Blood Volume In Patients Research Articles

Use of CXCR4-antagonist for haematopoietic stem cell mobilization in HIV-infected patients with haematological malignancies

Use of CXCR4-antagonist for haematopoietic stem cell mobilization in HIV-infected patients with haematological malignancies

Assessment of Pericardium Volume by the Stroke Volume Variation in Patients with Off-Pump Cardiac Surgery

Objective: SVV is derived from the cardiopulmonary interaction, which is used to predict the responsiveness of cardiac preload guiding fluid therapy in patients under general anesthesia in non-opened chest surgery. From a clinical point of view, it is important to know how well SVV reflects preload and fluid responsiveness during cardiac surgery. This study was undertaken to assess the accuracy and reliability of SVV derived from the FloTrac/Vigileo system in monitoring changes in blood volume in patients undergoing off-pump coronary artery bypass grafting (OPCABG) under general anesthesia. Methods: After approval from the ethics committee and obtaining the permission of the patients, twenty-nine patients, ASA II-III and NYHA II-III, aged 44-7 yr, undergoing elective off-pump coronary artery bypass grafting, were randomly divided into 2 groups: the control group (group C, n = 8) and volume expansion group (group V, n = 21). After patients entered the operating room, veins were put in line, ECG, HR, SpO2, and PETCO2 were continuously monitored. Left radial arterial and right internal jugular vein catheters were inserted under local anesthesia. The FloTracTM/VigileoTM system was connected and MAP, CO, CI, SVV, SV, SVI, SVR, SVRI, CVP were continuously monitored. BIS values were kept at 45%-55.6% hydroxyethyl starch 130/0.4 sodium chloride solution 7 ml/kg was intravenously infused after completion of sternotomy and pericardiotomy at a rate of 0.25 ml/kg–1/min–1 in group V. MAP, HR, CVP, systemic vascular resistance (SVR), SVV, and stroke volume index (SVI) were determined 10 min before (T1) and after the infusion of finished (T2), and the change rate (ΔHR, ΔMAP, ΔCVP, ΔSVR, ΔSVV, ΔSVI) was calculated. Sodium chloride injection 3 ml/kg was infused in group C. Results: CVP, SVI, CO and CI were increased after volume expansion, SVRI and SVV significantly decreased in group V(P r = –0.737, P and SVR(r = –0.480, P were significantly correlated to changes in SVI, but there was no correlation between ΔCVP, ΔMAP, ΔSVV and ΔSVI. SVV(</sp

Antifibrinolytic Agents Reduce Blood Loss During Pediatric Vertebral Column Resection Procedures

Retrospective multicenter review. To evaluate the effect of intraoperative antifibrinolytic (AF) agents on blood loss associated with vertebral column resection (VCR) procedures for pediatric patients. VCR procedures may be associated with substantial blood loss. A multicenter review of 147 patients (aged <21 yr) who underwent VCR as part of their spinal deformity correction was conducted. Estimated blood loss (EBL) was calculated as percentage of blood volume (BV) (EBL/BV × 100), which was normalized on the basis of the number of vertebral levels removed (%BV/level). The use of AF agents was noted (tranexamic acid [TXA], aminocaproic acid, aprotinin, none) and based on surgeons' choice. EBL was compared using analysis of covariance (controlling for deformity magnitude) (P < 0.05). Average preoperative major deformity (kyphosis or scoliosis) was 97° ± 31°. The average number of levels excised was 1.6 (range, 1-5). Total EBL averaged 1317 mL (range, 50-6026 mL). Eleven patients were excluded: 7 with incomplete data and 4 who received aminocaproic acid (too few to compare). This resulted in 136 cases; 64 with no AF, 42 received TXA, and 30 received aprotinin. Overall %BV/level EBL was 41% ± 39% (range, 6%-162%) and was significantly higher in the no-AF group (52% ± 37%) than the TXA (30% ± 34%; P < 0.01) and aprotinin (32% ± 24%; P < 0.05) groups. The effect of the AFs varied by site. EBL associated with VCR was highly variable and in many cases exceeded the patient's BV. AF agents were not routinely used and we had insufficient data to assess the efficacy of aminocaproic acid. Both aprotinin and TXA resulted in less EBL than when no AF was used; however, the effect of the reduction varied by site. Aprotinin has since been removed from the market. When normalized to patient size and levels excised, the use of TXA resulted in a reduction in intraoperative EBL.

Basics of fluid and blood transfusion therapy in paediatric surgical patients.

Perioperative fluid, electrolyte and blood transfusion therapy for infants and children can be confusing due the numerous opinions, formulas and clinical applications, which can result in a picture that is not practical and is often misleading. Perioperatively, crystalloids, colloids and blood components are required to meet the ongoing losses and for maintaining cardiovascular stability to sustain adequate tissue perfusion. Recently controversies have been raised regarding historically used formulas and practices of glucose containing hypotonic maintenance crystalloid solutions for perioperative fluid therapy in children. Paediatric intraoperative transfusion therapy, particularly the approach to massive blood transfusion (blood loss ≥ one blood volume) can be quite complex because of the unique relationship between the patient's blood volume and the volume of the individual blood product transfused. A meticulous fluid, electrolyte and blood transfusion management is required in paediatric patients perioperatively because of an extremely limited margin for error. This article reviews the basic concepts in perioperative fluid and blood transfusion therapy for paediatric patients, along with recent recommendations. For this review, Pubmed, Ovid MEDLINE, HINARI and Google scholar were searched without date restrictions. Search terms included the following in various combinations: Perioperative, fluid therapy, paediatrics, blood transfusion, electrolyte disturbances and guidelines. Only articles with English translation were used.

Evaluation of noninvasive methods for the estimation of haemoglobin content in red blood cell concentrates

Red blood cell concentrates (RCCs) are the major blood component transfused to patients. There is a great variability in patient response, depending on both the patient's blood volume and haemoglobin content in the RCC. Standardisation of transfusion practice is needed to improve the prediction of patient outcome. We hypothesise that labelling of RCCs with haemoglobin content will add possibilities for the standardisation of transfusion practice. Data from multiple international transfusion services regarding haemoglobin content and weight or volume of RCC were collected and analysed. We demonstrate a strong and highly significant correlation between haemoglobin content with both weight and volume of the RCCs. A linear regression model was used to assess these relationships, and it demonstrates how haemoglobin content can be estimated for different cell production processes. We recommend the use of weight or volume of the RCCs as the basis of estimating haemoglobin in the RCC and postulate that this can be used in future studies to explore the effects of a haemoglobin dose-based transfusion system. As the weight - and sometimes the volume - of the blood bag is easily accessible, in contrast to direct haemoglobin measurements from each individual unit, this method is feasible and simple.

SHORT-TERM EFFECTS OF LOSARTAN THERAPY ON HAEMODYNAMIC PARAMETERS IN HYPERTENSIVE PATIENTS: PP.5.223

Objectives: The aim of this study was to assess the short-term effects of antihypertensive therapy with losartan, alone or combined with hydrochlorthiaside, on blood pressure and hemodynamics parameters of hypertensive patients. Design and Methods: The study comprised 76 patients (36 men and 40 women) with arterial hypertension (grade I or II), aged 60.93 ± 10.51 years. Ambulatory 24-hour blood pressure monitoring (ABPM, using Space Labs 90202) and thoracic bioelectric impedance (TBI, using Task-Force monitor) were performed to estimate haemodynamic parameters (peripheral vascular resistance, PVR, and blood volume, BV). The subjects who had increased PVR [32 patients (12 men and 20 women)] were treated with 50 mg losartan per day. Those with increased both PVR and BV [44 patients (21 men and 23 women)] were treated with 50 mg losartan and 12.5 mg hydrochlorthiaside per day. Short-term effects of therapy were assessed after 30 and 60 days. Results: After a two months therapy both groups experienced a significant decrease of blood pressure. Patients with increased PVR responded to losartan therapy with significant decrease of PVR after 30 and 60 days (PVRbeginning=68.5 ± 14.0; PVR30days=36.0 ± 11.5; PVR60days=9.5 ± 9.0; p < 0.001). The group treated with losartan and hydrochlorthiaside showed significant decrease of PVR (PVRbeginning=42.5 ± 11.0; PVR30days=26.5 ± 10.0; PVR60days=15.5 ± 9.0; p < 0.001) and blood volume (BVbeginning=39.0 ± 12.0; BV30days=22.0 ± 9.5; BV60days=11.0 ± 8.5; p < 0.001). Heart rate remained unchanged during the treatment in both groups. Conclusion: Short-term therapy of losartan in patients with arterial hypertension was efficient in reducing blood pressure and peripheral vascular resistance. The combination of losartan and hydrochlorthiaside could in addition reduce patient's blood volume.

Prediction of symptomatic cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage: relationship to cerebral salt wasting syndrome

Objectives: Symptomatic cerebral vasospasm is a major complication in patients with subarachnoid hemorrhage (SAH). Symptomatic cerebral vasospasm has been reported to be related to the patient's blood volume which is influenced by cerebral salt wasting syndrome (CSWS). We undertook a prospective study to assess whether the onset of symptomatic cerebral vasospasm was predictable or not, by observing the phenomena of CSWS (natriuresis and osmotic diuresis).Methods: Sixty-seven consecutive aneurysmal SAH patients were analysed. After surgery, all patients underwent hypervolemic therapy in order to keep central venous pressure (CVP) within 8–12 cmH2O, serum sodium level above 140 mEq/l and a positive water balance. Patients were classified into two groups: those without symptomatic cerebral vasospasm (n=55) and those with symptomatic cerebral vasospasm (n=12). To estimate natriuresis and osmotic diuresis, sodium in/out, water in/out, CVP and other parameters were measured and compared between the two groups.Results: One day before symptomatic cerebral vasospasm, three factors reached statistical difference in the group that experienced symptomatic cerebral vasospasm: sodium balance, urine volume and water balance. On the day of symptomatic cerebral vasospasm, two factors reached statistical difference: sodium excretion and urine volume. No factor was significantly different 2 days before symptomatic cerebral vasospasm.Discussion: Symptomatic cerebral vasospasm has a strong relationship with CSWS. Negative sodium and water balance and increased urine volume indicate a predictor of symptomatic cerebral vasospasm. To predict symptomatic cerebral vasospasm, strict observations are required, because CSWS and symptomatic cerebral vasospasm which follows, develop rapidly.

Massive postpartum haemorrhage and management of coagulopathy

Postpartum haemorrhage (PPH) is a leading cause of maternal morbidity and mortality in both the developed and developing world. By definition, PPH refers to a blood loss of>500 ml (or>1000 ml during a caesarean section) after the delivery of the fetus. However, this is an arbitrary value as women who are ‘small made’ (low blood volume) or anaemic may not tolerate even a blood loss of 500 ml. Massive PPH refers to the loss of 30–40% (generally>2 L) of the patient's blood volume, resulting in changes in the haemodynamic parameters which lead to moderate or severe shock. Consequences of such massive blood loss include sudden and rapid cardiovascular decompensation and coagulopathy, as well as iatrogenic complications of fluid replacement and multiple blood transfusions (pulmonary oedema, transfusion reactions and adult respiratory distress syndrome).

Progenitor cell recruitment during individualized high‐flow, very‐large‐volume apheresis for autologous transplantation improves collection efficiency

Individual adaptation of processed patient's blood volume (PBV) should reduce number and/or duration of autologous peripheral blood progenitor cell (PBPC) collections. The durations of leukapheresis procedures were adapted by means of an interim analysis of harvested CD34+ cells to obtain the intended yield of CD34+ within as few and/or short as possible leukapheresis procedures. Absolute efficiency (AE; CD34+/kg body weight) and relative efficiency (RE; total CD34+ yield of single apheresis/total number of preapheresis CD34+) were calculated, assuming an intraapheresis recruitment if RE was greater than 1, and a yield prediction models for adults was generated. A total of 196 adults required a total of 266 PBPC collections. The median AE was 7.99 x 10(6), and the median RE was 1.76. The prediction model for AE showed a satisfactory predictive value for preapheresis CD34+ only. The prediction model for RE also showed a low predictive value (R2 = 0.36). Twenty-eight children underwent 44 PBPC collections. The median AE was 12.13 x 10(6), and the median RE was 1.62. Major complications comprised bleeding episodes related to central venous catheters (n = 4) and severe thrombocytopenia of less than 10 x 10(9) per L (n = 16). A CD34+ interim analysis is a suitable tool for individual adaptation of the duration of leukapheresis. During leukapheresis, a substantial recruitment of CD34+ was observed, resulting in a RE of greater than 1 in more than 75 percent of patients. The upper limit of processed PBV showing an intraapheresis CD34+ recruitment is higher than in a standard large-volume leukapheresis. Therefore, a reduction of individually needed PBPC collections by means of a further escalation of the processed PBV seems possible.

Safety of Central Venous Catheter Removal in the Setting of Thrombocytopenia and Peripheral Blood Stem Cell Collection.

Thrombocytopenia is not uncommonly seen in patients undergoing peripheral blood stem cell collection. It is most likely secondary to the administration of chemotherapy and G-CSF, as well as the apheresis process itself. Peripheral blood stem cell collection causes a variable loss of platelets, which are collected along with the mononuclear cells. The ensuing thrombocytopenia can be at times severe, but the bleeding risk in this setting is unclear, as is the need to administer platelets prophylactically when the central catheter used for collection is removed. In this study we retrospectively analyzed data on 40 patients who had a central venous line removed immediately after their last autologous stem cell collection and had a platelet count of less than 50000/μL before the apheresis procedure. Patients were divided into two groups, according to whether or not they had received a platelet transfusion. The expected pre-catheter removal platelet count was calculated, according to the patient's blood volume, the number of platelets in the stem cell product and the amount of platelets transfused in random donor platelet units (RDP) equivalents. Each chart was reviewed for the occurrence of catheter removal-associated bleeding. The results are shown in table 1. Post-apheresis platelet measurement is not routinely performed, due to its inconvenience to the patient and delay in catheter removal. Most clinicians use the pre-apheresis value as a guide to transfuse platelets before taking out the central line. As shown in table 1, in spite of significantly lower measured platelet counts before the harvest procedure in the transfused group, the calculated final counts were similar, due to the transfusion of allogeneic platelets. The patients' weight was significantly lower in the transfused group, and this might actually have contributed to their lower platelet counts after repeated peripheral stem cell collections. There was no bleeding associated with catheter removal in either group. One patient had persistent oozing at the catheter insertion site, likely secondary to an unusually large incision. Removal was uneventful however. In this study, removing the central venous catheter was performed safely without platelet transfusion in patients who had a pre-apheresis platelet count above 30000/μL. It might be safer to administer prophylactic platelet transfusions to patients with lower counts.Table 1Untransfused groupTransfused groupPN346Patient weight in kg (median, range)93 (52–125)76 (63–89)0.03Measured platelet count pre-apheresis X 1000/μL (median, range)40 (28–49)24 (19–30)<0.01Number of platelets removed X 1011 (median, range)0.51 (0.05–1.44)0.48 (0.14–2.34)0.58Number of transfused RDP equivalents per patient (median, range)05 (4–6)-Calculated platelet count post-apheresis (median, range)32 (19–44)39 (8–45)0.56Number of bleeding episodes00-

Intraoperative pediatric blood transfusion therapy: a review of common issues. Part I: hematologic and physiologic differences from adults; metabolic and infectious risks

Pediatric intraoperative transfusion therapy, particularly the approach to massive blood transfusion (blood loss > or =one blood volume) can be quite complex because of the unique relationship between the patient's blood volume and the volume of the individual blood product transfused. This paper is divided into two parts: part 1 presents an overview of the physiologic and hematologic differences between children and adults as well as an overview of the metabolic consequences of blood transfusions, risks of disease transmission, and blood compatibility issues.

Factors affecting the efficacy of peripheral blood progenitor cells collections by large‐volume leukaphereses with standardized processing volumes

Peripheral blood progenitor cell (PBPC) collections should be safe and efficient. Therefore, the influence and risk factors in large-volume leukaphereses (LVL) with standardized blood volumes was investigated. In a total of 724 autologous LVL performed at our center, either 4x or 6x the patient's blood volume (PBV) was processed. The group with processing 4x the PBV showed a median of 31 circulating CD34+ cells per microL, and the group with processing 6x the PBV had a median of 13 CD34+ cells per microL before LVL. Individual clinical factors, laboratory factors, and apheresis run variables influencing the yields of PBPCs were retrospectively analyzed. Furthermore, the changes of laboratory variables and adverse effects during LVL were investigated. Multivariate analysis identified "age,""circulating CD34+ cells," and "percentage of mononuclear cells" as only factors influencing the yields of PBPCs. Altogether, processing 6x versus 4x the PBV did not result in significantly higher yields of CD34+ cells for the total group, but requested PBPC yields were achieved more often after processing 6x the PBV in patients below 20 CD34+ cells per microL blood. Processing 6x versus 4x the PBV showed a significant difference for the decrease of platelets, but not for any other laboratory variable. Adverse effects were recorded in 4.97 percent of LVL without accumulation in one group. In particular, patients with low amounts of circulating CD34+ cells profited from enlarged LVL demonstrating higher PBPC yields but comparable rates of adverse effects.

Hand-Held Personal Digital Assistant Program for the HEMOCHRON® RxDx® Heparin and Protamine Dosing System

The use of in vitro dosing assays for heparin and protamine during cardiac surgery has significantly improved overall postoperative patient outcome. The HEMOCHRON® RxDx® system (International Technidyne Corp, Edison, NJ) is widely used for anticoagulation management. Based on a series of consecutive in vitro tests, the RxDx system is used to quantify the patient's heparin requirement (heparin response test, HRT), measure the activated clotting time (ACT), calculate the blood heparin concentration and the required protamine dose (protamine response test, PRT), as well as determine the efficacy of heparin reversal (protamine dose assay, PDA-O). A hand-held personal digital assistant (PDA) program has been developed that performs the RxDx calculations used for anticoagulation management during cardiac surgery. The Palm™ m505 handheld device (Palm, Inc., Santa Clara, CA) is used in concert with any standard Hemochron blood coagulation system. The Palm m505 device has been programmed to perform all the calculations required for the RxDx test system. Patient's body weight, height, and gender are entered into the program using the onscreen keypad and the template provided in the Hemochron program. The calculator automatically provides the patient's blood volume and the recommended heparin dose upon entering the baseline ACT and HRT values and a target ACT. At the end of the case, the optimal protamine dose is determined, and the total heparin level is calculated and displayed upon entry of ACT and PRT clotting times. Following protamine administration, the program calculates any additional protamine required to neutralize residual heparin using the data from a PDA-O test. The RxDx hand-held PDA is accurate, quick, simple, and easy to use, patient data are saved and can be retrieved. The inclusion of this rapid computing technology into the Hemochron RxDx system serves to expand the applications of the Hemochron RxDx system during cardiac interventions.

Reducing unnecessary cross-matching: a patient-specific blood ordering system is more accurate in predicting who will receive a blood transfusion than the maximum blood ordering system.

Most blood transfusions are given in the operating room. Adoption of the Maximum Surgical Blood Ordering Schedule in the 1970s reduced the amount of blood unnecessarily cross-matched, but the national cross-match-to-transfusion ratio remains at approximately two-to-one. We tested the ability of a patient-specific blood ordering system (PSBOS) to more accurately predict potential operative transfusion. All adult patients who had blood cross-matched before surgery (February through June 1999) for elective operative procedures at the University of Michigan Hospital were identified. Complex surgeries were excluded. Surgeons estimated the expected blood loss for their surgeries, and the expected postoperative hematocrit was calculated using the patient's blood volume, the surgeon-defined expected blood loss, and preoperative hematocrit. Lowest tolerated hematocrit was set at 21% except in patients with coronary artery disease or who were ASA physical status III or more (28%). Sensitivity, specificity, positive predictive value, and negative predictive value of the PSBOS were calculated. Our analysis included 178 cases in which blood was cross-matched before surgery, representing 69 different surgeries and 42 surgeons. Only 16% of patients received an intraoperative transfusion. Of the 156 patients that PSBOS predicted would not require an operating room transfusion, 139 were not transfused. Of the 21 patients PSBOS predicted would be transfused, 11 were. The sensitivity of the algorithm as tested was 41%, the specificity 93%, the positive predictive value was 55%, and the negative predictive value was 89%. We conclude that PSBOS, which includes patient and surgeon variables in transfusion prediction, is more accurate than the Maximum Surgical Blood Ordering Schedule, which uses only surgical procedure. Currently, many units of blood set aside for surgery are never required, resulting in extra work and expense for blood banks. A formula that included patient weight and hematocrit and typical surgery blood loss was used to predict who would require transfusions. We reduced the predicted number of patients who had blood set aside from 178 to 21.

How Effective is Acute Normovolaemic Haemodilution in Femoro-Distal Bypass Surgery?

Background: Recent guidelines have emphasised the use of autologous blood in the surgical setting. The aim of this study was to analyse the efficacy and efficiency of acute normovolaemic haemodilution (ANH) as a blood conservation intervention in patients undergoing elective femoro-distal surgery for critical limb ischaemia. Methods: Forty patients were studied prospectively. The volume of the blood collected was derived as follows: Blood volume removed = patient's blood volume (initial haematocrit - final haematocrit/average haematocrit) where final haematocrit is 30% and patient's blood volume is 70 and 65 ml/kg for a man and a woman, respectively. Results: Twenty-five patients were suitable for ANH and 15 patients were excluded because of poor ventricular function, anaemia or renal disease. Nine of the 25 patients (44%) had &lt; 500ml of surgical blood loss and would have avoided homologous blood transfusion (HBT). Four of the patients lost &gt;2000ml of blood and could not avoid HBT through ANH. Twelve patients had moderate blood loss (950–1400 ml), with eight of these patients requiring transfusion. Four patients avoided exposure to homologous blood. Conclusion: ANH is in evolution and as a single blood conservation intervention, contributes only modestly to blood conservation.

Double filtration plasmapheresis in critical care.

Many kinds of technologies have been introduced and successfully developed for therapeutic apheresis. Furthermore, several kinds of these technologies have also been applied in critical care. Double filtration plasmapheresis (DFPP), however, is rarely applied in this field in comparison with other treatments such as continuous hemofiltration, continuous hemodiafiltration, single filtration plasmapheresis, and plasma adsorption therapies. In this paper, the characteristics of the DFPP treatments for critical care are summarized. During the DFPP treatments, the patient's blood volume (BV) often decreases with time due to albumin loss induced by inadequate albumin infusion in a supplementation fluid. We examined the change of BV by a continuous hematocrit monitor, Crit-Line, during an in vivo study for 9 patients. As a result, albumin loss fairly occurred in DFPP treatments. The decrease of patient BV was induced by an oncotic pressure drop due to albumin loss and often resulted in a blood pressure drop. This is a serious problem for DFPP in critical care. We should avoid inadequate albumin infusion if the patient is suffering from these adverse effects. In order to determine the optimal concentration C(S) and volume V(S) values of a supplemented albumin solution, we introduced a variable blood volume model for albumin transport in DFPP.

Monitoring the Hematologic Complications of Cardiopulmonary Bypass

Patients undergoing cardiopulmonary bypass (CPB) procedures have a variety of hemostatic defects that lead to bleeding and the frequent need for transfusion of allogeneic blood products. Dilution of the patient's blood volume by the extracorporeal circuit priming so lution causes depletion of platelets and coagulation factor levels. Contact of blood with the extracorporeal circuit induces a hemorrhagic diathesis through a vari ety of mechanisms. Contact activation causes the for mation of kallikrein, bradykinin, and complement acti vation, leading to a whole-body inflammatory reaction. Intrinsic coagulation is stimulated, leading to subse quent activation of the fibrinolytic system. Platelet dys function caused by the effects of the extracorporeal circuit on platelet membrane integrity and the effects of circulating platelet inhibitors have also been described. The use of high-dose heparin for CPB mitigates these effects but does not completely eliminate them. Prota mine, administered to antagonize heparin's effects, has antiplatelet properties and anticoagulant effects when given in excess. Because of the numerous hemostatic insults incurred during and after CPB, complex moni toring techniques are necessary to ensure adequate anticoagulation, adequate heparin neutralization, and normal platelet function. Coagulation monitoring has allowed more specific identification of particular distur bances of hemostasis and has been linked with a reduc tion in hemorrhagic complications after CPB. Copyright © 2001 by W.B. Saunders Company.

Efficacy of acute normovolemic hemodilution assessed as a function of fraction of blood volume lost.

It has been recommended that intraoperative acute normovolemic hemodilution (ANH) be considered for patients expected to experience surgical blood loss of 20% or more of their blood volume. Previous mathematical analyses have not evaluated the potential efficacy of ANH in terms of fraction of blood volume lost. Since decrease of oxygen-carrying capacity is a function of erythrocyte loss relative to blood volume, the purpose of this analysis was to provide an assessment of ANH applicable to all blood volumes and to determine whether this recommendation is appropriate. Equations were developed to describe the fractional blood volume loss (blood volume loss/blood volume; VReM/VBld) required to reduce hematocrit below a "trigger" hematocrit with maintenance of isovolemia. This is also the minimum fractional blood volume loss required for initial erythrocyte savings by any conservation technique. Equations were also developed to describe the fractional surgical blood volume loss for which ANH will obviate the need for transfusion of erythrocytes from any source other than those removed by ANH, and the fractional surgical blood volume loss required for ANH to save a defined volume of erythrocytes. Acute normovolemic hemodilution can extend the allowable fractional surgical blood loss before erythrocyte transfusion is required. The VRem/VBld required to initiate erythrocyte savings is approximately 0.5-0.9. The efficacy of ANH in terms of erythrocytes saved cannot be expressed as a function of the fractional blood volume lost alone. To save 1 unit of erythrocytes requires a fractional surgical blood loss of approximately 0.7-1.2 for the usual surgical patient when the transfusion trigger hematocrit is 0.18-0.21. This analysis suggests that surgical blood loss should be 0.50 or more for ANH to begin to "save" erythrocytes and 0.70 or more of the patient's blood volume for ANH to save 1 unit erythrocytes, for the usual surgical patient with an initial hematocrit of 0.32-0.36 and a transfusion "trigger" hematocrit (the value at which transfusion is initiated) of 0.18-0.21.

Granulocyte colony‐stimulating factor alone at 20 µg/kg vs. 10 µg/kg for peripheral blood stem cell mobilization in children

Mobilization of peripheral blood stem cells (PBSC) by granulocyte colony-stimulating factor (G-CSF), at 10 micrograms/kg/day vs. 20 micrograms/kg/day (in 42 and 29 patients, respectively), was compared in children with solid tumors or leukemias. During mobilization, differences were noted in the peak values of CD34+ cells in peripheral blood (PB) in these two groups (median 28 x 10(6)/L for 10 micrograms/kg/day vs. 61 x 10(6)/L for 20 micrograms/kg/day; p = 0.025). Similar numbers of progenitor cells were harvested for the two concentrations of G-CSF. However, similar CD34+ cell levels in the leukapheresis product were obtained after only the third dose of G-CSF at 20 micrograms/kg/day compared with the fourth dose of G-CSF at 10 micrograms/kg/day (1.7 and 1.2 x 10(6) CD34+ cells/kg/one patient's blood volume processed, respectively). Of note is the impact of diagnosis on PB CD34+ cell levels. We conclude that, in children, mobilization with G-CSF at 20 micrograms/kg/day could minimize the duration of priming but not reduce the number of leukaphereses. Thus, the impact on outcome, clinical practice, bed utilization, and health economics is uncertain.

EXAMINATION OF NEW SUPPLEMENTAL FLUID SETTING METHOD IN DOUBLE FILTRATION PLASMAPHERESIS (DFPP)

(Purpose) We tried establishment of effective and safety treatment method by appropriate supplemental fluid setting in double filtration plasmapheresis (DFPP). (Methods) Patients of pre and post kidney transplantation received DFPP treatments under continuous blood volume (BV) monitoring. The Crit-Line instrument was used as a BV change monitor. We estimated the relation with patient's BV change rate and quantity of supplemental fluid, albumin concentration of supplemental fluid and serum albumin concentration before DFPP. Furthermore from these results, we established new supplemental fluid settings methods with a condition of BV decrease rate less than 10 % and IgG removal rate 70 %. And then we applied it to clinic. (Results) Loss of serum albumin was recognized accompanied with removal of globulin and decrease of BV due to hypoproteinemia was observed. Decrease of BV was remarkable when the volume of supplemental fluid was large, albamin concentration of supplemental fluid was low and serum albumin concentration before treatment was high. New supplemental fluid setting methods was established from these parameters and was applied to clinic. BV decrease rate was 10.0 ± 6.0 % and IgG removal rate was 69.6 ± 8.9 %. (Conclusion) It seems to be possible that we can enforce an effective and safety treatment with a little BV change by the new established supplemental fluid setting methods.