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Transfused Patients (transfused + patient)
Selected AbstractsAnalysis of outcome of laparoscopic splenectomy for idiopathic thrombocytopenic purpura by platelet countAMERICAN JOURNAL OF HEMATOLOGY, Issue 2 2005A. Keidar Abstract Laparoscopic splenectomy (LS) is now performed routinely in patients with idiopathic thrombocytopenic purpura (ITP) refractory to the medical treatment. Low preoperative platelet count was deemed to be a contraindication for a laparoscopic approach; however, there is no data reporting the outcome in those patients. We aimed to evaluate the influence of the preoperative platelet count on the operative and postoperative course and complication rate. Retrospective cohort study that was conducted in tertiary care university-affiliated medical center and included 110 consecutive patients who underwent LS. All patients were divided into three groups by their preoperative platelet counts: ,20 × 109/L (n = 12), (20,50) × 109/L (n = 18), and >50 × 109/L (n = 80). The outcome and the influence of preoperative factors predictive of complications, blood transfusion, and length of stay were compared between the groups. Patients with a platelet count of ,20 × 109/L had a much longer hospital stay, received more blood transfusions, and suffered more complications than patients with platelet counts of (20,50) × 109/L or higher (P < 0.05). Transfused patients had a longer hospital stay than non-transfused patients (2.08 vs. 6.4 days, P = 0.029). The strongest predictor for transfusion was the platelet count (odds ratio = 23, P = 0.008). LS in patients with very low platelet counts is feasible and reasonably safe, but the platelet count is a major determinant of morbidity. Every effort should be made to elevate platelet levels to >20 × 109/L before surgery. Patients with counts >20 × 109/L can safely undergo LS. Am. J. Hematol. 80:95,100, 2005. © 2005 Wiley-Liss, Inc. [source] Reduced insulin secretion in normoglycaemic patients with ,-thalassaemia majorDIABETIC MEDICINE, Issue 12 2006N. G. Angelopoulos Abstract Aims To assess insulin sensitivity and secretion in the fasting state in regularly transfused patients with ,-thalassaemia major with normal glucose response during an oral glucose tolerance test and to estimate its possible relation to iron overload. Methods We measured fasting glucose, insulin and C-peptide levels in 24 patients with ,-thalassaemia major and 18 control subjects matched for age and body mass index. Insulin sensitivity and insulin release index were calculated according to the homeostasis model assessment (HOMA). Correlations with age, body mass index and serum ferritin were also calculated. Results Fasting glucose levels in patients were increased compared with control subjects (5.5 ± 0.12 vs. 4.7 ± 0.13 mmol/l, mean ± sem, P < 0.001). Pancreatic B-cell insulin secretion in the fasting state (estimated by SCHOMA) was lower in thalassaemic patients (SCHOMA 88.5 ± 11.11 vs. 184.3 ± 23.72 in control subjects, P < 0.001). Patients were then divided into those with impaired (IFG) and normal (NFG) fasting glucose. SCHOMA was higher in the patients with NFG compared with those with IFG patients (110.6 ± 17.63 vs. 66.3 ± 10.88, respectively, P < 0.05) but estimated insulin sensitivity (ISIHOMA) was similar. Plasma values of C-peptide correlated positively with ferritin (r = 0.42, P = 0.04) and SCHOMA (r = 0.45, P = 0.02) and negatively with ISIHOMA (r = ,0.43, P = 0.03). Conclusions These results support the concept that impaired B-cell function, as reflected by a reduction in the insulin secretion index, is present in ,-thalassaemic patients with normoglycaemia before changes in oral glucose tolerance tests are apparent. [source] Factors affecting platelet yield and their impact on the platelet increment of patients receiving single donor PLT transfusion,JOURNAL OF CLINICAL APHERESIS, Issue 1 2007A. Aboul Enein Abstract The aim of this study was to analyze the impact of various donor and machine parameters on PLT yield in 127 PLT apheresis procedures, to optimize PLT yield achieving clinical and economic advantages. One hundred and twenty-seven apheresis procedures were analyzed. Age, gender, volume processed, Hb, and PLT precounts were included as donor predicting variables. AC infusion rate, processing time, and plasma volume collected with PLTs were assessed as machine parameters. We evaluated the post-transfusion effectiveness in 23 patients with thrombocytopenia, studying the effect of PLT dose, ABO group, and PLT storage time. Females gave higher yields, compared to males, P < 0.01. PLT yield correlated positively with PLT precount (r = 0.512), and TBV (r = 0.404), and negatively with donor preapheresis Hb (r = ,0.306). Processing time and AC infusion rate had a positive impact on PLT yield. Post-apheresis decrease in PLT count was 53.6 ± 26.3 × 1011. Donors with Hb , 12 g/dl, donated safely. Most of the complications were citrate related (13.4% of all procedures). PLT increments in transfused patients correlated positively with the number of units transfused (r = 0.41), and negatively with PLT storage days (r = ,0.342). PLT increments in patients receiving ABO-compatible PLTs were 75% higher, compared to the increments in patients receiving incompatible PLTs. PLT count and volume processed were the main predictors of PLT yield. Increasing the processing time, the AC infusion rate, or the volume of plasma obtained with PLTs can increase PLT yields. High PLT dose, short storage time, as well as ABO compatibility should be considered during PLT transfusion. J. Clin. Apheresis, 2007 © 2007 Wiley-Liss, Inc. [source] Nutritional deficiencies in iron overloaded patients with hemoglobinopathies,AMERICAN JOURNAL OF HEMATOLOGY, Issue 6 2009Susan Claster One of the hallmarks of both sickle cell disease (SCD) and thalassemia major (TM) is accelerated oxidative damage. Decreased antioxidant levels and increased oxidant stress biomarkers are found in both diseases. Although isolated vitamin deficiencies have been reported in TM and nontransfused SCD patients, a comprehensive evaluation of vitamin and trace mineral levels has never been performed in chronically transfused SCD or TM patients. As vitamins and trace minerals may be consumed as a result of chronic oxidative stress; we hypothesized that levels of these compounds would correlate with surrogates of iron overload, hemolysis, and inflammation in chronically transfused patients. Using a convenience sample of our group of chronically transfused patients we studied 43 patients with SCD (17 male, 26 female) and 24 patients with TM (13 male and 11 female). The age range for our patients varied from 1.5 to 31.4 years. Levels of vitamins A, thiamin, B6, B12, C, D, E as well as selenium, zinc, copper, and ceruloplasmin were measured. We found that 40,75% of the patients were deficient in A, C, D and selenium and 28,38% of the patients had low levels of B vitamins and folate. There was little association with iron overload, hemolysis, or inflammation. Although the precise mechanism of these deficiencies is unclear, they may contribute to the morbidity of chronically transfused hemoglobinopathy patients. Am. J. Hematol., 2009. © 2009 Wiley-Liss, Inc. [source] Avoiding Transfusion in Head and Neck Surgery: Feasibility Study of Erythropoietin,THE LARYNGOSCOPE, Issue 1 2000Erich M. Sturgis MD Abstract Objective: To determine the feasibility of perioperative erythropoietin to avoid blood transfusion in head and neck cancer surgery. Study Design: Retrospective chart review. Methods: Ninety-nine patients undergoing surgical resection of head and neck tumors at our institution were assessed for demographic data, nutritional parameters, tumor/surgical information, hematological/transfusion data, and contraindications to erythropoietin. Each transfusion was classified as to its appropriateness, and the potential benefit of erythropoietin was assessed in each patient. A cost analysis was also performed. Results: Most transfused patients (63%) received too many units. A subgroup at high risk of transfusion was identified who would benefit most from perioperative erythropoietin. Assuming that perioperative erythropoietin therapy is equivalent to the transfusion of 4 units, we estimate that the majority (74%) of transfused patients would not have required a transfusion if more stringent transfusion criteria were followed and those at high risk were given perioperative erythropoietin. Although the cost for transfusing 4 units is equivalent to that of a perioperative course of erythropoietin, the overall direct cost of erythropoietin treatment would actually have been more expensive. Conclusions: Perioperative erythropoietin therapy may be appropriate for a subgroup of head and neck cancer patients, but a prospective randomized controlled study in such a subgroup is needed to better define those most likely to benefit from it and to assess actual cost/benefit ratios. [source] Red blood cell transfusions and iron overload in the treatment of patients with myelodysplastic syndromesCANCER, Issue 5 2008Elias Jabbour MD Abstract BACKGROUND Approximately 15,000 new cases of myelodysplastic syndromes (MDS) are expected in the United States each year. METHODS The mainstay for the management of myelodysplastic syndromes (MDS) is supportive therapy with red blood cell (RBC) transfusions to improve the patient's quality of life. RBC transfusions enable adequate tissue oxygenation and increase hemoglobin levels, improve fatigue, and improve the physical and intellectual activity of patients. Up to 90% of patients with MDS will receive RBC transfusions during the course of their disease, and many will become chronically dependent on transfusions to manage their anemia. These transfusions lead to an accumulation of excess iron that, in turn, can develop into a condition known as iron overload, causing clinical consequences like hypertransaminasemia and cirrhosis, dilated cardiomyopathy, and progressive dysfunction of the endocrine glands. RESULTS Studies in patients with MDS have indicated that iron overload because of RBC transfusions was an independent, adverse prognostic factor for overall survival (OS) and leukemia-free survival (LFS): OS and LFS were significantly shorter in transfusion-dependent patients with MDS than in those who were not transfusion dependent. CONCLUSIONS Although the National Comprehensive Cancer Network guidelines for the treatment of patients with MDS recommend the use of RBC transfusions as supportive care, they further recommend that the iron burden of transfused patients be monitored regularly and that iron chelation therapy be considered to maintain serum ferritin levels of <1000 ng/mL. Cancer 2008. © 2008 American Cancer Society. [source] | ||||||||||