Repeated Blood Transfusions Research Articles

Practical aspects of the management of severely burned children

The care of extensively burned children requires untiring attention to a multitude of problems, beginning with the control of shock and continuing until full coverage of the wound is obtained. Such care is best accomplished in a hospital unit which is staffed by a dedicated team of hospital personnel and provided with centralized ward facilities which make efficient management possible. Infection is the most serious threat to life in these patients. Early debridement and adequate drainage are the most important principles in the control of local infection. Management of septicemia includes use of systemic bactericidal antibiotics, employment of blood transfusions and local care of wounds to remove necrotic tissue and provide drainage. Nutritional losses are prevented by nasogastric tube feedings. Anemia and blood volume deficits are forestalled by repeated blood transfusions. Early operative removal of the burn slough and prompt skin grafting are replacing the older methods of allowing the eschar to separate spontaneously. Debridement, beginning on the fourth day after burn, allows grafting to begin by the tenth to fourteenth day. Local care of the burn prior to and between graftings include tubbing and saline compresses. Since lengthy operations are poorly tolerated by these patients, careful planning must precede and adequate personnel must be available to permit expeditious and efficient procedures.

Jejunal adenoma producing intussusception: report on a case.

A case of adenomatous polyp of the jejunum with intussusception is described. The diagnosis was made on the radiological examination. Symptoms had been present for six years before the diagnosis was made. Melaena of sufficient severity to require repeated blood transfusions was the main symptom. The clinical and radiological features of benign small intestine tumours and intussusception are discussed briefly. The case illustrates the necessity for careful examination of the small intestine when routine examination fails to reveal the cause of melaena.

The significance of the presence in human serum of complement-fixing antibodies to human tissue antigens.

SummaryCertain human sera exhibit complement fixation with human tissue antigens, particularly liver and kidney, the reaction being designated auto‐immune complement fixation (AICF) ; the serum factor responsible is considered to be a type of autoantibody.Positive reactions were frequently associated with an elevated erythrocyte sedimentation rate, a positive response to the cephalin flocculation test and an elevated serum gamma globulin level, but other serological reactions were mostly negative.About 3% of normal sera reacted in low titre. Positive reactions were obtained in 22 of 28 cases of disseminated lupus erythematosus, in 16 of 99 cases of chronic liver disease, and in Wassermann‐positive cases of syphilis and leprosy. Dermatomyositis, rheumatic disease and nephritis yielded largely negative results. Positive reactions also occurred in cases of fungating carcinoma (in low titre), of aplastic anaemia requiring frequent transfusion, of macroglobulinnmia (two out of 14 cases), and of active Hashimoto's thyroiditis (two cases).Explanations considered for AICF reactivity of serum were : (a) abnormal antigenic stimulation, as a result of excess tissue autolysis (hepatitis, carcinoma), repeated blood transfusion (aplastic anemia) and liberation of "unfamiliar" antigens such as thryoglobulin (Hashimoto's disease) ; (b) a disease or disorder (possibly a mutation) in the antibody‐forming tissues causing abnormal antibody production (lymphoma, macroglobulinamia.) Consistently elevated AICF titres in disseminated lupus erythematosus suggest that this condition may be basically a disease of the antibody‐producing tissues.

Serum Vitamin B12 in Leukemias and Malignant Lymphomas

Abstract High serum vitamin B12 levels were found in chronic myeloid leukemia and in acute leukemia with myeloid differentiation. Following x-ray therapy and repeated blood transfusions, a drop of serum vitamin B12 was found. In chronic lymphatic leukemia, undifferentiated stem cell leukemia, Hodgkin’s disease, and multiple myeloma, the serum vitamin B12 concentrations were normal. In polycythemia with marked leukocytosis the serum B12 was normal. In myelosclerosis high B12 values may be found. The serum vitamin B12 in chronic myeloid leukemia is in a bound form and the binding capacity for added B12 is increased. Serum vitamin B12 determination may be of some value in differentiating various types of leukemia and other myelo-proliferative disorders.

Occurrence of secondary hemochromatosis in patient with thalassemia major.

IDIOPATHIC hemochromatosis was first described by Hartman and Chausser, in 1882. They described the classic tetrad of liver disease, diabetes, pigmentation of the skin, and atrophy of the gonads. Howard and Stevens, in 1917, were among the first to demonstrate that abnormal iron metabolism was the basis of this condition. What abnormality in iron metabolism leads to hemochromatosis has only recently been elicited. In 1937 a closely related disease following repeated blood transfusions was described by Kark. Since that time numerous observers have reported the occurrence of hemosiderin deposits in the liver and other organs following blood transfusions. Several of the reports, notably those of Mackey, of Aufderheide, Horns, and Goldish, and of Chesner, also have shown cirrhosis of the liver to be a further complication. Other instances of this condition have been reported after prolonged oral administration of iron salts. Goldish and Aufderheide pointed out that there is often

Gastrointestinal bleeding due to splenic vein obstruction by pancreatic tumors.

MASSIVE bleeding into the gastrointestinal tract may be caused by splenic vein obstruction due to involvement of the pancreas by neoplasms, either primary or secondary, or by cysts. Interference with the return flow of venous blood from the spleen may result in congestive splenomegaly, gastric varices, and at times esophageal varices. Fatal hemorrhage from ruptured varices may be prevented in such situations by splenectomy. Recently there have been three patients on the surgical division at this hospital in whom death due to exsanguination was averted by removal of the spleen and the obstructing tumor. REPORT OF CASES Case 1. —M. R. (Montefiore Hospital admission number 53369). The case history of this 51-year-old white man has been reported in detail in a previous publication.1Because of massive melena, he had been treated in another institution with repeated blood transfusions. At this hospital he was found to have gastric varices and

Thrombocytopenic purpura after morbilli.

SummaryA case of thrombocytopenic purpura after morbilli in a girl of 9 years, previously healthy, is reported. On the tenth day after the appearance of the morbillous exan‐them, cutaneous and mucous membrane haemorrhages with increased intensity were noted. On hospitalization, she had thrombocytopenia and a prolonged bleeding time. She lost large amounts of blood, which were replaced by repeated blood transfusions. The haemorrhages began to abate after 12 days. The patient was discharged after a month. The subsequent follow‐up period uneventful except for a moderate persistent thrombocytopenia. A brief comparison is made between the present case and 4 earlier ones. A discussion of the genesis, therapy and prognosis of the disease is added.

Researches on a Circulating Anticoagulant in a Hemophiliac: II. Effect of Administration of ACTH and Cortisone

Abstract The influence of the administration of ACTH and cortisone on a circulating anticoagulant appearing after repeated blood transfusions in a hemophiliac was studied. It was found that the activity of the anticoagulant was diminished to a considerable degree, even though temporarily, and the clotting time was reduced by plasma transfusions more than prior to the administration of ACTH and cortisone. Antibodies to the Duffy antigen were also present together with the circulating anticoagulant, but their activity was not clearly affected by the administration of ACTH and cortisone.

A hazard of repeated blood transfusions; hemolytic reaction due to antibodies to the Duffy (Fya) factor.

The use of whole blood in the treatment of medical and surgical conditions has increased greatly during the past 10 years to the point where about 3,000,000 transfusions are given each year in this country alone. 1 This widespread use of blood transfusions has led to the recognition of a number of serious hazards associated with the procedure, the most commonly encountered and best known of these being Rh immunization, hemolytic reactions due to major blood group incompatability, and the transmission of certain diseases, notably homologous serum jaundice, malaria, syphilis, and, in some areas, brucellosis. 2 An additional hazard that is less well recognized, but one that is growing in importance because of the increasing incidence of repeated blood transfusions, is that of hemolytic reaction due to immunization by one or more of the recently discovered blood group factors, such as Kell (K), 3 Cellano (k), 4 Duffy (Fya), 5

Idiopathic acquired hemolytic anemia in an infant; successful treatment with corticotropin (ACTH).

DEVELOPMENT of new techniques has revived interest in the hemolytic anemias and has led to new concepts in the pathogenesis and treatment of the so-called idiopathic acquired form of the disease. Whereas treatment formerly was confined to the use of whole-blood transfusions, with unfavorable results occurring in many cases, recently splenectomy and corticotropin (ACTH) have been employed to induce remission.1 It is the purpose of this report to present a case of idiopathic acquired hemolytic anemia in an infant who failed to respond to repeated blood transfusions but recovered after treatment with corticotropin. REPORT OF CASE T. B., a white boy 13 months of age, was admitted to the Medical Service of Milwaukee Children's Hospital on July 1, 1950, because of vomiting, pallor, and weakness. The infant had been well until June 15, 1950, when a cold developed. Within a few days recovery occurred, and the mother noted no

Leiomyoma of the stomach.

This case is reported because of the rarity of this condition and the radiological features conformed to the radiological characteristics described in the literature, subsequently confirmed by autopsy. G.S., a male aged 64, was referred for examination, because during the previous month he had been suffering from repeated attacks of melaena in spite of continued medical treatment and repeated blood transfusions. There had been a continued pyrexia and leucocytosis for the same period. In 1944 there had been a similar illness lasting about a month, and a barium meal examination (Fig. 1), carried out by Dr. F. F. C. Jagger, revealed a rounded filling defect containing a central spot of barium in the stomach. This appearance was confirmed by another barium meal examination three months later; but this time the central spot was not demonstrated.

Studies on the Blood Factor rhw

In 1945, Callender, Race and Paykoc reported a remarkable case in which a patient with diffuse lupus erythematosus treated by repeated blood transfusions became isosensitized to 5 agglutinogens in succession, namely, the agglutinogens hr' and N, and 3 others previously undescribed. The purpose of this paper is to describe some studies on one of the new blood factors discovered by these workers, namely, the factor designated C by them, after the donor Willis whose blood stimulated the production of the specific antibody. In their initial study of 768 blood specimens, Callender and Race encountered 19 bloods which gave positive reactions with the anti-Willis serum. All the positive-reacting bloods possessed the factor rh', indicating that a relationship existed between the Willis factor and the rh' factor. Since the rh' factor is designated as C under the British notations, the new factor was given the designation C. Under the International Rh-Hr Nomenclature, type Rhi blood containing the Willis factor was designated as Rhf, and the corresponding gene was designated R. The work of Callender and Race was soon confirmed when other instances of sensitization to the Willis factor were encountered by Lawler and van Loghem, and by Broman. The main purpose of the present paper, aside from presenting our own observations on the Willis factor, is to attempt to clarify the relationship of the new blood factor and antiserum to the previously found Rh factors. For reasons which will become apparent, in the present paper the Willis factor will be designated as the rh factor.

HEMOSIDEROSIS IN REFRACTORY ANEMIA

THE DISCOVERY of iron and liver therapy has brought into prominence a type of primary anemia which fails to respond to any known treatment. This type has therefore been referred to as primary refractory anemia by Bomford and Rhoads,¹who have further subdivided it into four types according to the histopathologic appearance of the bone marrow. These, with their clinically comparable conditions, are pseudoplastic anemia (partly mature, cellular marrow), aplastic anemia, or panmyelophthisis (hypocellular marrow), chronic granulocytopenia (immature cellular marrow) and myelosclerosis (fibrosis, sclerosis, and giant cell hyperplasia of the marrow). With the lack of specific therapy, the main source of treatment is repeated blood transfusions. A dramatic observation in cases of refractory anemia treated with multiple blood transfusions has been the development of hemosiderosis of the liver, spleen and other organs. An analysis of autopsy observations in 20 cases of refractory anemia from Bomford and Rhoad's series revealed

Severe anaemia in Indian Sepoys (Refractory tropical macrocytic anaemia)

1. (1) An account is given of 127 cases of severe anaemia with haemoglobin levels below 4·0 grammes occurring amongst Indian sepoys evacuated from the Burma campaign. 2. (2) The majority had had recent malarial infections, and just under half presented evidence of a defective nutrition. Ancylostomiasis was not frequent. 3. (3) A variety of haematological types occurred, but the majority were macrocytic anaemias. 4. (4) Many of the patients differed from cases of tropical macrocytic anaemia as usually described in that they were refractory and did not respond to either yeast or parental liver therapy. Repeated blood transfusions were found to be the most important therapeutic agent.

Severe sublingual and paratracheal hemorrhagein hemophilia with recovery following tracheotomy

<h2>Summary</h2> We have reported the case of a known hemophiliac child who, during the course of an upper respiratory infection, developed a massive sublingual and paratracheal hemorrhage with resultant severe upper respiratory distress. Tracheotomy became necessary and was successfully performed with immediate relief of the respiratory obstruction. Favorable progress followed the use of repeated blood transfusions.

Subacute streptococcus viridans endarteritis superimposed on patent ductus arteriosus: Spontaneous recovery. Recurrence after twelve and one-half years. Recovery following operative treatment

A 51-year-old female with patent ductus arteriosus, suffered an episode of subacute Streptococcus viridans endarteritis twelve and one-half years previously. At the time, the diagnosis of a congenital cardiac lesion was based upon the absence of a history of rheumatic fever and the presence of a characteristic murmur, known to be of long duration. The diagnosis of superimposed infection rested upon the presence of irregular fever, chills, malaise, splenic enlargement, petechiae, and several episodes of pulmonary infarction, and was confirmed by blood cultures which repeatedly were positive for Streptococcus viridans. The treatment consisted of repeated blood transfusions, supportive therapy, and injections of an autogenous vaccine. After an illness of approximately fifteen months, she apparently recovered completely. The patient first came under the observation of one of the authors, with symptoms of mild circulatory failure, approximately eight years prior to the present admission. During the ensuing years the circulatory symptoms increased slowly but progressively. Approximately four and one-half weeks before admission to the hospital, clinical manifestations of superimposed infection, similar to those present twelve and one-half years previously, reappeared. During a twenty-three-day period of hospital observation, the clinical course was progressively downhill. The administration of both sulfapyridine and sulfathiazole was without sgnificant effect; and blood cultures revealed as many as fifty-two colonies of Streptococcus viridans per cubic centimeter. Operation was performed primarily for the purpose of eliminating the infection. The procedure consisted of double ligation of the ductus, by a modification of technique devised by one of the authors. A blood culture taken forty minutes after operation was sterile throughout fourteen days of incubation. Four blood cultures were taken subsequently, and these likewise were negative. Chemotherapy was not administered during the postoperative course. Approximately nine months have elapsed since operation. All manifestations of infection and of circulatory failure remain absent, and the patient is in better health than in many years. This is the first case of spontaneous recovery from subacute Streptococcus viridans infection superimposed upon a proved patent ductus arteriosus. It also is the first case of infected patent ductus in which, after recovery from an initial episode, the infection recurred. Finally, it is our third, in which operation upon a patent ductus arteriosus has been followed by recovery from infection.

A case of damage to the ѴIII pair of nerves after blood transfusion

In the literature there are indications of all sorts of complications associated with blood transfusion; but we have never seen any reports of damage to the auditory nerve; all the more interesting is the case when a patient, after repeated blood transfusion for a lung abscess, developed inflammation of the VIII pair of nerves.

Placental blood transfusion for cancer of the uterus

The feasibility of blood transfusion in cancer patients is confirmed by a number of authors. According to Academician Bogomolets, repeated blood transfusions after radical surgery can prevent relapses. Great importance is attached to transfusion in case of intoxication in cancer patients as a result of treatment with large doses of X-rays (X-ray cutter).

OTITIC MENINGITIS: REPORT OF A CASE IN WHICH TREATMENT WAS FOLLOWED BY RECOVERY

The treatment given a patient with meningitis (Streptococcus haemolyticus) following mastoiditis which complicated scarlet fever is of interest, as it was followed by the unusual result of complete recovery. Surgical drainage of the mastoids was done. The value of repeated blood transfusions 1 to combat the strong hemolyzing influence of this type of infection was recognized, and that agent was used. Frequent spinal taps were done for the reduction of intracranial pressure. In addition to the aforementioned treatment, the following therapy was used: convalescent scarlet fever serum 2 both intravenously and intraspinally together with a derivative of sulfanilamide (prontosil) 3 intramuscularly and sulfanilamide by mouth. 4 REPORT OF CASE J. W., a boy 6 years old, was admitted to the scarlet fever ward of the Willard Parker Hospital on Oct. 28, 1936, the fifth day of his illness. Five days before coryza had developed, with malaise; on the following day a slight rash on

Surgical treatment of puerperal sepsis

1. 1. Surgical treatment should be utilized in certain types of puerperal sepsis in conjunction with medical treatment. 2. 2. These certain types of puerperal sepsis can only be determined by history and careful repeated examinations with thorough and constant clinical study. 3. 3. The operations employed were colpotomy, abdominal drainage and removal of diseased structures and hysterectomy, each operation being employed in certain pathological states. Vein ligation has been done so rarely in this hospital and the mortality in these people so low that the tendency is entirely towards conservative management with repeated blood transfusions.