Transfusion alternatives in transfusion medicine : TATM最新文献

{"title":"Removal of iron dextran (Cosmofer®) during hemodialysis","authors":"Yuqing Chen, Mei Wang","doi":"10.1111/J.1778-428X.2007.00078.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2007.00078.X","url":null,"abstract":"SUMMARY \u0000 \u0000 \u0000Intravenous iron dextran is widely used in hemodialysis patients receiving erythropoietin (EPO) therapy because of its significant convenience in clinical practice. However, the amount of iron removed by hemodialysis in vivo is unknown. The purpose of this study was to measure the removal of iron dextran in patients undergoing hemodialysis. Six patients were enrolled in this study. All were stable patients treated by hemodialysis for at least 1 month. Both F6 (polysulphone membrane) and GFSplus12 (hemophane membrane) dialyzers were used sequentially in each patient. Each patient received 2 mL of low-molecular-weight iron dextran (Cosmofer® aktieselskab/aksjeselskap and supplied by Zhuhai Schwarz Pharma Company Ltd) intravenously, containing 100 mg of elemental iron, administered during the second hour of dialysis over 30 to 60 minutes. A baseline sample of fresh dialysate was collected before the commencement of dialysis. A control sample of spent dialysate was collected during the first hour of dialysis, before the infusion of low-molecular-weight iron dextran. Then, all spent dialysate after the iron dextran infusion until the end of dialysis was collected. The samples were treated with lanthanum nitrate solution, and the iron content was measured using an atomic-absorptive spectrum method. The iron concentration in the control group was 4.31 ± 2.55 µg/L. After the infusion of iron dextran, the iron concentration in the spent dialysate increased significantly, irrespective of whether an F6 or GFSplus12 dialyzer was used. However, the amount of iron eliminated through the dialyzer was minimal, less than 3% of the infusion dose. There was no significant difference in removal of iron through either the F6 or GFSplus12 dialyzer. These results indicate that the removal of iron dextran by hemodialysis when using either a polysulfphone or hemophane membrane dialyzer is negligible. It is time-efficient and convenient to administer low-molecular-weight iron dextran during hemodialysis.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2007.00078.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63388971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transfusion-attributable acute respiratory distress syndrome, hospital utilization and costs in the USA: a model simulation","authors":"M. Zilberberg","doi":"10.1111/J.1778-428X.2007.00087.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2007.00087.X","url":null,"abstract":"SUMMARY \u0000 \u0000 \u0000There are nearly 150,000 acute respiratory distress syndrome (ARDS) admissions in the USA, annually incurring 2.7 million hospital days. Although packed red blood cell (pRBC) transfusions increase the risk of developing ARDS, nearly one-half of intensive care unit (ICU) patients receive pRBCs. The rate of transfusion-attributable ARDS remains unknown. I estimated this annual rate, and the hospital utilization and costs in the USA. A model utilizing inputs from publicly available sources was constructed. Step 1 calculated the at-risk population. In step 2, the proportion of ARDS cases attributable to pRBC transfusion was estimated. Step 3 computed excess annual ARDS cases related to transfusion. Step 4 quantified hospital utilization and costs. Of 141,500 annual ARDS cases, 86,315 (61%) comprised at-risk population. Of those, 20% (n = 16,980) were estimated to be attributable to pRBCs, or 12% of all ARDS. In base-case analysis, using median hospital length of stay of 14 days and mean cost of $31,846 per case, aggregate annualized hospital days and costs were 237,720 and $599,241,180, respectively. This model demonstrates that pRBC transfusions may be responsible for a substantial number of ARDS cases. These cases may incur hospital costs of nearly $600 million. A restrictive transfusion strategy in appropriate at-risk ICU patients may be effective in mitigating the magnitude of this clinical and economic burden.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2007.00087.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63389181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SAGM blood for neonatal large volume transfusion","authors":"L. Beattie, E. Harrison","doi":"10.1111/J.1778-428X.2007.00088.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2007.00088.X","url":null,"abstract":"","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2007.00088.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63389190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pelvic surgery in a child with hemophilia C: a rare disease, a real challenge, a simple solution","authors":"A. Holtan, U. Kongsgaard, F. Brosstad","doi":"10.1111/J.1778-428X.2007.00079.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2007.00079.X","url":null,"abstract":"SUMMARY \u0000 \u0000 \u0000Coagulation factor XI deficiency, also called hemophilia C, is the least common type of hemophilia in Norway. It differs from hemophilia A and B in its unpredictable clinical pattern. Patients often have no spontaneous bleeding tendency, but they can have serious and life-threatening bleedings when suffering trauma or undergoing surgical procedures. We report the case of a child with a hitherto undiagnosed factor XI deficiency. She had previously experienced excessive bleeding and required transfusion of saline-adenine-glucose erythrocytes after minor surgery. The patient was planned to a major surgical procedure with partial pelvic resection (hemipelvectomy) because of an Ewing sarcoma. Routine preoperative coagulation tests showed a moderately elevated international normalized ratio and a substantially prolonged activated partial thromboplastin time, which were due to a factor XI level at 0.2% of normal. Perioperative management of the patient was planned in collaboration with a coagulation specialist. In addition to replacement of erythrocytes, two different mechanisms were targeted for correcting the hemostatic defect. Substitution of factor XI was done by infusion of plasma, and inhibition of fibrinolysis was achieved by systemic and local administration of tranexamic acid. Surgery was then performed without excessive bleeding, and the patient did not require postoperative blood transfusions.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2007.00079.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63388982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plethysmographic pulse oximeter waveform monitoring for immediate hemolytic transfusion reaction","authors":"P. Dubey","doi":"10.1111/J.1778-428X.2008.00094.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2008.00094.X","url":null,"abstract":"","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2008.00094.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63388869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful outcome of using recombinant activated factor VII in the management of severe bleeding due to placental abruption in a patient with anti-C and anti-e alloantibodies","authors":"Farzal Anwar, M. Abdelaal, F. Nasrallah, A. El-Guindy","doi":"10.1111/J.1778-428X.2008.00101.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2008.00101.X","url":null,"abstract":"","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2008.00101.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63388925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The safety profile of Hemospan®: a new oxygen therapeutic designed using maleimide poly(ethylene) glycol conjugation to human hemoglobin","authors":"K. Vandegriff, M. Young, P. Keipert, R. Winslow","doi":"10.1111/J.1778-428X.2007.00083.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2007.00083.X","url":null,"abstract":"SUMMARY \u0000 \u0000 \u0000Hemoglobin-based oxygen carriers have been under development for several decades, but so far none has completed clinical trials due to safety issues, including fundamental concerns regarding hemoglobin-induced vasoconstriction and oxidative reactions. The question becomes whether these attributes are inherent to the hemoglobin molecule itself, or if the molecule can be modified in such a way as to avoid untoward side effects. To this end, Sangart designed a new type of oxygen therapeutic, Hemospan®, based on site-specific, maleimide poly(ethylene) glycol conjugation chemistry. The product, also referred to as MP4, is neither vasoconstrictive nor does it promote oxidation in vivo. The design principles were three-fold: (i) increase hemoglobin molecular size to prolong intravascular retention; (ii) increase oxygen affinity to prevent premature unloading of oxygen in the arterioles, thus avoiding arteriolar vasoconstriction; and (iii) optimize colloidal osmotic pressure and viscosity to enhance blood flow. Preclinical studies with Hemospan in animal models of hemodilution and hemorrhage show maintenance of blood pressure and cardiac output, with improved oxygen delivery compared to early-generation products of cross-linked and polymerized hemoglobins. Four Phase I and II clinical trials have been completed, showing that Hemospan is generally well tolerated in humans, with additional evidence of efficacy through Hemospan's capacity to impart hemodynamic stability in surgical patients. Two multi-center Phase III trials of Hemospan in orthopedic surgery are now underway in Europe.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2007-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2007.00083.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63389073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pegylated hemoglobins mechanisms to avoid vasoconstriction and maintain perfusion","authors":"P. Cabrales, J. Friedman","doi":"10.1111/J.1778-428X.2007.00090.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2007.00090.X","url":null,"abstract":"SUMMARY \u0000 \u0000 \u0000Despite the advances in blood substitutes, the development of materials that are effective in maintaining blood volume and oxygen delivery remains the priority for emergency care and trauma. Vasoactivity, i.e. vasoconstriction, presumably caused by nitric oxide (NO) scavenging has been defined as the principal problem associated with acellular hemoglobin (Hb) with low hydrodynamic radius. Conversely, Hb-based materials with very large hydrodynamic radius, achieved by surface decoration of the Hb tetramer with water-trapping polymers such as polyethylene glycol (PEG) conjugation, have been found vasoinactive in spite of being effective NO scavengers. This article explores possible mechanisms for why PEGylated Hbs not only are not vasoconstrictive but also are actually facilitators for maintaining high perfusion levels in the microcirculation. The most promising mechanisms are based on relatively recent observations and models; they indicate that Hb can actively regulate availability of ‘bioactive’ NO forms. This regulation can occur via: (i) NO transport by Hb in an allosterically controlled reversible chemical reaction with the Cys beta 93 (S-NO-Hb); and (ii) production of bioactive forms of NO through nitrite reductase activity of deoxyHb. The principal issues associated with these proposed mechanisms are: (i) how these reactions generate bio-available NO and (ii) how the generated NO is delivered to the site of action without being either degraded or sequestered. We present a promising hypothesis and preliminary supporting data that PEGylated Hbs through a nitrite-mediated reaction are especially effective in generating nitrosothiols, creating a transportable source of bioactive NO.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2007-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2007.00090.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63388799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modulation of the polyethylene glycol-hemoglobin structure to increase the efficiency of plasma expansion and O2carrying capacity","authors":"S. Acharya, M. Intaglietta, A. Tsai","doi":"10.1111/J.1778-428X.2007.00091.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2007.00091.X","url":null,"abstract":"SUMMARY \u0000 \u0000 \u0000Polyethylene glycol (PEG) surface decoration of hemoglobin (Hb) is being developed as a design strategy for generating an oxygen carrier with optimal plasma expansion characteristics and maintenance of microvascular function. HexaPEGylated Hb using six copies of 5 kDa PEG provides excellent tissue perfusion when used to correct blood volume losses at a plasma concentration of 2 g Hb/dL (as compared with unPEGylated Hbs used at 6–9 g Hb/dL). Efficacy attained with limited concentration of Hb allows effective use of available Hb obtained from outdated blood. However, the high oxygen affinity of PEG-Hb in combination with its low plasma concentration limits the effective oxygen delivery capacity, impacting tissue oxygenation. This problem can be remedied either by lowering oxygen affinity of PEG-Hb or by increasing its concentration in the circulation. PEGylation of low oxygen affinity intramolecularly cross-linked Hbs, for example αα-fumaryl-Hb, lowers oxygen affinity and modulating the pattern of PEGylation (size and number of PEG-chains to lower the colloidal osmotic pressure of PEG-Hb) reduces the tendency to dilute the PEG-Hb concentration in circulation because of fluid shifts into the intravascular volume. Novel chemistry platforms for PEGylation set the stage for next generation lower oxygen affinity PEGylated Hbs that optimizes oxygen delivery and tissue perfusion.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2007-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2007.00091.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63388810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Blood substitutes better than blood?","authors":"M. Intaglietta","doi":"10.1111/J.1778-428X.2008.00092.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2008.00092.X","url":null,"abstract":"","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2007-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2008.00092.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63388822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}