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Purpose: To analyze the transfusion rate of adult transfused patients undergoing standard curative surgery made in operating room (not ambulatory).

Patients and methods: Data from discharge reports of patients having surgery during 1996, codified according to the International Diseases Classification (ICE-9-MC). Age, sex, diagnosis, procedures (including transfusions), were analysed along with the surgical procedures and if the patient was subsequently admitted.

Results: 11,673 adult patients had surgery, of whom 890 underwent transfusion (7.6%). The transfusion rate was greater in males, in patients over 60 years old, in patients with several surgical procedures simultaneously, in patients who were subsequently admitted, and in patients with surgery procedures of pancreas, spleen, dorsolumbar column, liver, pharynx, hip and stomach.

Conclusions: Given the variability in the blood transfusion practices among the hospitals, to know the transfusion rates of each clinic and surgical situation would permit a better planning of: the surgical blood transfusions, the autologous blood transfusion program, the criteria on crossmatching tests, as well as to increase the information to the patient in the surgical Informed Consent.

Purpose: Donor leukocyte infusions (DLI) are useful for treating leukaemic relapse after allogeneic bone marrow transplantation (BMT). We reviewed our experience with eleven patients who received DLI between 1995 and 1997.

Patients and methods: The diagnoses prior to DLI were: chronic myeloid leukaemia (CML) in chronic phase (CP) (two patients) or accelerated phase (two patients), acute myeloid leukaemia (AML) (two patients), acute lymphoid leukaemia (ALL) (two patients), and refractory anaemia with excess blasts under transformation (tRAEB) (three patients). The patients received a median of 1.72 x 10(8) CD3+ cells/Kg (range: 0.58 x 10(8) CD3+ cells/Kg). Four patients were infused cryopreserved cells. Six patients received interferon alpha (IFN alpha) concomitantly.

Results: Seven patients (four CML, one AML, one ALL, one tRAEB) obtained complete remission (CR). Graft-versus-host disease (GVHD) was observed in all patients with CR and one without response. Marrow hypoplasia or severe bicytopenia occurred in four patients. Of all patients achieving CR, two died after relapsing within 3 months of DLI, while three others died of GVHD. Four patients had no response to DLI or were not evauable. Only two patients--both with CML--are alive 1096 and 374 days after DLI, the former in clinical, cytogenetic and molecular CR, and the latter in second CP after 2 months in CR.

Conclusions: DLI results in CR in most patients with relapsing leukaemia or myelodysplasia after BMT, especially in CML patients. The anti-leukaemia effect is highly correlated with GVHD. This complication and marrow hypoplasia remain major causes of morbidity and mortality of this procedure.

Objective: Neoantigen formation during heat treatment (HT) of factor VIII:von Willebrand Factor (FVIII:vWF) concentrates may induce an immune response against the modified protein, which may also affect the native protein. We present a comparative in vitro study on the immunogenicity of a dual virally inactivated (solvent-detergent and 80 degrees C 72 hours) high purity FVIII:vWF concentrate (Fanhdi) versus the same product without heat treatment.

Material and methods: For this purpose rabbit antisera were prepared using both Fanhdi and the same product from which the human albumin, used as stabilizer, had been removed (these were both HT products). Also, antisera were prepared against the same products made without the dry-heat treatment step (non-HT products). Antisera were analysed by Elisa. Mixtures of antisera with increasing amounts of product (incubation-absorption in liquid phase) were assayed in plates coated with HT and non-HT products.

Results: The binding of antibodies against HT products to ELISA plates coated with HT products, could be blocked (in a saturable manner) with non-HT products, following liquid phase incubation. These results strongly suggest the absence of neonantigens. Furthermore, the binding of antibodies against non-HT products to ELISA plates coated with non-HT products, could be blocked (also in a saturable manner) with HT products. This result indicates that there is no epitope loss.

Conclusions: The data obtained in these studies suggest that the heat treatment of viral inactivation as applied in Fanhdi, does not give rise to any major alteration in immunogenicity of the product. The data from clinical and drug surveillance studies carried out with Fanhdi do not show any indication of an increase in the frequency of inhibitors.

Purpose: Prenatal and postnatal prophylaxis of the Rh (D) haemolytic disease of the newborn have clearly reduced the number of cases but still there are alloimmunizations.

Patients and methods: All cases detected in our Hospital in the last 24 years have been reviewed and possible causes analyzed.

Results: From a total of 10,332 deliveries in Rh (D) negative women we have detected 114 anti-D in 86 women. In 74 women anti-D was the only antibody and in 12 there were more antibodies. Data were managed in 3-year periods and we see a progressive decrease in the incidence of alloimmunization with a minimum of 0.03 per 1000 pregnancies in the period 89-91 and a posterior progression to an incidence of 0.12 in the last 3-year period 95-97. The causes were: pregnancies before 1970 in 31, incorrect prophylaxis in 12, despite a correct prophylaxis in 6, previous pregnancies without complete information about the prophylaxis in 13, previous transfusion in 6, previous pregnancies or transfusion in 8 and indetermined in 10.

Conclusion: It is desirable to reduce at minimum the number of Rh (D) alloimmunizations by strictly following the prophylaxis protocols.

Purpose: To detect patterns of endogenous polypeptide phosphorylation in monocyte, lymphocyte, and polymorphonuclear leukocyte populations, induced by the products of the catalytic action of L-asparaginase (EcA).

Materials and methods: Monocytes, polymorphonuclear cells and lymphocytes were isolated from heparinized blood from healthy, voluntary donors. The samples were incubated in 0.4 mCi/ml of [gamma-32P]H3PO4, with: 1 microgram/microliter of EcA, EcA and the substrate or with the products of EcA's catalytic activity: NH4+ and aspartate. The cells were lysated and electrophoresed using denaturing polyacrylamide gels that were then exposed on radiographic plates. The levels of polypeptide phosphorylation were quantified by computer densitometric analysis.

Results: The autoradiographs and the densitometric quantification of the electrophoretic profiles of monocytes, polymorphonuclear leukocytes, and lymphocytes revealed an increase in polypeptide phosphorylation when the cells were incubated with the enzyme and its substrate, ammonium and aspartate, or ammonium, which demonstrates that the NH4+ triggers intracellular phosphotransferase activity. A 58 kDa phosphoprotein outstood, it being common to the three cell populations studied. There were also specific phosphorylable polypeptides in monocytes, polymorphonuclear leukocytes, and lymphocytes.

Conclusions: Escherichia coli L-asparaginase, binds the plasma membrane in normal human immune cells, catalyzing the L-asparagine substrate. The products of its activity: aspartate and NH4+ modify the extracellular environment, particularly the latter since it could diffuse into the cytosol and modify the pH, which would activate signal transduction pathways associated with the phosphorylation of substrates.

Purpose: The widespread use of aggressive surgical procedures, along with the increasing incidence of traffic accidents, has raised the necessity of homologous blood beyond the supplies of blood banks. This fact, plus the risks of homologous transfusion and the costs of blood bank maintenance, has prompted the advance of blood saving procedures such as autotransfusion, both in the pre-deposit (preoperative autotransfusion, POA) and the surgical drainage reinfusion (postoperative autotransfusion, SDR) modalities. As there is some controversy about the use of one or the other of the above procedures, the purposes of this study were: 1) to analyse the haematological and biochemical characteristics of blood, both pre-donated and stored at 4 degrees C for 4 weeks, and that recovered from surgical drains, from patients subjected to programmed orthopaedic or heart surgery; 2) to assess the metabolic and functional state of red cells attained from that blood, and 3) to compare the results achieved.

Material and methods: The following data were examined: red cell count, haematocrit, haemoglobin, red cell indicates, white cell count, platelet count, free plasma haemoglobin, red cell morphology, glucose, cholesterol, triglycerides, phospholipids, serum proteins and their fractions, ions, histamine, red cell glucose and amino acid transport, and ATP and 2,3-DPG content.

Results: The red cells, haemoglobin and haematocrit concentrations in POA blood did not show significant variations during the storage for 4 weeks and their values were significantly higher than found in drained blood. The biochemical values showed heterogeneous variations. Glucose and amino acid uptake by red cells of POA blood slightly decreased in the first 2 weeks of storage but always less than measured in SDR red cells. In POA blood it was noticed a progressive decrease in intra-erythrocytic ATP and 2,3 DPG, those levels being normal in SDR.

Discussion: In spite of lower haematocrit and haemoglobin but higher free plasma haemoglobin content, drained blood had higher ATP and 2,3-DPG concentration than pre-deposit, stored blood. Drained blood showed also less ion alterations and probably a lesser immunosuppressor capability. Thus, postoperative blood recovery seems a good source of red cell, with high oxygen transport power, and so, alone or in combination with pre-donated blood, it may contribute to reduce the necessities for homologous blood and decrease its risks.