sealing drainage (VSD) cannot quantitative and automatically cut off. Excessive drainage damages the negative pressure source, causes drainage interruption, so once drainage was continuously performed, medical staff need to closely observe drainage bottle calibration. It was also important to known whether there was a large amount of fresh blood sucked out during continuous drainage because it could lose too much blood. To solve these two problems, we designed a kind of negative pressure drainage device, which volume was constant, with the function of automatic cutting off continuous drainage. It can not only prevent drainage fluid flowing back to the negative pressure source and cause drainage interruption, but also prevent massive blood loss from continued drainage after the hemorrhage. We could benefit from this device, which possess many advantages, such as simple structure, security and reliability. It is worthy promoting in the clinical work.

PTLD Involving the Colon Graft in Small Bowel Transplant Recipient

Intestinal transplant is indicated in those who have intestinal failure with resultant life-threatening complications. Complications from intestinal transplant include surgical complications eg. graft thrombosis, rejection and complications due to a high immunosuppressive requirement eg. atypical viral/fungal infections and PTLD. We present a 23-year-old white female with combined small bowel and colonic transplant 11 months ago due to intestinal failure from small bowel volvulus. She was diagnosed with PTLD with diffuse large B-cell lymphoma 1 month ago after presenting with painless LAD. She was on tacrolimus 4 mg BID, 2000 mg/day MMF, and 5 mg/day prednisone. Her EBV DNA was > 2 million copies/ml at the time of diagnosis. She underwent reduction in immunosuppression followed by 1 cycle of R-CHOP and presented with new-onset GI bleeding. EGD to jejuno-jejunal anastomosis was unremarkable but colonoscopy showed a large amount of fresh blood in the colon and ileum. The visualization of colonic mucosa was limited but CTA showed positive luminal extravasation just beyond jejuno-jejunal anastomosis which was successfully treated with embolization. Follow-up colonoscopy to evaluate for small bowel and colonic graft rejection showed normal small bowel and colonic allograft and multiple non-bleeding discreet raised yellowish black-crusted sub-epithelial nodules obliterating nearby normal colonic vasculature in native colon. Pathology showed an atypical lymphoid infiltrate with necrosis in the native colon confirmed to be monomorphic PTLD (positive for CD79a, Pax5, Mum-1, CD 20, EBV-LMP, negative CD3, Ki-67 of 70%). Her abdominal CT scan showed progressive disease burden with extensive liver metastasis. Despite treatment, her hospital course was complicated by neutropenic fever, septic shock, malignant ascites, and spontaneous intracranial hemorrhage from CNS involvement of PTLD. Therefore, no escalation of treatment was discussed and she was made comfort care. The risk of PTLD is high in intestinal transplant recipients due to high immunosuppression requirement (tacrolimus and MMF) and occur in 15% of adults and 20% of children. Colonic involvement of PTLD may portend the aggressive nature of PTLD and be seen more in disseminated or multiple organs involvement. This case highlights a variety of symptoms of PTD in an intestinal transplant recipient from initial presentation with painless LAD followed by an obscure overt GI bleeding due to colonic PTLD

Common bile duct compression caused by cyanoacrylate glue injection into bleeding duodenal varices: a rare adverse event (with videos)

A 54-year-old man with alcohol-related chronic pancreatitis presented with hematemesis and postural hypotension. His admission liver function biochemical tests were normal. After resuscitation he underwent an emergent EGD that revealed small esophageal and gastric fundic varices. A large amount of fresh blood and clots had pooled in the duodenum and active bleeding from an unknown source was observed. Endoscopic injection of adrenaline (total volume: 8 mL, 1:10,000 dilution) into the duodenal wall was performed for a presumptive ulcer-related UGI bleed. A second-look EGD 24 hours later confirmed a small duodenal ulcer without stigmata of recent bleed and non-bleeding duodenal varices in the second portion of the duodenum (A). Contrast-enhanced CT of the abdomen showed chronic pancreatitis with thrombosis of the main portal vein, splenic vein, superior mesenteric veins, and multiple collaterals (B). Linear echoendoscopy (model UCT180, EU-ME1 processor, Olympus, Tokyo, Japan) confirmed changes of chronic pancreatitis, multiple duodenal varices communicating with deeper extra-luminal collaterals, and a normal CBD.

Endoscopic Tattooing Site Presenting as Colonic Pseudotumor

Purpose: Endoscopic tattooing is performed to facilitate identification of gastrointestinal lesions at follow-up endoscopy or surgery. We present a rare complication of endoscopic tattooing presenting as inflammatory pseudotumor. Case: A 62-year-old male presented with painless hematochezia and acute blood loss anemia. The patient had undergone colonoscopy with polypectomy 2 days prior to admission. During polypectomy, piecemeal resection of a large 2-cm sessile serrated adenoma was performed in the ascending colon. Proximal and distal ends of the polypectomy site were tattooed by injecting a sterile suspension of highly purified carbon particles (SPOT ink). A repeat colonoscopy was performed after admission for likely post-polypectomy bleed. A large amount of fresh blood was seen throughout the colon. Recent polypectomy site was identified in the ascending colon with ulceration and an adherent clot. The clot was dislodged and a visible vessel with active bleeding was seen. Hemostasis was achieved by injecting 1:10,000 diluted epinephrine and placing three endoclips on the bleeding lesion. Incidentally, a second large ulcer (1.5 x 1.0 cm in size) with heaped-up margins and surrounding induration was noted just proximal to the polypectomy site. This was the area of recent endoscopic tattooing with blue-black discoloration of the colonic mucosa and the ulcer crater. Conclusion: Endoscopic tattooing is an effective technique to mark gastrointestinal lesions by submucosal dye injection. It is a safe procedure; however, rare complications (focal peritonitis, abscess formation, infected hematomas, perforation) have been reported. Tattooing agents may elicit inflammation, thrombosis, and fibroblast proliferation resulting in fat necrosis and ulceration at the injection site. It is important for endoscopists to be aware of the potential localized tissue injury induced by endoscopic tattooing because it can mimic malignancy.

X-Ray Quiz: A 27-Year-Old Male with Sudden Dyspnoea

A 27-year-old male presented to our emergency department due to sudden onset of dyspnoea. On clinical examination, his vital signs were normal except for the dyspnoea (27 breaths/min). Physical examination revealed decreased breath sound and tympanic percussion note over the right hemithorax. The blood test showed no specific findings. Chest radiography revealed right-sided pneumothorax with a severely collapsed lung. Emergency chest tube insertion was done, but there was poor expansion of the lung, and low pressure suction was applied after admission. Suddenly, a large amount of fresh blood was drained.

Fatal penetrating and perforating peptic ulceration

Fatal complications of peptic ulcer disease usually involve either perforation or hemorrhage. The case of a 27-year-old female is reported who was found dead at her home address. The autopsy revealed a perforated pyloroduodenal ulcer with localized abscess formation in the lesser sac behind the stomach and established peritonitis. In addition, there was significant hemorrhage with filling of the stomach with fresh blood and the intestine with large amounts of fresh blood and melena. Death was caused by the synergistic effects of both sepsis and significant upper gastrointestinal hemorrhage due to a perforating and penetrating peptic ulcer. Rarely cases of upper gastrointestinal disease may involve more than one fatal mechanism.

A Gastrointestinal Stromal Tumor (GIST) Presenting as a Dieulafoyʼs Lesion

Purpose: An 81-year-old female presented with melena and lightheadedness. She was recently discharged 4 days prior with similar symptoms. Endoscopic gastroduodenoscopy (EGD) on prior admission found a 5 mm clean based gastric ulcer with no stigmata of recent bleed. Pulse was 112 otherwise vitals were stable. Hemoglobin (Hgb) was 5.5 g/dl (9 g/dl on recent discharge). After transfusion, repeat EGD now revealed a large amount of fresh blood in the stomach. The previously visualized gastric ulcer was again without stigmata of bleeding. An active bleeding site could not be found despite thorough EGD examination. Emergent arterial angiography revealed aneurysmal changes in the splenic and short gastric arteries, with no early venous return which is the angiographic definition of a Dieulafoy's lesion. A gastric mucosal blush along the greater curvature near the fundus was noted. No active bleeding was seen but the aneurysms were embolized. Her Hgb continued to decline so computed tomography angiography (CTA) of her abdomen was done which revealed a 6.8 cm hypovascular eroding mass possibly arising from the left adrenal gland into the gastric fundic region (Figure A). Repeat EGD identified in this area a nipple-like protuberance without ulceration, consistent with a Dieulafoy's lesion. The lesion was clipped to provide hemostasis. Endoscopic ultrasound (EUS) of this area revealed a large mass near the left adrenal gland with both cystic and solid components. Needle biopsy results revealed spindle cell neoplasm consistent with a GIST. The patient subsequently underwent exploratory laparotomy revealing a 7.8 cm exophytic submucosal lesion arising from the greater curve of the stomach near the gastroesophageal junction which was resected with clean margins. Pathology again confirmed the diagnosis of a GIST and was positive for KIT (CD117). The patient was started on imatinib therapy after discharge and was doing well on subsequent follow-up. We demonstrate in this case report the diagnostic and therapeutic challenges of this rare scenario, a GIST presenting as a Dieulafoy's lesion.Figure: (A) CTA with lobular mass invading the posterior wall of the stomach.

Life-threatening Variceal Bleeding from Chronic Schistosomal Liver Disease

Purpose: To present a rare case of Schistosoma mansoni infection causing chronic liver disease, portal hypertension, variceal bleeding, and hemorrhagic shock. Case Report: The patient was a 20-year-old pre-medical student who migrated to the U.S. from Kenya 6 years ago. He grew up in Nairobi, but spent summers in Western Kenya around the Lake Victoria basin. The patient presented with two days of diffuse abdominal pain, nausea, vomiting, and multiple melenic stools. His hemoglobin was 8 and dropped to 7 within 1.5 hours. He became hypotensive with blood pressure of 70/50 and heart rate of 120. He vomited a large amount of fresh blood and had syncope for a few minutes. He was transferred to the ICU and resuscitated with IV fluid, pantoprazole drips, and octreotide drips. Blood works showed BUN 28, creatinine 0.8, total protein 5.7, albumin 3, bilirubin 1.5, AST 106, ALT 121, alkaline phosphatase 372, INR 1.2, and platelet 56. An abdominal sonogram showed a small, heterogeneous liver and an enlarged spleen. The rest of the comprehensive liver work-up was negative. The patient underwent an EGD that showed hypertensive portal gastropathy and multiple large esophageal varices. Seven ligation bands were placed for hemostasis. A liver core biopsy showed marked fibrosis with expansion of portal tracts and formation of septae, highly suggestive of chronic Schistosoma masoni infection. Due to the endemic area of his childhood, the life-threatening presentation at a young age, the liver biopsy results, and the lack of other risk factors for chronic liver disease, the patient was started on Praziquantel. One month later, he had another EGD that showed improved esophageal varices. Six more bands were placed. He was started on propranolol. He will have more variceal bandings until resolution of varices and close monitoring until normalization of liver function tests. Conclusion: Schistosoma masoni is a waterborne trematode found predominantly in Africa, South America, the Caribbean, and Middle East. The parasite can live for more than 20 years in the human host. Eggs are laid in the intestinal walls, enter the portal vein, and are trapped in the venules of the portal triads of the liver causing a granulomatous reaction and eventually portal hypertension. Variceal hemorrhage is the most lethal complication of this chronic infection. Praziquantel is the drug of choice for eradication. Clinicians should consider hepatic Schistosoma masoni disease as a cause of variceal bleeding in immigrants and travelers from endemic areas.

Predictors of Clinically Significant Upper Gastrointestinal Hemorrhage Among Children With Hematemesis

The aim of the study was to determine the proportion of children with hematemesis who experience a clinically significant upper gastrointestinal hemorrhage (UGIH) and to identify variables predicting their occurrence. A retrospective cohort study was conducted. All of the emergency department visits by children ages 0 to 18 years who presented with hematemesis between 2000 and 2007 were reviewed. The primary aim of the study was to determine the proportion of children who developed a clinically significant UGIH; the secondary aim was to identify risk factors predictive of a clinically significant UGIH. A significant UGIH was defined by any of the following: hemoglobin drop >20 g/L, blood transfusion, or emergent endoscopy or surgical procedure. Twenty-seven of 613 eligible children (4%; 95% confidence interval 3%-6%) had a clinically significant UGIH. Clinically significant hemorrhages were associated with older age (9.7 vs 2.9 years; P<0.001), vomiting moderate to large amounts of fresh blood (58% vs 20%; P<0.001), melena (37% vs 5%; P<0.001), significant medical history (63% vs 24%; P<0.001), unwell appearance (44% vs 6%; P<0.001), and tachycardia (41% vs 10%; P<0.001). The frequency of laboratory investigations increased with age (P<0.001). The hemoglobin level was the only laboratory investigation whose results differed between those with and without significant bleeds. The presence of any one of the following characteristics identified all of the children with a clinically significant hemorrhage: melena, hematochezia, unwell appearance, or a moderate to large volume of fresh blood in the vomitus, sensitivity 100% (95% confidence interval 85%-100%). The occurrence of a clinically significant UGIH was uncommon among children with hematemesis, especially in well-appearing children without melena, hematochezia, or who had not vomited a moderate to large amount of fresh blood.

Duodenal Diverticular Bleeding: A Rare Cause of Massive Upper Gastrointestinal Bleeding

Purpose: A 69-year-old African American male with a history of hypertension, diabetes, stroke, and laryngeal cancer status post chemotherapy and radiation presented to emergency room for three episodes of hematemesis. He denied any abdominal pain and history of taking any NSAIDs. He had no melena, weight loss, dysphagia, odynphagia or hematochezia. Physical examination revealed a well nourished man who was tachycardic but normotensive. Abdomen was soft, non-tender and without signs of organomegaly. Rectal examination revealed brown stool with no palpable masses in the rectum and a nasogastric lavage revealed coffee grounds but no bright red blood. Laboratory analysis revealed a normochromic and normocytic anemia with a hemoglobin of 10.4. The rest of his labs were unremarkable. An urgent upper endoscopy was scheduled but prior to the procedure, the patient started to vomited a large amount of fresh blood. A repeat hemoglobin showed a drop to 6.4. The patient was aggressively resuscitated and intubated for airway protection. Subsequent endoscopy revealed a hypopharyngeal stricture and a large diverticulum in the third portion of duodenum with an adherent blood clot. After removal of the blood clot, a visible vessel with active oozing was seen at the rim of the diverticulum. After injection of epinephrine at the rim of the diverticulum, gold probe cautery was applied several times with good hemostasis. There was no recurrent bleeding post procedure. A repeat upper endoscopy confirmed adequate therapy. Discussion: The incidence of duodenal diverticula in the general population is uncertain but a prevalence rate of up to 22% has been reported of which most are on the medial aspect of the second portion of duodenum within 2.5 cm of the ampulla of Vater. Complications from duodenal diverticula are rare. The treatment of duodenal diverticular bleeding was traditionally surgical but endoscopic therapy has been shown to be effective in recent years. We report successful treatment of a large, distal duodenal diverticulum through endoscopic dual therapy.

Esophageal Dieulafoy Lesion: Rare Cause of Massive Upper GI Bleeding

Purpose: Introduction The Dieulafoy lesion is tortuous large caliber arteriole protruding through small mucosal defect. It is uncommon cause of upper GI bleeding and accounts for about 2% of cases of bleeding from upper GI tract. Esophageal Dieulafoy lesion is extremely uncommon and less than 10 cases have been reported so far. We report a case of massive upper GI bleeding related to esophageal Dieulafoy lesion that was successfully managed by epinephrine injection and placement of hemoclips. Case Presentation 37 year old Hispanic man with history of alcohol abuse and gastroesophageal reflux disease presented to the emergency room with sudden onset hematemesis. He was actively vomiting a large amount of fresh blood and was intubated for airway protection. There was no prior history of NSAIDs use. He underwent esophagogastroduodenoscopy (EGD) with the finding of a small actively bleeding lesion with fresh adherent clot in the lower esophagus. A total of 4 cc of epinephrine (1 mg, 1:10,000) was injected around the lesion and the clot was suctioned. After removal of clot and irrigation, it was noted that there was a very small mucosal defect with prominent visible vessel in the center with active oozing of blood. At this point two hemoclips were applied over this Dieulafoy lesion with cessation of bleeding. The EGD was otherwise normal. Patient was observed in the intensive care unit over next 24 hours and eventually discharged within 72 hours. Discussion Dieulafoy lesions can cause massive, recurrent and sometimes life threatening gastrointestinal bleeding. In the upper gastrointestinal tract, the clinical presentation is hematemesis with or without aspiration pneumonia and melena. About 75-95% of the Dieulafoy lesions are found in the stomach, predominantly along the lesser curvature. However, Dielafoy lesions are also reported in the esophagus, small intestine and colon. Esophageal Dieulafoy lesions are extremely rare. With advances in the endoscopic technique over the years, endoscopic therapeutic interventions for bleeding Dieulefoy lesions are preferred over surgery as the initial management. Epinephrine injection with or without application of band ligation or hemoclip application are described in the literature as therapeutic options. In the only published randomized control trial comparing epinephrine injection alone versus band ligation, lower rebleeding rates were observed with band ligation. However, therapeutic efficacy of hemoclips has not been compared with band ligation due to the rare nature of the disease.

A model for blood components processing

Blood component therapy is advantageous in terms of increasing the effective availability of blood units and reducing the transfusion-related risks. One unit of blood can be separated into components and made available to multiple patients by transfusing suitable components. It is often believed that most, if not all, of the blood should be fractionated. But the process of componentizing increases the availability of blood products at the expense of increased costs of holding, processing, and wastage at a blood bank. The objective of this study was to determine the optimum level of components to be produced at a blood bank given its objectives and context. We developed a simulation-based model to determine the optimum amount of fresh blood to be fractionated at a blood bank operating in southern India was developed. The simulation model is a virtual representation of an actual blood bank, and it can help the administrator to test the effects of changing the level of components production on the overall blood bank performance. The results from the model suggest that it may not be optimal for the chosen blood bank to componentize large amounts of fresh blood as it leads to high costs of operation and huge wastage in the system. The same methodology can be applied to determine the optimum level of componentizing at other blood banks by providing appropriate inputs to the simulation model.

Intramural gallbladder hematoma mimicking gallbladder neoplasm in a 55-year-old male patient

Hemorrhage in the gallbladder (GB) is usually associated with cholecystitis, GB neoplasm, trauma, hemobilia, and cystic artery aneurysm. Our patient had not experienced any previous abdominal trauma, and GB hemorrhage was unlikely to result from cholecystitis or bleeding diathesis. A 55-year-old male was admitted because of right upper quadrant pain. Both prothrombin time and partial thromboplastin time were normal. Abdominal computed tomography, endoscopic ultrasound and magnetic resonance cholangiopancreatography were performed. Image studies revealed GB wall thickening and an intraluminal mass. Laparoscopic cholecystectomy was performed. Upon opening the GB postoperatively, a large amount of fresh blood and old blood clot was noted. The incidence of GB hematoma is very rare. GB hematoma should always be considered in the differential diagnosis of GB tumor. In such a situation, surgical intervention is needed for further patient evaluation and management. We present a rare case of intramural GB hematoma, of which we were unable to make a definitive diagnosis preoperatively.

Esophageal Dieulafoy lesion: an unusual cause of GI bleeding

A 38-year-old male with a history of mental retardation presented with aspiration pneumonia. He had an episode of hematemesis and vomited a large amount of fresh blood. He also had melena. He underwent an upper GI endoscopy for further evaluation. In the mid esophagus there was a medium-sized blood vessel that protruded into the lumen through a small mucosal defect with no active bleeding, but it was coated with bright red blood. The surrounding mucosa appeared normal (Fig 1. with white light, Fig 2.

A Case Delayed Hemorrhage from the Stump of the Superior Rectal Artery after Abdominoperineal Resection of the Rectum

A 66-year-old man underwent abdominoperineal resection for advanced rectal cancer. On day 3 post surgery, a decompression tube was placed for postoperative ileus. Symptoms associated with ileus immediately disappeared. On day 7 post surgery, the patient vomited large amounts of fresh blood and became hemodynamically unstable. An emergency angiography revealed active bleeding from the stump of the superior rectal artery communicating with the third portion of the duodenum. Complete obliteration of the stump by proximal coil embolization was performed to achieve successful hemostasis. The postclinical course was uneventful and the patient was discharged on day 40 post surgery.

Massive gastrointestinal bleeding due to the rupture of arterial aneurysm in Behçet’s disease: case report and literature review

Massive gastrointestinal bleeding is a very rare manifestation of gastrointestinal Behçet's disease, mainly from the gastrointestinal mucosal lesions. We report herein the case of a 50-year-old man with intestinal Behçet's disease who suffered massive hemorrhage from ruptured arterial aneurysm. Colonoscopy demonstrated large amount of fresh blood in the entire colon, but we were not able to localize bleeding focus anywhere in the colon. Angiography was performed and it revealed that a small aneurysm on the right ileocolic artery with apparent extravasation of contrast material. A guiding catheter was inserted to a right ileocolic artery and superselective arterial embolization using microcoils was successful. Following this procedure, the gastrointestinal bleeding gradually subsided and completely stopped within a few days. He is now treating with prednisolone and sulfasalazine without recurrent bleeding until now.

Gastrointestinal: Rectal Dieulafoy lesion

A Dieulafoy lesion is a term that is used to describe gastrointestinal bleeding caused by rupture of an exposed submucosal artery associated with a minute mucosal defect. The lesion was originally described by Dr Gallard in 1884 and was subsequently characterized by a French surgeon, Georges Dieulafoy, in 1898. Bleeding from Dieulafoy lesions can occur at any age but is most common in elderly men. The typical site of bleeding is the proximal stomach, usually within 6 cm of the cardio-esophageal junction, but bleeding has been described in a variety of other sites including the esophagus, small bowel and large bowel. Most patients present with intermittent and severe bleeding over several days. When bleeding seems likely to be arising from the large bowel, the initial investigation could be either colonoscopy or mesenteric arteriography. The latter is more likely with torrential bleeding. At colonoscopy, techniques that have been used to control bleeding include epinephrine injections, cauterization, clipping and band ligation. The patient illustrated below was a 76-year-old man who presented with massive rectal bleeding. His medical history included bladder cancer, cecal cancer and a previous cerebral infarct. After resuscitation and a blood transfusion, urgent colonoscopy was performed without bowel preparation. A large amount of fresh blood and clots were noted within the bowel lumen and a bleeding point was not identified. Seven days later, colonoscopy was repeated after a further episode of bleeding. Careful inspection revealed an exposed vessel without surrounding ulceration in the distal rectum consistent with a Dieulafoy lesion (Fig. 1). The vessel was ligated with a single elastic band (Fig. 2). Thereafter, bleeding settled and a follow-up colonoscopy showed that the lesion had healed with scar formation. Although rare, Dieulafoy lesions need to be considered in the differential diagnosis of major rectal bleeding, particularly as they are often suitable for endoscopic therapy.

Spontaneous splenic rupture in pregnancy after heparin treatment

A 32-year-old woman presented in the 34th week of her fourth pregnancy with sudden diffuse abdominal pain. She had previously undergone a preterm delivery of twins at 24 weeks of gestation and an early miscarriage at seven weeks of gestation. After her first two pregnancies, she underwent evaluation for thrombophilia and was diagnosed as being homozygous for methyl-tetra-hydro-folatereductase (MTHFR) deficiency. During her third pregnancy, she had been treated with folic acid 5 mg daily and prophylactic subcutaneous low molecular weight heparin (enoxaparin) 40 mg daily. She carried that pregnancy to full-term (38 weeks) without complications. In the present pregnancy, she had received enoxaparin 40 mg and folic acid 5 mg daily until she presented with abdominal pain. She described the pain as sudden in onset, sharp and continuous. She denied any past or recent abdominal trauma. She had taken her last dose of enoxaparin at 19:00 and arrived at the hospital at 23:30 of the same evening. On admission, blood pressure was 100/70 mmHg and pulse 70 bpm. Physical examination revealed a diffusely tender and distended abdomen, with signs of peritoneal irritation. The uterine tone was normal, and there was no vaginal bleeding. Non-reactive stress testing and her biophysical profile were normal. She was transferred to our delivery room for further observation because of her unrelenting pain. A severe prolonged fetal bradycardia was identified 10 minutes later and an emergency caesarean was performed under the assumption of a placental abruption. The peritoneum was opened, revealing a large amount of fresh blood and blood clots in the abdominal cavity. A live baby was delivered. The amniotic fluid was clear and no evidence of abruption was seen on the placenta. After suturing the uterus, persistent bleeding was noted to appear from the upper abdominal cavity and a general surgeon was called in order to locate the source of bleeding. He performed a vertical abdominal incision and an exploratory laparotomy revealed a tear in the splenic hilum, whereupon he performed a splenectomy. There appeared to be no other source of bleeding. The patient received blood products during and after the operation. Her recovery was uneventful and she was discharged with a healthy baby 10 days after her admission. The pathology report confirmed a rupture of the splenic capsule.

Transfusion-transmitted cytomegalovirus infections: significance and control.

Cytomegalovirus (CMV) is a herpes virus which can give rise to primary infections, reactivated infections, or reinfections in humans. Seroepidemiologic studies have shown CMV infection to be worldwide with the highest antibody prevalences detected in Third World countries; however, significant regional variations can be seen within a given country. Antibody prevalence varies directly with age and inversely according to socioeconomic status. Numerous prospective studies of blood transfusion recipients carried out since 1966 have shown marked differences in infection rates but relatively little associated disease. Infection rates were highest in seronegative recipients given large amounts of fresh blood. Recently published reports have shown substantially lower infection rates than earlier studies, a change likely to be due to the current practice of transfusing fewer units of older blood. CMV has not been found to play a significant role in the etiology of posttransfusion hepatitis. CMV infections have been found to be an important source of morbidity and mortality in immunocompromised patients. Several studies of transfused, premature infants have shown significant differences in infection rates and disease expression. Seronegative low-birth-weight infants receiving blood from seropositive donors are at greatest risk. Blood from CMV-seronegative donors substantially lowers the risk of infection. Receiving a kidney or heart from a CMV-seropositive donor appears to be a more salient risk factor than blood transfusion in renal and cardiac transplant patients who are also more likely to have symptomatic CMV infections. Leukocyte transfusions have been found to be a significant source of CMV infection and disease in bone marrow transplant patients.(ABSTRACT TRUNCATED AT 250 WORDS)