摘要:

Posttransfusion hepatitis of the non‐A, non‐B variety continues to be a significant problem in current hemotherapy. This disorder is many times more common than transfusion‐associated disease caused by hepatitis B virus, cytomegalovirus, and Epstein‐Barr virus, and also seems to be viral in origin. Several potential etiological agents have been implicated, but none has been identified with certainty, despite concerted efforts at doing so. Clinical disease is usually attended by few symptoms and signs, but evolution to chronic liver disease is distressingly common; over 50 percent of all cases of non‐A, non‐B posttransfusion hepatitis manifest this transition. Efforts at prevention of non‐A, non‐B hepatitis associated with blood transfusion have thus far been hampered by the lack of reliable laboratory markers for carriers of this disease, and controversy exists over the implementation of screening tests on blood donors, using such nonspecific indicators of possible viral carriage as serum alanine aminotransferase levels. It is probable, however, that simple measures such as more restrained blood usage, encouraged by greater educational efforts within the medical community, could be beneficial in minimizing the number of new cases of non‐A, non‐B posttransfusion hepatitis seen each year i

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1985.25285169225.x

出版商:Blackwell Science Ltd    

年代:1985

数据来源: WILEY

ISSN:0041-1132    

DOI:10.1111/j.1537-2995.1985.tb02296.x

出版商:Blackwell Science Ltd    

年代:1985

数据来源: WILEY

摘要:

The level of alanine aminotransferase (ALT) in blood donors has been related to the frequency of posttransfusion hepatitis in recipients. Sixty‐seven donors with elevated ALT levels were evaluated to define the duration and significance of the elevation. The ALT level remained elevated in 41 donors (61%) for a mean interval of 9 months. The ALT level was greater than the aspartate aminotransferase in all of the donors. Alcohol intake did not correlate with ALT level. Donors with persistently elevated ALT levels had a significantly higher mean percent ideal body weight (128 +/− 3.9) than donors whose ALT level became normal (116 +/− 3.1). Nine donors with elevated ALT levels for at least 6 months had needle biopsies of the liver. Seven had prominent fatty vacuolization of hepatocytes without evidence of alcoholic hepatitis. One biopsy demonstrated chronic persistent hepatitis. No other cause for the elevated ALT levels could be identified. An overweight male donor with an isolated ALT elevation may need no further investigation unless clinical evaluation suggests a source of liver i

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1985.25285169196.x

出版商:Blackwell Science Ltd    

年代:1985

数据来源: WILEY

摘要:

We studied the red cell antigens present on K562 human leukemia cells before and after induction of hemoglobin synthesis by hemin. The fetal antigens i, IF, and IT were detected on uninduced cells. While expression of both i and IT antigens increased after hemin induction, expression of IT was closely related to fetal hemoglobin synthesis as determined in experiments in which the induction was reversed. The EnaFR, NVg, and T antigens of glycophorin A were also present on uninduced cells. In contrast, the M and Pra antigens of glycophorin A, the Kell system antigens, and the P1 antigen became detectable only after hemin induction. Antigens of other major red cell systems were not detected.

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1985.25285169197.x

出版商:Blackwell Science Ltd    

年代:1985

数据来源: WILEY

摘要:

Clinical and serological data on 1435 Italian thalassemia major patients were collected during a cooperative study involving 19 centers in 10 regions. The main findings were as follows: 18 percent of the patients were under 6 years of age, 63 percent between 6 and 15, and 19 percent over 15. Forty‐one percent had undergone splenectomy. Sixty‐two percent of the patients were maintained at pretransfusion hemoglobin levels higher than 10 g per dl, 36 percent between 8 and 10 g per dl, and 2 percent below 8 g per dl. Overall, 5.2 percent of the patients had clinically significant red cell alloantibodies (136 alloantibodies in 74 patients). One‐half of the immunized patients had more than one and one‐fourth had more than two alloantibodies. The specificities of the 136 alloantibodies were almost exclusively confined to the common antigens of the Rh, Kell, Kidd, and Duffy systems, in that decreasing order of frequency. The antibody screening procedure, using a low‐ionic‐ strength solution antiglobulin test against a three‐red‐cell panel and the patient's own red cells (autocontrol) with a serum to cell ratio of 100 to 1 was shown to be an adequate technique for red cell ant

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1985.25285169198.x

出版商:Blackwell Science Ltd    

年代:1985

数据来源: WILEY

摘要:

In this 3‐year study, we analyzed the transfusion pattern of 288 patients undergoing potentially curative resection of colorectal cancer to determine the magnitude and causes of unnecessary blood transfusions. Transfusions were considered unnecessary if the preoperative hematocrit exceeded 36 percent or the discharge hematocrit exceeded 33 percent. Twenty‐five percent of the units of blood administered were unnecessary by these criteria. Excessive intraoperative transfusion (67 patients) and the practice of administering blood in pairs of units (33 patients) without reevaluating the hematocrit between successive units accounted for 90 percent of unnecessary transfusions. This study indicated that determination of the hematocrit immediately before administration of each unit of blood will reduce blood consumption of elective colon resections by 25 perc

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1985.25285169199.x

出版商:Blackwell Science Ltd    

年代:1985

数据来源: WILEY

摘要:

A prospective randomized study at a single renal transplant center between 1980 and 1982 compared the influence of leukocyte‐depleted versus packed red cell pretransplantation blood transfusions on patient sensitization to leukocyte (HLA) antigens, likelihood of receiving a graft, and eventual transplantation results. All consenting potential cadaver renal transplant recipients (n = 107) were randomly assigned to receive transfusions at 6‐week intervals with either packed red cells (Group 1) or leukocyte‐poor red cells (Group 2) until they were transplanted. Actuarial graft and patient survival were identical for graft recipients in both groups. Although the likelihood of receiving a graft was associated with the level of pretransplant sensitization to leukocyte (HLA) antigens (p less than 0.02) as measured by the percent of panel reactive antibody (PRA), it was not associated with the type of blood used. The highest mean peak reactive PRA level for all patients showed a low but significant increase (29 +/− 4 versus 43 +/− 5%; p less than 0.0005) following entry into the transfusion protocol, but the rate of increase was the same for patients in both treatment groups. The likelihood of receiving a transplant was primarily associated with a history of prior graft rejection (p less than 0.05), and patients with prior graft loss had the greatest increase in sensitization following entry into the transfusion protocol. These findings indicate that using leukocyte‐poor red cells for pretransplant transfusions provided no added benefit when compared with packed red cells in terms of patient sensitization, the likelihood of receiving a transplant, or eventual gra

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1985.25285169200.x

出版商:Blackwell Science Ltd    

年代:1985

数据来源: WILEY

摘要:

Liver transplantation is a relatively new procedure in which unusually large quantities of blood are used. Blood use in 68 adult and 49 pediatric liver transplants was reviewed. The median (range) intraoperative red cell use for adults and children was 28.5 (3‐251) and 11 (2‐55), respectively. Blood use closely correlated with the patient's primary diagnosis. Adult patients with primary biliary cirrhosis and carcinoma used about one‐half as much blood as those with a diagnosis of sclerosing cholangitis, hepatitis, or cirrhosis. Patients in the former diagnostic groups also had better survival rates. Total red cell use for the patient's entire hospitalization was about twice that used during surgery. Fresh‐frozen plasma use paralleled red cell transfusions, but platelet use was modest. These data can serve as a baseline in helping other hospital transfusion services prepare for the advent of liver transplantation in their insti

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1985.25285169201.x

出版商:Blackwell Science Ltd    

年代:1985

数据来源: WILEY

摘要:

Acute hemolysis as a reaction to rifampicin is extremely rare; case reports number less than 15. We recently evaluated a 65‐year‐old Cambodian refugee who self‐regulated the use of rifampicin and isoniazid for pulmonary tuberculosis. Fifteen minutes after a single discontinuous oral dose, he developed flank pain, chills, rigors, vomiting, diarrhea, fever, and brown turbid urine. Laboratory tests at presentation showed acute intravascular hemolysis. Nonoliguric renal failure ensured, and he was transferred to our institution 2 days later. The patient was group A, Rh (D) positive, P1 negative with a cold autoantibody and cold anti‐P1 alloantibody. The direct antiglobulin test was negative at the time of transfer. To evaluate the hemolysis, studies were done to test for rifampicin‐ or isoniazid‐ dependent antibodies. Rifampicin‐dependent antibodies were detected in the antiglobulin phase with broad spectrum anti‐human globulin, monospecific anti‐gamma chain, and anti‐complement antisera. Agglutination titers did not change after dithiothreitol reduction of the patient's serum. We conclude that this patient developed rifampicin‐ dependent IgG antibodies with complement‐fixing capability. The presence of rifampicin‐dependent antibodies should be suspected in a patient with hemolysis and/or renal

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1985.25285169202.x

出版商:Blackwell Science Ltd    

年代:1985

数据来源: WILEY

摘要:

A case of successful coronary artery bypass grafting in a patient with hemophilia B is described. The patient underwent preoperative plasmapheresis and replacement with fresh‐frozen plasma. Fresh‐frozen plasma was administered pre‐ and postoperatively. The use of factor IX concentrate was av

ISSN:0041-1132    

DOI:10.1046/j.1537-2995.1985.25285169203.x

出版商:Blackwell Science Ltd    

年代:1985

数据来源: WILEY