ISSN:0958-7578    

DOI:10.1111/j.1365-3148.1994.tb00261.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SUMMARY.The objective of this study was to assess the use of blood products and artificial colloids in six commonly performed elective surgical procedures in 43 teaching hospitals in 10 European countries. 7,195 patient data were analysed. For each product wide differences were found between hospitals, both in the proportion of patients transfused and the amount of product used for the same patient category. Adjustment for age, gender, preoperative haematocrit and blood loss, left major differences among hospitals in patient red unit transfusion. Hospitals in the Mediterranean area used less albumin and artificial colloids and more autotransfusion than those of central‐northern Europe. The reasons for perioperative red cell transfusion were stated in the patient's medical record for 23% of patients. The ratio of preoperative blood request to transfusion was maximal in cholecystectomy, where it exceeded 10. The documentation of blood request and transfusion, and of transfusion complications in medical records, did not fully agree with that in the transfusion service in 49, 53 and 92% of the hospitals, respectively.The wide differences in blood product used for the same patient category were due to a variety of causes of which only some could be explained by the clinical factors taken into account. This suggests that consensus conferences and guidelines have so far had a limited impact on transfusion practice in many clinical units, even in teaching environment

ISSN:0958-7578    

DOI:10.1111/j.1365-3148.1994.tb00262.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SUMMARY.A retrospective study was undertaken to identify recipients of blood from donors subsequently shown to be positive for hepatitis C virus using second‐generation tests and polymerase chain reaction. The main aims were to determine the numbers of such recipients who were still alive and traceable, and to determine the risk of infection in this group. The feasibility and workload of this procedure, which is currently not practised in the U.K. or U.S.A., was also assessed.In the first six months of routine testing 42,697 donors were tested. Of 20 confirmed to be HCV‐positive, 15 were regular donors. Eighty‐three components were prepared from 63 anti‐HCV positive previous donations from these donors. In all, nine recipients were found to be alive. All were positive for anti‐HCV. We conclude that although this retrospective procedure is time‐consuming and difficult, substantial numbers of infected recipients can be identified. The availability of treatment for chronic hepatitis C for such patients should encourage transfusion services to reassess current policies on the hepatitis C re

ISSN:0958-7578    

DOI:10.1111/j.1365-3148.1994.tb00263.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SUMMARY.Routine screening of Hungarian blood donors for anti‐HCV commenced in the second half of 1992. Before this, five available anti‐HCV ELISA kits were compared in pilot studies. In the first series, 831 random donor samples were tested by one of the tests and the 12 (1.4%) reactives found were retested by the other four. Six of the reactives were positive in all ELISA. In the second series, 325 samples from donors with elevated transaminase levels were tested by all five kits. Forty‐four were found to be reactive by one or more of the tests and 32 (10%) were positive in all five assays. Samples concordantly reactive in the ELISA were positive in second or third generation recombinant immunoblot assay (RIBA 2 or RIBA 3); those that gave discordant results were indeterminate or negative. Eleven concordantly reactive samples from the second series were HCV RNA positive by polymerase chain reaction (PCR). In the first period of screening with Abbott ELISA 2 a repeat‐reactivity rate of 0.98% was observed in 171,106 samples tested. Reactives were retested for supplementary testing by Wellcozyme anti‐HCV. Donors reactive in both tests and strongly reactive (ELISA ratio (ER) = optical density/cut off 2.5) in either of them were permanently deferred. Those negative in the supplementary ELISA or weakly reactive (1.0<2.5) in both tests were subjected to RIBA 2. On the basis of RIBA, positive donors were permanently deferred, indeterminates were excluded for 1 year and negatives were readmitted. In 1992, 1,347 supplementary tests were completed; 824 (61%) of the respective donors were permanently deferred, 218 (16%) were deferred for 1 year and 305 (23%) were r

ISSN:0958-7578    

DOI:10.1111/j.1365-3148.1994.tb00264.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SUMMARY.The recognition that spontaneous intracranial haemorrhage (ICH) may occurin uteroin fetomaternal alloimmune thrombocytopenia (FMAIT) led us to attempt to prevent this in 15 pregnancies of 11 women who had previously affected infants with FMAIT due to anti‐HPA‐la. The antenatal management included fetal platelet transfusions and maternal steroids and/or high‐dose intravenous immunoglobulin (IVIgG).In the first pregnancy, ICH occurred between 32 and 35 weeks' gestation before any treatment had been given, emphasizing the need for earlier intervention.Five of the 14 subsequent pregnancies in this study were considered to be severely affected (severe haemorrhagic complications in a previous infant and initial fetal platelet count50 times 109/L in this study). The platelet counts were maintained in one case with steroids and in three with IVIgG without the need for repeated platelet transfusions, but in the fifth the fetal platelet count fell despite steroids and IVIgG and serial platelet transfusions were required.Four pregnancies were unsuccessful; two pregnancies were terminated after severe ICH occurred at an early stage before fetal blood sampling had been carried out, one fetus died after the mother had a severe fall despite the successful initiation of fetal platelet transfusions and one died due to a cord haematoma which occurred at the time of the initial fetal blood sampling.The optimal management of FMAIT to reduce the risk of antenatal ICH remains uncertain. Steroids and IVIgG may be effective in some mildly affected cases but serial fetal platelet transfusions are the preferred therapy for those who are severely a

ISSN:0958-7578    

DOI:10.1111/j.1365-3148.1994.tb00265.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SUMMARY.In fetal alloimmune thrombocytopenia (FAIT) the fetus is threatened by intracranial haemorrhage (ICH); therefore early diagnostic and therapeutic intervention is required. We followed the clinical course of a 30‐year‐old woman during her fifth pregnancy after she had given birth to a child with alloimmune thrombocytopenia due to anti‐Zwa. The fetus was monitored by 13 fetal blood samplings (FBS) always followed by transfusion of either maternal or compatible donor platelets. Intravenous immunoglobulin (ivIg) treatment of the mother was begun at 20 weeks of gestation when the fetal platelet count was 36 times 109/1. The fetal platelets were typed Zwapositive by DNA analysis. Despite 11 weeks of maternal ivIg treatment fetal platelet counts progressively declined to 6 times 10/1 and ICH occurred. Subsequently, the fetus was successfully managed by intrauterine platelet transfusions at shorter intervals (3–5 days) and elective Cesarean section was carried out at 35 weeks of gestation. We conclude that maternal ivIg treatment does not prevent ICH in FAIT. The treatment of choice for severely affected cases is serial FBS combined with transfusion of compatible pl

ISSN:0958-7578    

DOI:10.1111/j.1365-3148.1994.tb00266.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

SUMMARY.Rh(D)‐ and K‐negative women who have become severely isoimmunized by pregnancy are at risk of fetal loss or damage in subsequent pregnancies. A flow cytometric method is described whereby the presence of Rh(D) or K antigen on fetal erythrocytes may be determined using chorion villus samples taken during the first trimester. This method has the advantage of speed and sensitivity with results being available within 2h. Decisions as to management of the pregnancy or termination may thus be made with minimal de

ISSN:0958-7578    

DOI:10.1111/j.1365-3148.1994.tb00267.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0958-7578    

DOI:10.1111/j.1365-3148.1994.tb00268.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0958-7578    

DOI:10.1111/j.1365-3148.1994.tb00269.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0958-7578    

DOI:10.1111/j.1365-3148.1994.tb00270.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY