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Transfusion
Kinds of Transfusion Terms modified by Transfusion Selected AbstractsManagement of major blood loss: An updateACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2010P. I. JOHANSSON Haemorrhage remains a major cause of potentially preventable deaths. Trauma and massive transfusion are associated with coagulopathy secondary to tissue injury, hypoperfusion, dilution and consumption of clotting factors and platelets. Concepts of damage control surgery have evolved, prioritizing the early control of the cause of bleeding by non-definitive means, while haemostatic control resuscitation seeks early control of coagulopathy. Haemostatic resuscitation provides transfusions with plasma and platelets in addition to red blood cells (RBCs) in an immediate and sustained manner as part of the transfusion protocol for massively bleeding patients. Transfusion of RBCs, plasma and platelets in a similar proportion as in whole blood prevents both hypovolaemia and coagulopathy. Although an early and effective reversal of coagulopathy is documented, the most effective means of preventing coagulopathy of massive transfusion remains debated and randomized controlled studies are lacking. Results from recent before-and-after studies in massively bleeding patients indicate that trauma exsanguination protocols involving the early administration of plasma and platelets are associated with improved survival. Furthermore, viscoelastic whole blood assays, such as thrombelastography (TEG)/rotation thromboelastometry (ROTEM), appear advantageous for identifying coagulopathy in patients with severe haemorrhage, as opposed to conventional coagulation assays. In our view, patients with uncontrolled bleeding, regardless of its cause, should be treated with goal-directed haemostatic control resuscitation involving the early administration of plasma and platelets and based on the results of the TEG/ROTEM analysis. The aim of the goal-directed therapy should be to maintain a normal haemostatic competence until surgical haemostasis is achieved, as this appears to be associated with reduced mortality. [source] Blood group antigens and immune responses,detailed knowledge is necessary to prevent immunization and to follow up immunized individualsISBT SCIENCE SERIES: THE INTERNATIONAL JOURNAL OF INTRACELLULAR TRANSPORT, Issue n1 2010A. Husebekk Background The immune system is educated to detect and react with foreign antigens and to tolerate self-antigen. Transfusion of blood cells and plasma and pregnancies challenge the immune system by the introduction of foreign antigens. The antigens may cause an immune response, but in many instances this is not the case and the individual is not immunised after exposure of blood group antigens. Aims The aim of the presentation is to dissect some immune responses to blood group antigens in order to understand the mechanism of immunisation. Methods The results of immune responses to blood group antigens can be detected by the presence of antibodies to the antigens. If the antibodies are of IgG class, the activated B cells have received help from antigen specific T cells. Both antibodies, B cells and T cells can be isolated from immunised individuals and studied in the laboratory. Also B-cell receptors and T-cell receptors as well as MHC molecules on antigen presenting cells can be studied and models of the immune synapses can be created in vitro. Results The most classic immune responses in transfusion medicine and in incompatible pregnancies are immune responses to the RhD antigen on red cells, HLA class I molecules on white cells and platelets and human platelet antigens. The nature of these antigens are different; RhD antigens are part of a large complex, present on red cells from RhD positive individuals and completely lacking on red cells from RhD negative individuals. It is likely that many peptides derived from this antigen complex may stimulate T cells and B cells. HLA antigens are highly polymorphic and the antigens are known to induce strong alloimmune responses. The HPA antigens are created by one amino acid difference in allotypes based on a single nucleotide polymorphism at the genetic level. HPA 1a induce immune responses in 10% of HPA 1b homozygote pregnant women. The result of these immune responses is destruction of blood cells with clinical consequences connected to the effect of transfusions or the outcome of pregnancies. Summary/Conclusions Even though there is emerging knowledge about the immune responses to some of the blood group antigens, more information must be gained in order to understand the complete picture. The action of the innate immune response initiating the adaptive immune response to blood group antigens is not well understood. A detailed understanding of both the innate ad the adaptive part of the immune response is necessary to identify individuals at risk for immunisation and to prevent immunisation to blood group antigens. [source] Transfusion in resource-limited countriesISBT SCIENCE SERIES: THE INTERNATIONAL JOURNAL OF INTRACELLULAR TRANSPORT, Issue 1 2008J. C. Emmanuel [source] International Society of Blood Transfusion: The Platelet Immunobiology Working PartyISBT SCIENCE SERIES: THE INTERNATIONAL JOURNAL OF INTRACELLULAR TRANSPORT, Issue 1 2008C. Kaplan [source] International Society Blood Transfusion Working Party on information technologyISBT SCIENCE SERIES: THE INTERNATIONAL JOURNAL OF INTRACELLULAR TRANSPORT, Issue 1 2008P. Bruce The aims and goals of the International Society Blood Transfusion Working Party on Information Technology (WPIT) are to define and promote strategies on using ITs for transfusion medicine and related areas considering usability, implementability, financial and business impacts. The focus is on new, emerging ITs and their applicability. The active topics involve radio-frequency identification applications, interfacing equipment and IT systems, and automated system validation. [source] Controversy concerning platelet doseISBT SCIENCE SERIES: THE INTERNATIONAL JOURNAL OF INTRACELLULAR TRANSPORT, Issue 1 2007N. M. Heddle The highest level of support for evidence based decisions is the randomized controlled trial (RCT); however, RCT results are only useful if the study has strong internal and external validity. There have been a number of clinical trials that have addressed the issue of the optimal platelet dose; however, none of these studies have provided definitive data on the optimal platelet dose due to a variety of methodological issues associated with the study designs. Currently two randomized controlled trials have been implemented to address the issue of optimal platelet dose. The results of these trials will not be available until 2007,2008. The BEST (Biomedical Excellence for Safer Transfusion) Collaborative has initiated a platelet dose study comparing the frequency of WHO bleeding Grade 2 with low and standard dose platelets. The Transfusion Medicine/ Haemostasis Clinical Trials Network (CTN) is also performing a platelet dose study comparing three treatment strategies (high, standard and low dose platelets). There were numerous methodological issues that had to be considered when designing these two studies. More recently some European investigators have questioned the need for prophylactic platelet transfusions and several studies are currently underway to investigate the efficacy of changing this practice. [source] Successful rotational thromboelastometry-guided treatment of traumatic haemorrhage, hyperfibrinolysis and coagulopathyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2010M. BRENNI Transfusion of allogeneic blood products is associated with increased morbidity and mortality. Therefore, strategies for reducing transfusion of these products during trauma management are valuable. We report a case of severe blunt abdominal trauma, successfully treated with antifibrinolytic medication and fibrinogen concentrate. Rotational thromboelastometry (ROTEM) was used to identify hyperfibrinolysis and afibrinogenaemia. In order to achieve haemostasis, over a 3-h period, the patient received a total of 1 g of tranexamic acid, 7 U of packed red blood cells, 16 g of fibrinogen concentrate (Haemocomplettan P), 3500 ml of colloids and 5500 ml of lactated Ringer's solution. Together with surgical measures, this treatment stopped the bleeding and stabilised the patient. There was no transfusion of either fresh-frozen plasma or platelets. The limited need for allogeneic blood products is of particular interest, and clinical studies of the approach used here appear to be warranted. [source] Administration of blood transfusions to adults in general hospital settings: a review of the literatureJOURNAL OF CLINICAL NURSING, Issue 2 2001Dip N Ed, John Wilkinson BSc ,,The Serious Hazards of Transfusion (SHOT) haemovigilance scheme for the United Kingdom and Republic of Ireland has clearly indicated that there are avoidable risks to which recipients of blood transfusion are exposed. ,,Sometimes errors in practice have led to serious and even fatal consequences, particularly when a haemolytic response occurs due to an incompatible transfusion. ,,Despite the risks, blood transfusion is an important and frequently life-saving therapy and its use in clinical practice is common. ,,This paper discusses recently published national guidelines for the care of recipients of blood transfusion in the light of a review of the literature relevant to the administration of blood transfusions to adults in general hospital settings. ,,Recommendations for practitioners, managers and teachers are offered in relation to preventing errors and to patient care associated with blood transfusion in the context of contemporary emphasis upon evidence based care. [source] Transfusion in premature infants impairs production and/or release of red blood cells, white blood cells and plateletsJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 3 2002B Frey Objective: To examine whether red blood cell transfusion in infants with anaemia of prematurity alters peripheral counts of red blood cell precursors, total white blood cells and white cell differential and platelets. Methodology: In 18 consecutive stable premature infants with anaemia of prematurity, peripheral cell counts were prospectively recorded immediately before transfusion of 20 mL/kg packed red blood cells (given over 6 h), and at 48 h after completion of the transfusion. Results: The median (interquartile range) haematocrit increased from 22.0% (21.3,24.0%) pre-transfusion to 37.0% (36.0,38.0%) post-transfusion (P < 0.001). Red-cell precursors decreased: median (interquartile range) reticulocytes from 3.7% (3.0,7.7%) to 3.7% (2.6,4.1%) (P = 0.03); and median (interquartile range) nucleated red blood cells from 0 G/L (0,0.2 G/L) to 0 G/L (0,0 G/L) (P = 0.03). The mean (SD) platelet count decreased from 420 G/L (154 G/L) to 313 G/L (101 G/L) (P = 0.001). The total white blood cell count and neutrophils did not change significantly; however, median (interquartile range) immature neutrophils decreased from 0.12 G/L (0.06,0.74 G/L) to 0.08 G/L (0.01,0.24 G/L) (P = 0.03). Lymphocytes, eosinophils, basophils and plasma cells remained unchanged. Monocytes increased (P = 0.01). Conclusions: Forty-eight hours after red blood cell transfusion to premature infants, there is an absolute decrease in red blood cell precursors, immature white blood cells and platelets, probably due to erythropoietin-suppression. [source] Post-transfusion white cell count in the sick preterm neonateJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1 2001IMR Wright Objective: A previous report demonstrated post-transfusion leucocytosis as a potential confounding factor in the diagnosis of sepsis in critically ill adult patients. In We wished to establish if the same phenomenon occurred in the sick preterm neonate and whether this significantly altered the indices considered for potential neonatal infection. Methodology: Transfusion and full blood count data in a level 3 neonatal intensive care unit were prospectively recorded for 3 months. Results: One hundred and fourteen transfusion events were recorded from 37 infants. Median white blood cell count increased 0.9 × 109/L (confidence interval (CI) 0.4,2.4) in the first 8 h following transfusion (P = 0.032). Median neutrophil count increased by 0.4 × 109/L (CI 0.1,1.7) in the same 8 h (P = 0.05). Median neutrophil left shift decreased 1.2% (CI 1.1,5.8%) over the 24 h post-transfusion. No change in band count was observed. Conclusions: A mild post-transfusion white cell increase occurs in sick neonates. Because of the magnitude of effect, it is unlikely that this interesting physiological response would interfere with the diagnosis of sepsis in this population. [source] Serum IgG Concentrations after Intravenous Serum Transfusion in a Randomized Clinical Trial in Dairy Calves with Inadequate Transfer of Colostral ImmunoglobulinsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2010M. Chigerwe Background: Plasma transfusions have been used clinically in the management of neonates with failure of passive transfer. No studies have evaluated the effect of IV serum transfusions on serum IgG concentrations in dairy calves with inadequate transfer of passive immunity. Hypothesis: A commercially available serum product will increase serum immunoglobulin concentration in calves with inadequate transfer of colostral immunoglobulins. Animals: Thirty-two Jersey and Jersey-Holstein cross calves with inadequate colostral transfer of immunoglobulins (serum total protein <5.0 g/L). Methods: Thirty-two calves were randomly assigned to either control (n = 15) or treated (n = 17) groups. Treated calves received 0.5 L of a pooled serum product IV. Serum IgG concentrations before and after serum transfusion were determined by radial immunodiffusion. Results: Serum protein concentrations increased from time 0 to 72 hours in both control and transfused calves and the difference was significant between the control and treatment groups (P < .001). Mean pre- and posttreatment serum IgG concentrations in control and transfused calves did not differ significantly. Median serum IgG concentrations decreased from 0 to 72 hours by 70 mg/dL in control calves and increased over the same time interval in transfused calves by 210 mg/dL. The difference was significant between groups (P < .001). The percentage of calves that had failure of immunoglobulin transfer 72 hours after serum transfusion was 82.4%. Conclusions and Clinical Importance: Serum administration at the dosage reported did not provide adequate serum IgG concentrations in neonatal calves with inadequate transfer of colostral immunoglobulins. [source] Use of recombinant factor VIIa for uncontrolled bleeding in neonates after cardiopulmonary bypassPEDIATRIC ANESTHESIA, Issue 4 2009NINA A. GUZZETTA MD Summary Background:, Increasingly, recombinant activated factor VII (rFVIIa) is used adjunctively in nonhemophiliacs to control hemorrhage unresponsive to conventional therapy in a variety of settings including postcardiopulmonary bypass (CPB). Studies examining rFVIIa administration to neonates after CPB are limited. The goal of this study was to evaluate retrospectively the clinical outcomes of neonates treated at our institution with rFVIIa for uncontrolled post-CPB bleeding. Methods:, We retrospectively identified eight neonates undergoing complex congenital cardiac surgery who received rFVIIa, either intraoperatively or postoperatively, for uncontrolled post-CPB bleeding. Transfusion trends and prothrombin times (PT) were assessed both pre- and post-rFVIIa administration. Chest tube drainage volumes were recorded pre- and post-rFVIIa administration in those neonates receiving rFVIIa postoperatively in the intensive care unit. We documented such adverse events as thrombosis, dialysis (hemodialysis and peritoneal dialysis), extracorporeal membrane oxygenation (ECMO) and in-hospital mortality. Results:, The mean amount of transfused packed red blood cells, platelets and fresh frozen plasma decreased significantly after the administration of rFVIIa. Transfusion of cryoprecipitate trended towards a decrease but did not reach statistical significance. PT values also decreased significantly after the administration of rFVIIa. A high mortality was found in neonates exposed to both rFVIIa and ECMO; however, this was not significantly different from the mortality of neonates exposed to ECMO alone. Conclusions:, Administration of rFVIIa to neonates for the treatment of uncontrolled post-CPB bleeding significantly reduced transfusion requirements and normalized PT values. Future randomized, controlled trials are needed to evaluate the potential hemostatic benefit and adverse effects of rFVIIa administration to neonates following CPB. [source] A trial of fresh autologous whole blood to treat dilutional coagulopathy following cardiopulmonary bypass in infantsPEDIATRIC ANESTHESIA, Issue 4 2006ROBERT H. FRIESEN MD Summary Background:, Transfusion of fresh whole blood is superior to blood component therapy in correcting coagulopathies in children following cardiopulmonary bypass (CPB); however, a supply of fresh homologous whole blood is difficult to maintain. We hypothesized that transfusion of fresh autologous whole blood obtained prior to heparinization for CPB and infused following CPB would be associated with improved coagulation function when compared with standard therapy. Methods:, A total of 32 infants 5,12 kg undergoing noncomplex open cardiac surgery were randomly assigned to either the treatment or control group. In the treatment group, 15 ml·kg,1 of autologous whole blood was collected into a CPDA bag prior to heparinization while 15 ml·kg,1 of 5% albumin was infused intravenously. After reversal of heparin, coagulation tests were drawn in both groups, and the autologous whole blood was infused over 20 min in the treatment group. Results:, The treatment group had greater (P < 0.05) improvement in platelet count, prothrombin time, and fibrinogen than the control group. Conclusions:, We conclude that collection of fresh autologous whole blood prior to heparinization and reinfusion following CPB is associated with greater improvement of coagulation status after CPB in infants. [source] Urinary hepcidin in congenital chronic anemiasPEDIATRIC BLOOD & CANCER, Issue 1 2007Susan L. Kearney MD Abstract Background Hepcidin, a regulator for iron homeostasis, is induced by inflammation and iron burden and suppressed by anemia and hypoxia. This study was conducted to determine the hepcidin levels in patients with congenital chronic anemias. Procedure Forty-nine subjects with anemia, varying degrees of erythropoiesis and iron burden were recruited. Eight children with immune thrombocytopenia were included as approximate age-matched controls. Routine hematologic labs and urinary hepcidin (uhepcidin) levels were assessed. For thalassemia major (TM) patients, uhepcidin was obtained pre- and post-transfusion. Results In TM, uhepcidin levels increased significantly after transfusion, demonstrated wide variance, and the median did not significantly differ from controls or thalassemia intermedia (TI). In both thalassemia syndromes, the hepcidin to ferritin ratio, a marker of the appropriateness of hepcidin expression relative to the degree of iron burden, was low compared to controls. In TI and sickle cell anemia (SCA), median uhepcidin was low compared to controls, P,=,0.013 and <0.001, respectively. In thalassemia subjects, uhepcidin levels were positively associated with ferritin. In subjects with SCA, uhepcidin demonstrated a negative correlation with reticulocyte count. Conclusions This study examines hepcidin levels in congenital anemias. In SCA, hepcidin was suppressed and inversely associated with erythropoietic drive. In thalassemic syndromes, hepcidin was suppressed relative to the degree of iron burden. Transfusion led to increased uhepcidin. In thalassemia, the relative influence of known hepcidin modifiers was more difficult to assess. In thalassemic syndromes where iron overload and anemia have opposing effects, the increased erythropoietic drive may positively influence hepcidin production. Pediatr Blood Cancer 2007;48:57,63. © 2005 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] Portal Venous Donor-Specific Transfusion in Conjunction with Sirolimus Prolongs Renal Allograft Survival in Nonhuman PrimatesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 1 2009K. K. Dhanireddy Pretransplant exposure to donor antigen is known to modulate recipient alloimmunity, and frequently results in sensitization. However, donor-specific transfusion (DST) can have a protolerant effect that is dependent on route, dose and coadministered immunosuppression. Rodent studies have shown in some strain combinations that portal venous (PV) DST alone can induce tolerance, and uncontrolled clinical use of PVDST has been reported. In order to determine if pretransplant PVDST has a clinically relevant salutary effect, we studied it and the influence of concomitant immunosuppression in rhesus monkeys undergoing renal allotransplantation. Animals received PVDST with unfractionated bone marrow and/or tacrolimus or sirolimus 1 week prior to transplantation. Graft survival was assessed without any posttransplant immunosuppression. PVDST alone or in combination with tacrolimus was ineffective. However, PVDST in combination with sirolimus significantly prolonged renal allograft survival to a mean of 24 days. Preoperative sirolimus alone had no effect, and peripheral DST with sirolimus prolonged graft survival in 2/4 animals, but resulted in accelerated rejection in 2/4 animals. These data demonstrate that PVDST in combination with sirolimus delays rejection in a modest but measurable way in a rigorous model. It may thus be a preferable method for donor antigen administration. [source] Transfusion for trauma in AustraliaANAESTHESIA, Issue 11 2009M. Maguire No abstract is available for this article. [source] Transfusion for trauma: the French army policyANAESTHESIA, Issue 10 2009S. Ausset No abstract is available for this article. [source] Transfusion for trauma: civilian lessons from the battlefield?ANAESTHESIA, Issue 5 2009P. Moor First page of article [source] Transfusion is associated with increased colorectal cancer recurrence ratesANZ JOURNAL OF SURGERY, Issue 10 2009FANZCA, Roger Browning MBChB, Staff Specialist No abstract is available for this article. [source] Impact of Transfusion of Fresh-frozen Plasma and Packed Red Blood Cells in a 1:1 Ratio on Survival of Emergency Department Patients with Severe TraumaACADEMIC EMERGENCY MEDICINE, Issue 5 2009Shahriar Zehtabchi MD Abstract Objectives:, Coagulopathy is common after severe trauma and occurs very early after the initial insult. Some investigators have suggested early and aggressive treatment of the trauma-induced coagulopathy by transfusion of fresh-frozen plasma (FFP) and packed red blood cells (PRBC) in a 1:1 ratio. This evidence-based emergency medicine (EBM) review evaluates the evidence regarding the impact of 1:1 ratio of FFP:PRBC transfusion on survival of emergency department (ED) patients with severe trauma. Methods:, The MEDLINE, EMBASE, Cochrane Library, and other databases were searched. Studies were selected for inclusion if they included trauma patients who required blood transfusion. The outcome measures of interest included mortality and adverse effects of high FFP:PRBC ratios. For comparison, the patients were classified into high ratio (1:1, defined as a ratio of 1:,1.5) and low ratio (1:>1.5) groups. Results:, The authors did not identify any randomized controlled trials (RCT), but included four observational studies (three retrospective registry and one prospective cohort studies), which enrolled 1,511 patients cumulatively. One study found a statistically significant difference in mortality rate, favoring high FFP:PRBC ratio (relative risk = 0.72, 95% confidence interval [CI] = 0.59 to 0.89), while three studies showed no benefits. One study reported higher rates of sepsis and single/multiorgan failure (MOF), and another study revealed a higher risk of nosocomial infections and acute respiratory distress syndrome (ARDS) in the high FFP:PRBC ratio group. Conclusion:, Three retrospective registry reviews with suboptimal methodologies and one prospective cohort study provide inadequate evidence to support or refute the use of a high FFP:PRBC ratio in patients with severe trauma. [source] Management of blunt injuries to the spleenBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 11 2010P. Renzulli Background: Non-operative management (NOM) of blunt splenic injuries is nowadays considered the standard treatment. The present study identified selection criteria for primary operative management (OM) and planned NOM. Methods: All adult patients with blunt splenic injuries treated at Berne University Hospital, Switzerland, between 2000 and 2008 were reviewed. Results: There were 206 patients (146 men) with a mean(s.d.) age of 38·2(19·1) years and an Injury Severity Score of 30·9(11·6). The American Association for the Surgery of Trauma classification of the splenic injury was grade 1 in 43 patients (20·9 per cent), grade 2 in 52 (25·2 per cent), grade 3 in 60 (29·1 per cent), grade 4 in 42 (20·4 per cent) and grade 5 in nine (4·4 per cent). Forty-seven patients (22·8 per cent) required immediate surgery. Transfusion of at least 5 units of red cells (odds ratio (OR) 13·72, 95 per cent confidence interval 5·08 to 37·01), Glasgow Coma Scale score below 11 (OR 9·88, 1·77 to 55·16) and age 55 years or more (OR 3·29, 1·07 to 10·08) were associated with primary OM. The rate of primary OM decreased from 33·3 to 11·9 per cent after the introduction of transcatheter arterial embolization in 2005. Overall, 159 patients (77·2 per cent) qualified for NOM, which was successful in 143 (89·9 per cent). The splenic salvage rate was 69·4 per cent. In multivariable analysis age at least 40 years was the only factor independently related to failure of NOM (OR 13·58, 2·76 to 66·71). Conclusion: NOM of blunt splenic injuries has a low failure rate. Advanced age is independently associated with an increased failure rate. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Recurrence of kernicterus in term and near-term infants in DenmarkACTA PAEDIATRICA, Issue 10 2000F Ebbesen Classical acute bilirubin encephalopathy (kernicterus) in term and near-term infants had not been seen in Denmark for at least 20 y until 1994. From 1994 to 1998, however, six cases were diagnosed. Aetiology of the hyperbilirubinaemia was known in two infants; spherocytosis and galactosaemia, most likely known in two infants; possible A-O blood type immunization, and unknown in two infants. However, one of these last-mentioned infants had a gestational age of only 36 wk. The maximum plasma total bilirubin concentrations were 531,745 ,mol/L. The increase in the number of cases of kernicterus was considered to have been caused by: (i) a decreased awareness of the pathological signs, (ii) a change in the assessment of the risk of bilirubin encephalopathy, (iii) early discharge of the infants from the maternity ward, (iv) so-called breastfeeding-associated jaundice, (v) demonstration of bilirubin being an antioxidant, and (vi) difficulty in estimating the degree of jaundice in certain groups of immigrants. Accordingly, for prevention: (a) Attempt to change the healthcare workers' understanding of the risk of bilirubin encephalopathy, (b) give further instructions, both orally and in writing, to mothers before discharge from the maternity ward, (c) be more liberal in giving infant formula supplements, (d) conduct home visits by the community nurse at an earlier stage, (e) follow authorized guidelines for phototherapy and exchange transfusion, (f) lower plasma bilirubin concentration limits as an indication for phototherapy and exchange transfusion, (g) screen all term and near-term infants, and (h) measure the skin's yellow colour with a device that corrects for the skin's melanin content. Conclusions: Audit of the six cases presented indicates that measures are necessary in both the primary and secondary healthcare sectors if the risk of kernicterus is to be avoided. Screening may be considered, but in order to identify the problems it would first be reasonable to perform a larger prospective study in which audit is performed on all newborn infants, born at term and near-term, who develop a plasma bilirubin concentration above the exchange transfusion limit. [source] Effect of Normal Saline Infusion on the Diagnostic Utility of Base Deficit in Identifying Major Injury in Trauma PatientsACADEMIC EMERGENCY MEDICINE, Issue 12 2006Richard Sinert DO Abstract Background Base deficit (BD) is a reliable marker of metabolic acidosis and is useful in gauging hemorrhage after trauma. Resuscitation with chloride-rich solutions such as normal saline (NS) can cause a dilutional acidosis, possibly confounding the interpretation of BD. Objectives To test the diagnostic utility of BD in distinguishing minor from major injury after administration of NS. Methods This was a prospective observational study at a Level 1 trauma center. The authors enrolled patients with significant mechanism of injury and measured BD at triage (BD-0) and at four hours after triage (BD-4). Major injury was defined by any of the following: injury severity score of ,15, drop in hematocrit of ,10 points, or the patient requiring a blood transfusion. Patients were divided into a low-volume (NS < 2L) and a high-volume (NS , 2L) group. Data were reported as mean (±SD). Student's t- and Wilcoxon tests were used to compare data. Receiver operating characteristic (ROC) curves tested the utility of BD-4 in differentiating minor from major injury in the study groups. Results Four hundred eighty-nine trauma patients (mean age, 36 [± 18] yr) were enrolled; 82% were male, and 34% had penetrating injury. Major-(20%) compared with minor-(80%) injury patients were significantly (p = 0.0001) more acidotic (BD-0 mean difference: ,3.3 mmol/L; 95% confidence interval [CI] =,2.5 to ,4.2). The high-volume group (n = 174) received 3,342 (±1,821) mL, and the low-volume group (n = 315) received 621 (±509) mL of NS. Areas under the ROC curves for the high-volume (0.63; 95% CI = 0.52 to 0.74) and low-volume (0.73; 95% CI = 0.60 to 0.86) groups were not significantly different from each other. Conclusions Base deficit was able to distinguish minor from major injury after four hours of resuscitation, irrespective of the volume of NS infused. [source] The Risk of Intra-abdominal Injuries in Pediatric Patients with Stable Blunt Abdominal Trauma and Negative Abdominal Computed TomographyACADEMIC EMERGENCY MEDICINE, Issue 5 2010Jeffrey Hom MD Abstract Objectives:, This review examines the prevalence of intra-abdominal injuries (IAI) and the negative predictive value (NPV) of an abdominal computed tomography (CT) in children who present with blunt abdominal trauma. Methods:, MEDLINE, EMBASE, and Cochrane Library databases were searched. Studies were selected if they enrolled children with blunt abdominal trauma from the emergency department (ED) with significant mechanism of injury requiring an abdominal CT. The primary outcome measure was the rate of IAI in patients with negative initial abdominal CT. The secondary outcome measure was the number of laparotomies, angiographic embolizations, or repeat abdominal CTs in those with negative initial abdominal CTs. Results:, Three studies met the inclusion criteria, comprising a total of 2,596 patients. The overall rate of IAI after a negative abdominal CT was 0.19% (95% confidence interval [CI] = 0.08% to 0.44%). The overall NPV of abdominal CT was 99.8% (95% CI = 99.6% to 99.9%). There were five patients (0.19%, 95% CI = 0.08% to 0.45%) who required additional intervention despite their initial negative CTs: one therapeutic laparotomy for bowel rupture, one diagnostic laparotomy for mesenteric hematoma and serosal tear, and three repeat abdominal CTs (one splenic and two renal injuries). None of the patients in the latter group required surgery or blood transfusion. Conclusions:, The rate of IAI after blunt abdominal trauma with negative CT in children is low. Abdominal CT has a high NPV. The review shows that it might be safe to discharge a stable child home after a negative abdominal CT. ACADEMIC EMERGENCY MEDICINE 2010; 17:469,475 © 2010 by the Society for Academic Emergency Medicine [source] SPLENIC RUPTURE FOLLOWING ROUTINE COLONOSCOPYDIGESTIVE ENDOSCOPY, Issue 4 2010Tabraze Rasul Splenic rupture is a life-threatening condition characterized by internal hemorrhage, often difficult to diagnose. Colonoscopy is a gold standard routine diagnostic test to investigate patients with gastrointestinal symptoms as well as to those on the screening program for colorectal cancer. Splenic injury is seldomly discussed during consent for colonoscopy, as opposed to colonic perforation, as its prevalence accounts for less than 0.1%. A 66-year-old Caucasian woman with no history of collagen disorder was electively admitted for routine colonoscopy for surveillance of adenoma. She was admitted following the procedure for re-dosing of warfarin, which was stopped prior to the colonoscopy. The patient was found collapsed on the ward the following day with clinical shock and anemia. Computed tomography demonstrated grade 4 splenic rupture. Immediate blood transfusion and splenectomy was required. Splenic rupture following routine colonoscopy is extremely rare. Awareness of it on this occasion saved the patient's life. Despite it being a rare association, the seriousness warrants inclusion in all information leaflets concerning colonoscopy and during its consent. [source] Hemispheric Surgery in Children with Refractory Epilepsy: Seizure Outcome, Complications, and Adaptive FunctionEPILEPSIA, Issue 1 2007Sheikh Nigel Basheer Summary:,Purpose: To describe seizure control, complications, adaptive function and language skills following hemispheric surgery for epilepsy. Methods: Retrospective chart review of patients who underwent hemispheric surgery from July 1993 to June 2004 with a minimum follow-up of 12 months. Results: The study population comprised 24 children, median age at seizure onset six months and median age at surgery 41 months. Etiology included malformations of cortical development (7), infarction (7), Sturge-Weber Syndrome (6), and Rasmussen's encephalitis (4). The most frequent complication was intraoperative bleeding (17 transfused). Age <2 yr, weight <11 kg, and hemidecortication were risk factors for transfusion. Postoperative complications included aseptic meningitis (6), and hydrocephalus (3). At median follow-up of 7 yr, 79% of patients are seizure free. Children with malformations of cortical development and Rasmussen's encephalitis were more likely to have ongoing seizures. Overall adaptive function scores were low, but relative strengths in verbal abilities were observed. Shorter duration of epilepsy prior to surgery was related significantly to better adaptive functioning. Conclusions: Hemispheric surgery is an effective therapy for refractory epilepsy in children. The most common complication was bleeding. Duration of epilepsy prior to surgery is an important factor in determining adaptive outcome. [source] Evaluation of the genetic basis of phenotypic heterogeneity in north Indian patients with Thalassemia majorEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 6 2010Nidhi Sharma Abstract Objectives: To assess the molecular basis of phenotypic heterogeneity in north Indian patients with thalassemia major (TM). Methods: To determine the clinical severity, 130 patients of TM were studied for the age of first presentation and frequency of blood transfusion. The type of beta mutations, Xmn,1G, polymorphism and G6PD Mediterranean mutation was characterized. Analysis of the phenotypic presentation and the genotype was performed. Results: Majority (83.8%) presented before 1 year of age (mean 8.8 months). The caste distribution showed 41.6% were Aroras and 32.3% were migrants from Pakistan. IVS1-5(G,C) was commonest (32.7%) and the common five Indian mutations comprised of 88.4% of alleles. The mean age of presentation with IVS1-5(G,C), Fr 8/9, (+G) 619-bp del and IVS1-1(G,T) homozygosity was 4.3, 6, 3.4 and 9.1 months respectively. Xmn,1G, status showed ,/, in 66.9%, +/, in 26.1% and +/+ in 6.9% patients. Xmn,1G,,/, presented before 1 year of age. The mean age of presentation with +/+ was 18.3 months. Six hemizygous boys and one heterozygous girl with G6PD Mediterranean were found (prevalence 5.3%). Eight patients could be reclassified as thalassemia intermedia on follow up. Conclusions: This study showed that majority of TM in north India present before 1 year of age and homozygous 619-bp deletion presents the earliest. The presence of Xmn-1G, polymorphism delays the presentation, is associated with the IVS 1-1 (G,T) and shows variable improvement with hydroxyurea therapy. Based on the results of genotyping, reevaluation of patients can improve the outcome in a few patients. [source] Heart rate variability in beta-thalassemia patientsEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 5 2009Wasarut Rutjanaprom Abstract Background:, Cardiac failure remains the major cause of death in beta-thalassemia major (TM). Reduced heart rate variability (HRV) is associated with a higher risk of arrhythmias after myocardial infarction and heart failure. We evaluated HRV in TM patients and its relationship with hemodynamics and echocardiographic parameters during a 6-month follow-up. Methods:, Thirty-four TM patients (19 ± 10 yr) and 20 healthy subjects (17 ± 6 yr) were evaluated. Hematologic, biochemical, echocardiographic and HRV parameters were determined at entry and at 6-month follow-up. Time and frequency domain HRV parameters were analyzed from 24-h recorded electrocardiograms. All TM patients received blood transfusion and chelation therapy. Results:, Both time and frequency domain HRV parameters were markedly reduced in TM patients, compared to the control. The significantly improved HRV was seen in correlation with higher hemoglobin (Hb) level when compared within TM group at different time point. No correlation was seen between HRV and serum ferritin, reactive oxygen species (ROS) and non-transferrin bound iron (NTBI). Conclusion:, HRV is depressed in TM patients. HRV was significantly correlated with Hb level, suggesting that anemia greatly influences the cardiac autonomic balance. [source] Bernard Soulier syndrome in pregnancy: a systematic reviewHAEMOPHILIA, Issue 4 2010P. PEITSIDIS Summary., Bernard Soulier syndrome (BSS) is a rare disorder of platelets, inherited mainly as an autosomal recessive trait. It is characterised by qualitative and quantitative defects of the platelet membrane glycoprotein (GP) Ib-IX-V complex. The main clinical characteristics are thrombocytopenia, prolonged bleeding time and the presence of giant platelets. Data on the clinical course and outcome of pregnancy in women with Bernard Soulier syndrome is scattered in individual case reports. In this paper, we performed a systematic review of literature and identified 16 relevant articles; all case reports that included 30 pregnancies among 18 women. Primary postpartum haemorrhage was reported in 10 (33%) and secondary in 12 (40%) of pregnancies, requiring blood transfusion in 15 pregnancies. Two women had an emergency obstetric hysterectomy. Alloimmune thrombocytopenia was reported in 6 neonates, with one intrauterine death and one neonatal death. Bernard Soulier syndrome in pregnancy is associated with a high risk of serious bleeding for the mother and the neonate. A multidisciplinary team approach and individualised management plan for such women are required to minimise these risks. An international registry is recommended to obtain further knowledge in managing women with this rare disorder. 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