摘要:

AbstractOBJECTIVE: To explore the efficacy of plasmapheresis/plasma exchange as the primary therapy to arrest and reverse the progression of severe preeclampsia with or without HELLP syndrome in order to postpone delivery and improve perinatal outcome in very preterm pregnancies. STUDY DESIGN: In this case series of patients managed over a 4‐year period from 1984 to 1987, seven gravidas with severe preterm preeclampsia underwent 1‐2 plasmaphereses/plasma exchange procedures using the IBM 2997 Cell Separator with continuous electronic fetal heart rate monitoring (n = 7 patients) and central cardiovascular monitoring (n = 3 patients). RESULTS: The seven patients (one with HELLP syndrome, six without HELLP) presented between 24 and 30 weeks gestation and, despite plasmapheresis/plasma exchange, the severity of each study subject's preeclampsia persisted without clinically significant improvement. Maternal‐fetal deterioration required cesarean delivery in all cases within 48 (in four patients within<36) hours of therapy. No clinically significant adverse effect of plasma exchange therapy was recorded during cardiovascular and laboratory monitoring; two fetuses developed repetitive late decelerations during exchange despite adequate maternal fluid preload. The only patient with HELLP syndrome developed eclampsia as her third plasma exchange within 25 hours was being initiated. Significant problems with fluid retention and displacement (variable amounts of pulmonary edema, pleural effusions, large volume ascites) were encountered in all patients. Four neonates died (24‐27 weeks/438‐820 g) and three survived intact (740, 950, and 1,280 g). One mother (case 5) developed end‐stage renal disease 21 months postpartum. CONCLUSIONS: The application of plasmapheresis/plasma exchange therapy as described in order to prolong very preterm pregnancies in the undelivered patient with severe preeclampsia/eclampsia with or without HELLP syndrome did not produced encouraging results. Patients in general were exposed to additional medical and surgical risk without a corresponding improvement in perina

ISSN:0733-2459    

DOI:10.1002/jca.2920090302

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractOBJECTIVE: To explore the potential efficacy of plasma exchange as an ancillary interventive therapeutic tool immediately before or after delivery in the patient with severe preeclampsia/eclampsia and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. STUDY DESIGN: Two gravidas with complicated severe preeclampsia/eclampsia/HELLP syndrome were treated emergently in the immediate peripartal period with single‐volume plasma exchange and fresh frozen plasma fluid replacement using the IBM 2997 Cell Separator. RESULTS: Despite multiple platelet unit infusions, one primigravida in active labor at 5 cm cervical dilatation and 39 weeks' gestation remained at a platelet count of 14,000/μL and began to ooze from her gums. A second primigravida remained obtunded, oliguric, and thrombocytopenic with epistaxis and hematuria following cesarean delivery and platelet transfusions. A single expedited 3‐liter plasma exchange procedure reversed the rapidly deteriorating clinical situation for each patient and accelerated recovery from HELLP syndrome. Both patients and progeny suffered no permanent sequelae. CONCLUSION: Based on our experience, we believe that the therapeutic modality of plasma exchange with fresh frozen plasma can be employed effectively for the pregnant patient with severe atypical HELLP syndrome that progressively worsens during labor or the early puerperium despite the use of conventional transfusion the

ISSN:0733-2459    

DOI:10.1002/jca.2920090303

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractWith the advancement in apheresis technique and collection, the role of peripheral blood stem cell (PBSC) transplantation has emerged. PBSC are now being utilized either alone to reconstitute hematopoiesis following high‐dose myeloablative therapy, or in combination with autologous bone marrow transplantation to enhance hematopoietic recovery, or as supportive therapy to allow dose‐intensity of conventional chemotherapy. The role and efficacy of PBSC transplantation will be reviewed in the arti

ISSN:0733-2459    

DOI:10.1002/jca.2920090304

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractPreoperative autologous blood donation (PABD) is both under‐ and overused. Although the decision to order PABD lies with the surgeon, it is quite likely that other surgery clinic personnel influence patient acceptance and enrollment into PABD programs. Accordingly, we measured knowledge, attitudes, and the referral practice of clinic personnel pertaining to PABD. We administered a questionnaire to 102 nurses and 33 clerks working in surgery clinics at three university medical centers‐one center in an area with a high incidence of AIDS and two centers in areas of low incidence of AIDS. Knowledge of PABD was poor when assessed by six questions. Only 6% each of nurses and clerks answered all questions correctly; 55% of nurses and 54% clerks missed three or more of the six questions. Surprisingly, no differences (P>.05) in knowledge deficits were noted when personnel from high and low AIDS areas were compared‐indicating an overall need for education about PABD. In general, attitudes about PABD were positive, as most respondents (63%) gave favorable answers. Clinic personnel from the high AIDS area had even more favorable attitudes (P = .02). Because of these favorable attitudes, it seems likely that educational programs dealing with PABD would be readily accepted by clinic personnel. Greater knowledge should enhance the effectiveness of clinic staff in identifying, counseling, and referring eligible patients for this se

ISSN:0733-2459    

DOI:10.1002/jca.2920090305

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractTwo patients were treated with photopheresis for marked cardiac allograft rejection with hemodynamic compromise that had become unresponsive to standard therapy. Multiple episodes of rejection had occurred, and initial response to standard therapy was favorable. However, progressive deterioration was documented by serial endomyocardial biopsies, fever, congestive heart failure, and abnormal cardiac catheterization findings. In the absence of retransplantation, death seemed imminent. Photopheresis was begun. Both patients received oral 8‐methoxypsoralen and ⩾5 × 109mononuclear cells were collected, treated with ultraviolet light A for 1.5 hours, and were reinfused. One procedure was performed weekly X4 and then monthly X5. Responses were striking with rapid loss of fever, improvement in exercise tolerance, normalization of cardiac hemodynamics, and improvement in endomyocardial biopsies. Although our experience with these two patients is anecdotal, photopheresis merits further study as treatment for severe cardiac allograft rejec

ISSN:0733-2459    

DOI:10.1002/jca.2920090306

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractModest success has been achieved with the use of high‐dose cytotoxic therapy and bone marrow transplantation in solid tumors. Patient outcome can potentially be improved with further intensification of the therapy. The rapid hematologic recovery achieved with mobilized peripheral blood progenitor cells (PBPC) may reduce the toxicity of transplantation enabling the use of sequential courses of myeloablative therapy. We report on 42 patients with solid tumors enrolled in a tandem transplant protocol involving the use of PBPC mobilized with cyclophosphamide (4 g/m2), etoposide (1 g/m2), and granulocyte‐colony‐stimulating factor (G‐CSF: 10 μg/kg/day). This regimen significantly increased the number of circulating progenitor cells; only 1‐2 aphereses were sufficient to collect 2.5 × 108/kg mononuclear cells, our goal for each transplant course. The median number of circulating colony‐forming units (CFU) and CD34+ cells obtained for each transplant course were 70.3 × 104/kg and 11.7 × 106/kg, respectively. There was a significant correlation between the numbers of CD34+ cells and CFU measured in the apheresis product (r = 0.49, P = .003). The first transplant regimen given to 38 patients consisted of thiotepa, carboplatin, and cyclophosphamide. The second transplant regimen given to 29 patients consisted of busulfan and etoposide. Hematologic recovery was comparable after each of the two transplant courses. The median time to neutrophil recovery over 0.5 × 109/L and to platelet transfusion independence was 9 and 8 days, respectively. There was no difference in engraftment rates after transplant with PBPC only (n = 28 courses) compared to transplant with PBPC plus bone marrow (n = 39 courses). There was a significant correlation between hematologic recovery after transplant and the number of CD34+ cells present in the PBPC. In conclusion, 1) PBPC are significantly mobilized with this combination chemotherapy and G‐CSF, 2) mobilized PBPC result in rapid engraftment after myeloablative therapy, 3) hematologic recovery rates are comparable after sequential PBPC transplants, 4) PBPC alone are sufficient for long‐term engraftment, and 5) rapid engraftment after PBPC transplant enables the use of a second course of myeloablative therapy within a sh

ISSN:0733-2459    

DOI:10.1002/jca.2920090307

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe cell separator MCS‐3P is an apheresis system offering the flexibility to collect standardized red blood cells, plasma, and/or platelets from one donor. Two different programs were used for the red cell apheresis'RBCP (collection of one unit of red cells and two units of plasma) and RBCPS (one unit of red cells and one unit of plasma). The quality of the red cell concentrates (RCC resuspended in SAG‐Mannitol) during the storage time of 42 days was measured by biochemical (ATP, 2,3‐DPG, pH, free Hb, free potassium, glucose, lactose, p50, hemoglobin derivatives) and Theological (morphological index, filtration/rigidity index) parameters. The donation time with 53 donors was 20 min for 355 ml RCC‐SAGM and 440 ml plasma and 7 min for 335 ml RCC‐SAGM and 239 ml plasma. The donor tolerance was analogous to plateletpheresis or plasmapheresis. Twenty units of the RCC‐SAGM were in‐line filtered within 6 or 24 hours after donation. The results obtained for red blood cell storage are at least as good as with standard collection (free hemoglobin, free potassium, glucose, lactose, hemolysis) or better (ATP, 2,3‐DPG, p50, hemoglobin derivatives, filtration/rigidity index) owing to prevention of collection lesion. All blood preparations were sterile after storage (red cells 42 days, plasma after freezing). The erythroplasmapheresis with MCS‐3P can be especially recommended for application in an autologous blood program because the application of autologous blood donation in hospitals is often limited by the preconditions of component separation. The erythroplasmapheresis data with MCS‐3P are encouraging for the development of a new blood col

ISSN:0733-2459    

DOI:10.1002/jca.2920090308

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractUsing a paired study, in vivo and in vitro characteristics of apheresis platelets collected on a cell separator and single‐donor whole‐blood (recovered) platelets via platelet‐rich plasma (PRP) were compared after storage for 5 days in similar plastic containers. Autologous platelets from each of 12 volunteers were labeled with111Indium after storage and reinjected. There was no significant difference in circulating recovery between platelets prepared by the two methods, and only one of five models of survival showed a significant difference. Hypotonic shock recovery was significantly better in apheresis than recovered platelets (57.0% and 32.4%, respectively), whilst aggregation to ADP at 3.2 μM and 32 μM was significantly higher in recovered than in apheresis platelets (17.0% and 45.2% versus 7.8% and 32.9%, respectively). Lactate dehydrogenase (LDH) content was significantly higher in recovered platelets (143.3 versus 77.1 IU/1011platelets), but LDH release was similar (15.0% cf. 12.6%). There was no significant difference between the two platelet preparations for platelet concentration, pH, aggregation with the calcium ionophore A23187 or collagen plus epinephrine, or ATP content or release. $bL‐TG release was lower in apheresis platelets. Neither product was consistently better than the other for the parameters tested, but apheresis platelets have the advantage of lower donor exposure to th

ISSN:0733-2459    

DOI:10.1002/jca.2920090309

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractThere has been an increasing interest in recent years over the qualitative superiority of single‐donor platelets in the management of hemato‐oncologic patients. The reasonable desire of both patients and physicians to limit the risks of transfusion along with the need for limiting the costs involved in this kind of therapy have led to application of multicomponent donations both in terms of double platelet concentrates and double products such as red blood cells (RBC) and platelets from the same donor. Single donor platelets and RBC have been collected in a semi‐automated mode and only the very recent introduction of the Haemonetics MCS 3p with its SDP/RBC protocol provides a totally closed‐system automated protocol for this combined collection. Twenty procedures have been carried out so far at our unit. In a mean of 87 minutes (6–7 passes), a mean of 3.1 × 1011platelets were collected along with ∼220 mL of packed RBC. The leukocyte contamination of the platelet product was in the range of 0.4–1.1 × 107(99% lymphocytes), and the quality of platelets was very satisfactory as measured by the hypotonic shock response, aggregation induced by ADP, collagen and ristocetin, morphology score, and membrane glycoproteins modifications. Equally satisfactory was the quality of the RBC concentrate, suspended in 80 mL of SAG‐M, with a total hemoglobin (Hb) content approaching 55 g as compared to the normal Hb content of a standard RBC concentrate that is approximately 62 g. No adverse effect has complicated the 20 procedures carried out so far, and the donors' evaluation of the procedure was favorable, except for the length

ISSN:0733-2459    

DOI:10.1002/jca.2920090310

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

ISSN:0733-2459    

DOI:10.1002/jca.2920090311

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY