ISSN:1660-3796    

DOI:10.1159/000223319

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

ISSN:1660-3796    

DOI:10.1159/000223246

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

ISSN:1660-3796    

DOI:10.1159/000223320

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Platelet transfusion practices in Europe are summarized based on survey questionnaire returns from 36 centers in 17 countries. In marrow hypoplasia the platelet transfusion trigger varied from 10,000 to 20,000/µl with a minority at 5,000/µl. These levels increased up to 50,000/µl in case of signs of major bleeding. In surgery levels of 50,000 to 100,000/µl were desirable with attempts to maintain postoperative levels of 30,000 to 50,000/µl for up to one week. A large majority of centers used random-pooled platelet concentrates (RPC) for surgical patients, while apheresis platelets were used by a small majority for chronic thrombocytopenic patients. HLA-matched platelets were used in most cases for immunized or refractory patients. An increasing majority prepares RPC by the buffy-coat technique. There is a tendency to store apheresis platelets for shorter times. Leukocyte-depleted platelets were used primarily for refractory chronic thrombocytopenic patients, although levels considered effective rang edfrom < 106 to < 108 About half the centers used leukocyte-depleted platelets in lieu of cytomegalovirus (CMV)-seronegative platelets. A large majority irradiated products for patients at risk of GvHD, although irradiation doses varied widely. The dose of platelets per transfusion also varied wi

ISSN:1660-3796    

DOI:10.1159/000223321

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Objective: The clinical compatibility of two newly developed lipid emulsions based on soy oil (20%) emulsified with egg lecithin (12 g/l) or soy lecithin (15 g/l) (Solipid® 20% E & S) has been compared. Design: Double-blind prospective randomized study. Setting: Intensive care unit of a university hospital. Patients: 20 patients (16 men, 4 women, age 20-59 years) were entered into the study. Interventions: One g of lipids/kg body weight per day was administered on day 1 and subsequently 2 g/kg/day on days 2-5. Blood was drawn once a day, lipids, lipoproteins, apoproteins and other routine clinical chemistry parameters were determined. Results: No significant increase of total triglycerides could be observed. Total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, apolipoproteins A I and B usually remained below the reference ranges. Electrolytes, uric acid and glucose, blood cells, parameters of liver and kidney function, coagulation and protein metabolism did not show relevant changes; only the activity of gamma-GT in both groups – independent of the sort of lecithin – increased significantly. Conclusion: The results indicate adequate elimination of both tested lipid emulsions from the plasma at usual clinical conditions. Therefore Solipid® 20% S&E can be used in critically ill pat

ISSN:1660-3796    

DOI:10.1159/000223248

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

A strategy for platelet support of thrombocytopenic patients based on platelet count, clinical findings, and complicating factors is presented. Depending on underlying clinical conditions, for example, presence of fever or disseminated intravascular coagulation (DIC), the sites and degree of hemorrhage, and the existing platelet count, transfusion strategies ranged from no transfusion – as in the case of a patient with no complicating factors, no bleeding, and a platelet count of at least 10,000/μl -to 1-2 times daily transfusion for a patient with serious CNS or gastrointestinal tract GI bleeding with a count less than 50,000/μl. Transfusion dose should be based on patient size, target platelet count, and underlying conditions expected to influence corrected count increment (CO) or platelet recovery. These underlying conditions include alloimmunization, fever, infection, hypersplenism, DIC, and hemorrhage. Complications of platelet transfusion, such as transfusion reactions or refractoriness due to immunization or consumptive disorders, must be taken into account in the support of the thrombocytopenic pati

ISSN:1660-3796    

DOI:10.1159/000223322

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Ziel: Die Praktikabilität und Effektivität einer standardisierten, unmittelbar präoperativ durchgeführten isovolämischen Hämodilution wurde bei großen gynäkologischen Eingriffen (Wertheim-Operation u. a.) untersucht. Design: Prospektive klinische Studie mit historischer Vergleichsgruppe. Rahmen: Operations-saal einer gynäkologischen Universitätsklinik. Patienten und In-terventionen: Bei 48 Patientinnen (mittleres Alter: 53 Jahre) wurde in Allgemeinanästhesie eine Hämodilution auf eine H-ämoglobinkonzentration von 9 g/dl durchgeführt (Abnahmemen-ge 900 ± 210 ml). Intraoperativ wurde bei Unterschreiten eines Hb-Wertes von 7 g/dl Eigenblut bzw. Fremdblut transfundiert. Ergebnisse: Gegenüber dem Vergleichskollektiv von 57 Patientinnen ohne Hämodilution wurde die Gesamtzahl an Fremdbluttransfusionen signifikant reduziert. Perioperativ konnte bei 65% aller Patientinnen jegliche Fremdblutübertragung vermie-den werden (Kontrollgruppe: 21%). Unerwünschte Nebenwir-kungen traten nicht auf. Schlußfolgerungen: Die Untersuchung zeigt, daß die akute isovolämische Hämodilution bei großen gynäkologischen Eingriffen ein sicheres, leicht zu handhaben-des und effektives Verfahren ist, das erlaubt, bis zu einem Ge-samtblutverlust von 1300 bis 1400 ml – in Einzelfällen auch dar-über – gänzlich auf eine Fre

ISSN:1660-3796    

DOI:10.1159/000223249

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Leukocyte depletion of blood components has been shown to be effective in the prevention of HLA alloimmunization and cytomegalovirus (CMV) infection and reactivation in patient groups at risk. If all blood products are leukocyte-reduced to below 5 × 106 leukocytes, a primary immune response to HLA antigens can be avoided; secondary immune responses are not avoided. While other viruses have been shown to be contained predominantly in leukocytes, only in the case of CMV leukocyte reduction is effective in preventing viral transmission. Leukocyte reduction also reduces transfusion-related viral reactivation. Although leukocytes may not be the only cause, their removal reduces the incidence of nonhemolytic febrile transfusion reactions. Leukocyte depletion is not effective in preventing graft-versus-host disease. A number of techniques can be used to achieve low levels of leukocytes in blood products, and each must be carefully validated and controlled to assure the products are adequately and consistently leukocyte-reduced

ISSN:1660-3796    

DOI:10.1159/000223323

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Apheresis systems for the production of single-donor platelets may be divided into 3 categories: those which collect high-yield products with low leukocyte contamination, those with high yields but higher WBC residuals, and those giving lower yields with high leukocyte contamination. Systems in the first category have clear advantages. Of the 2 methods for producing platelet concentrates (PC) from whole blood – the platelet-rich-plasma (PRP) and the buffy-coat (BC) methods – platelets produced by the BC method are better in terms of yield, WBC residuals, and in vitro function assays. In studies comparing the in vitro function of apheresis platelets and BC platelets, the apheresis platelets show better results in some assays, however, the differences are small. In a recent study carried out in Bristol, UK, corrected count increments (CCIs) for apheresis platelets were significantly higher than those for PRP platelets and not significantly higher than those for BC platelets. Use of apheresis platelets reduces the number of donors to which a recipient is exposed. A further reduction can be achieved if a larger dose of platelets is used per transfusion. A multicenter study carried out in France confirmed earlier findings that the platelet survival time in thrombocytopenic patients is improved if sufficient platelets are given to bring the post-transfusion platelet count above levels achieved with standard-dose transfusi

ISSN:1660-3796    

DOI:10.1159/000223324

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger

摘要:

Ziel: Erarbeitung von Daten für die Gabe von Blutprodukten zur Immunprophylaxe des Tetanus bei immuninkompetenten Patienten. Design: Prospektive Einzelfallanalyse. Rahmen: Klinische Behandlung in hämatologischer Abteilung mit konti-nuierlicher Bestimmung der Tetanus-Antikörperkonzentra-tionen in Patientenseren und verabreichten Blutprodukten mittels Enzym-Immunoassay. Patienten: 3 Patienten mit akuter myeloischer Leukämie (FAB-Klassifikationen Ml, M3, M4). Interventionen: Regelmäßige Verabreichung von Blutprodukten im Rahmen der klinischen Therapie. Ergebnisse: Durch die Gabe von etwa 4000 IE Tetanus-Antitoxin i.v. ist die Serumkonzentration um 1 IE/ml anzuheben. Die Serum-halbwertszeit beträgt 7 Tage. Ein Schutz ist damit bis zu 6 Wochen vorhanden. Schlußfolgerungen: Immuninkompe-tente Patienten können durch Auswahl geeigneter Blutprodukte einen mittelfristig wirksamen Schutz gegen Tetanus erhalten. Dieses Verfahren ist auch interessant zur Prophylaxe des postoperativen Tetanus bei immunkompetenten P

ISSN:1660-3796    

DOI:10.1159/000223250

出版商:S. Karger GmbH    

年代:1996

数据来源: Karger