Infusionstherapie und Transfusionsmedizin最新文献

Background: Pseudothrombocytopenia (PTP) is an in vitro phenomenon with falsely low platelet counts determined automatically. Usually the thrombocytopenia is noticed accidentally without a corresponding tendency to bleeding. If this phenomenon is not recognized, misinterpretation may bring the patient into a considerable risk by diagnostical and therapeutical mistakes. By own cases and analysis of the literature, causes, appearance. incidence, as well as diagnostic and clinical problems of PTP shall be explained in detail.

Casuistics: We report on three patients who showed a significant decrease of platelet counts after surgery DIC (disseminated intravascular coagulation) and heparin-induced thrombocytopenia type II (white clot syndrome) were assumed primarily. In all three cases the reason for the low postoperative platelet counts was found to he due to PTP caused by cold agglutinins.

Conclusion: From the cases described it can he concluded that PTP may develop during postoperative clinical course. Due to the broad differential diagnostic spectrum in the postoperative situation. PTP is hardly considered. Therefore, there is a greater chance of misinterpretation and therapeutic mistakes. In case of low platelet counts PTP should always be excluded, even when thrombocytopenia seems to be explicable differently.

Objective: To review the main characteristics of the 'immune complex (IC) transport system of erythrocytes', and its possible relevance for transfusion medicine.

Data sources: Literature search, and results Of Studies performed in the laboratory of Dr J. Schifferli from 1986 to 1995.

Selection criteria: Peer review journals and work relevant to the topic.

Results: When antigen/antibody IC form in the presence of complement. C3b binds covalently to the complexes. Such opsonized complexes attach to cells bearing complement receptor 1 (CR1), which is mostly found on erythrocytes in the circulation. This allows IC to be transported through the circulation to the fixed macrophage system of the liver and spleen. In addition, C3b bound to the complexes is catabolized by factor 1 (with CR1 as a cofactor) so that the complement-activating properties of the complexes are reduced.

Conclusions: Complement and erythrocyte CR1 contribute to the safe and effective elimination of IC in humans. This physiologic system prevents IC deposition in the vessel walls.

Objective: This study aimed to test the hypothesis that the initial distribution volume of glucose (IDVG) is correlated with plasma volume determined by indocyanine green (ICG) following colloidal fluid challenges. The IDVG was also compared with cardiac output (CO) as measured by the conventional thermodilution method.

Design and setting: The study was prospective and was conducted in the animal laboratory, University of Hirosaki School of Medicine, after approval of the institutional animal experiment committee.

Participants: Thirteen mongrel dogs of either sex, weighing 9.0-14.5 kg, were the subjects of the study.

Interventions: They were anesthetized with pentobarbital and paralyzed with pancuronium. 30 ml x kg(-1) of 3% dextran in lactated Ringer's solution was given twice to induce a hypervolemic state.

Measurements and results: In each stage of the fluid loading, the IDVG, plasma volume and CO were measured simultaneously. The IDVG was measured following an injection of glucose (100 mg x kg(-1)) by repeated determinations of plasma glucose (3-7 min) with a one-compartment model, and plasma volume was assessed similarly following ICG (0.5 mg x kg(-1) injection. A closer correlation was observed between the IDVG and plasma volume (r = 0.79, p < 0.001) than between the IDVG and CO (r = 0.48, p < 0.01).

Conclusion: The IDVG correlates with plasma volume following volume challenge in dogs. CO did not show a consistent change following volume challenge. The IDVG may have the potential as an indicator to presume the fluid volume in the body, even though the IDVG cannot be used directly to estimate plasma volume.

Background: Current estimates of blood group frequencies in Germany were often derived from studies involving less than 12,000 individuals. The frequency of the D category VI was unknown.

Methods: ABO. Kell, and Rhesus blood group data of more than 600,000 donors were reviewed. Allele frequencies were derived by the maximum-likelihood method. The frequency of D category VI was determined in more than 70,000 Rhesus typings.

Results: ABO allele frequencies were: O: 0.640, A: 0.279. B: 0.081. Rhesus haplotype frequencies were: cde: 0.394, CDe: 0.431, cDE: 0.136, cDe: 0.021, and Cde: 0.011. D category VI represented 7%, of all weak D (formerly D(u)). The 95% confidence interval for the D category VI frequency was 1:3,600-1:11,200. Kell allele frequencies were: K: 0.040, and k: 0.960, 95% confidence intervals for rare phenotypes were: Oh: 1:88,000-1:1,760,000, p: 1:200,000-1:5,200,000. Rh(null): 1:180,000-1:10,300,000, and D-deletion: 1: 180,000-0.

Conclusions: We presented refined estimates of ABO, Rhesus D and Kell blood group frequencies and established reliable frequency estimates for Rhesus haplotype and some rare blood groups. The prevalence of D category VI was about 0.02%, which necessitates specific detection for Rh-D-negative transfusion therapy. A protocol is presented for Rh D typing in transfusion recipients. which obviates the need for an antiglobulin test.

Objective: To evaluate the effect of the early postoperative administration of an enriched enteral diet in cancer patients.

Design: Randomised controlled study.

Setting: Surgical intensive care unit of a university hospital.

Patients: 77 consecutive patients undergoing curative surgery for gastric or pancreatic cancer.

Interventions: Patients were randomised into 3 groups to receive: a standard enteral formula (n=24); the same formula enriched with arginine, RNA, and omega-3 fatty acids (n = 26), isonitrogen isocaloric total parenteral nutrition (n = 27). Enteral nutrition was started within 12 h following surgery. Infusion rate was progressively increased reaching the full regimen on postoperative day (POD) 4. On admission and on POD 1 and 8, the following measurements were performed: serum level of total iron-binding capacity, albumin, prealbumin, retinol-binding protein (RBP), and cholinesterase. Delayed hypersensitivity response (DHR), IgG, IgM, IgA, lymphocyte subsets. and monocyte phagocytosis ability were also evaluated. Bioelectrical impedance analysis was performed preoperatively and on POD 2, 7, and 11. The rate and severity of postoperative infections and the length of hospital stay were evaluated.

Results: In all patients, a significant drop of nutritional and immunologic parameters was observed on POD 1. A significant increase of prealbumin (p<0.02), RBP (p<0.005), monocyte phagocytosis ability (p<0.001), and DHR (p<0.005) was found on POD 8 only in the group fed with the enriched diet. A significant reduction of severity of postoperative infections and length of postoperative stay was found in the group with the enriched diet compared to the other groups.

Conclusions: These data are suggestive of an improvement of the nutritional and immunologic status and clinical outcome in cancer patients who receive an enriched enteral diet in the early postoperative course.

Unlabelled: Changes in hemostasis during orthotopic liver transplantation (OLT) and an intraoperative bleeding complication requiring massive transfusion are discussed.

Design: The monitoring of hemostasis included bed-sided thromboelastography, measurement of in vitro platelet function with the thrombostat and routine coagulation tests as well as retrospective analysis of coagulation factors.

Results: Changes in hemostasis during OLT were documented as reported previously until reperfusion of the donor organ. Due to an incongruence between the caval veins and massive surgical bleeding, the liver had to be clamped again for reconstruction and perfused with University-of-Wisconsin solution. The second reperfusion was technically uncomplicated. However, the coagulation profile deteriorated dramatically: especially a decrease in platelet function and hyperfibrinolysis led to massive oozing. Successful therapeutical intervention included substitution of packed red blood cells. fresh frozen plasma, platelets. concentrates of hemostatic factors, and aprotinin. The patient was discharged from hospital after 5 weeks with a good liver function and a normal coagulation profile.

Conclusion: During OLT, clinically relevant changes in hemostasis can occur suddenly. Therefore. a close perioperative monitoring of primary and secondary coagulation is mandatory.

Background: The lack of additional antibodies--for example anti-T--which can be contained in test sera of human origin has been pointed out as an advantage of monoclonal reagents in blood group serology. It was the aim of our study to examine whether the reactions of monoclonal reagents are nevertheless disturbed by T activation of red blood cells or not.

Materials and methods: Monoclonal reagents of several manufacturers of the specificities anti-A, -B, -AB, -A1, -H, -C, -c, -D, -E, -e, -K, -Jka, -Jkb, -Lea, -Leb, -M, and -N were tested. For this study we examined sialidase-treated and not treated red blood cells with and without the tested blood group antigen by the reagent using the tube centrifugation method.

Results: We found no significant disturbances for the monoclonal reagents of the AB0-system, A subgroups, Rhesus system, Kidd system, Kell antigen, and Leb antigen. Monoclonal anti-M and anti-N showed missing reactivity with sialidase-treated erythrocytes, which is already known from polyclonal test sera. Most of the monoclonal anti-Lea reagents showed strong false-positive reactions with T-positive Le(a-) erythrocytes. After several absorptions of one of the monoclonal anti-Lea reagents with T-activated Le(a-b-) red blood cells, the reactivity of the reagent with the Lea antigen and the T antigen had disappeared.

Conclusions: In contrast to the other monoclonal reagents for most of the monoclonal anti-Lea reagents the lack of additional anti-T antibodies does not indicate the lack of false-positive reactions. This cross-reactivity might be caused by the fact that the type 1 chain antigen Lea and the type 3 chain antigen T have the same terminal saccharide (galactose) in beta 1-->3 connection to the preterminal saccharide of their peripheral core structure.

Background: In thrombocytapheresis, intermittent flow cell separators produce platelet concentrates (PC) with a higher leucocyte contamination than continuous flow blood cell separators. The new discontinuous flow cell separator Haemonetics MCS 3p offers a low-leucocyte solution for PC. The quality of PC obtained by the MCS 3p was investigated in this study.

Design: Prospective study.

Setting: Haemapheresis Unit of a University Clinic.

Patients: Healthy blood donors from the haemapheresis unit.

Materials and methods: Platelet (PLT) yield, separation efficiency and white blood cell (WBC) contamination were studied in three different protocols. Two protocols used a haemocalculator, which calculated the target volume based on the donor's physical characteristics and the desired PLT yield for the procedure. Protocol I used 3,000 ml as target process volume and protocol II 3.3 x 10(11) as desired PLT yield. Protocol III was used without haemocalculator. Glucose, lactate, lactate dehydrogenase (LDH), morphology score and pH value were analysed to investigate the quality of the PC.

Results: Platelet yield and separation efficiency were not statistically different in the three protocols. Leucocyte contamination was lowest in the protocol without haemocalculator (median: 3.15 x 10(6), range 0.4-20.8 x 10(6)). Glucose, lactate, LDH and pH were not statistically different in the three protocols. Morphology score was best in protocol III.

Conclusions: PLT collection with the MCS 3p blood cell separator results in sufficient thrombocyte yields. Using the haemocalculator we were not able to achieve the desired platelet yield. For this reason, and because of the higher WBC contamination in protocol II we prefer PLT collection without the haemocalculator. The quality of the platelet concentrates was good with respect to the parameters glucose, lactate, LDH, morphology score and pH.

Background: Second-generation enzyme immunoassays (EIA-2) for antibodies to hepatitis C virus (anti-HCV) have an improved specificity and sensitivity compared to first-generation enzyme immunoassays (EIA-1). Therefore the question arises how many anti-HCV-positive blood donors were missed by the EIA-1, how many were false positive, how false-positive donors should be dealt with and how the results of the EIA-2 correlate with demographic data and surrogate testing for serum alanine aminotransferase (ALT).

Material and methods: A total of 208,544 individual North German blood donors not preselected for anti-HCV negativity were tested for anti-HCV with EIA-2 and, if repeatedly reactive (rr), with a licensed supplementary test (RIBA-2).

Results: Overall, 0.43% of the donors were EIA-2 rr, but only 0.12% of women and 0.09% of men were RIBA-2 positive. RIBA-2 positivity rates were very low in donors 18 to 27 years old (0.03% and 0.05%) and clearly rose with age in women but not in men. The rate of unspecifically positive EIA-2 results (entirely negative in RIBA-2) rose with age in both sexes and did not correlate with ALT. The ALT distribution was age dependent with a completely different pattern for men and women. Anti-HCV positivity was strongly correlated with ALT albeit on a very low level: more than 97% of donors with strongly elevated ALT were anti-HCV negative. Follow-up and comparison of EIA-1, EIA-2 and RIBA-2 results for the subsequent donations showed that only 8% of now RIBA-2-positive donors were not detected by EIA-1. Apparent seroconversions in EIA-2 are usually not specific: only one out of 66 apparent seroconversions could be confirmed by RIBA-2. 0.15% of the donor population showed an inconsistent EIA-2 pattern during follow-up.

Conclusions: We therefore suggest that donors should not be excluded from further donations on the basis even of multiple EIA-1 positive results or on the basis of only one EIA-2-positive donation. The value of ALT screening for transfusion safety should be reconsidered.