Beitrage zur Infusionstherapie = Contributions to infusion therapy最新文献

In addition to several conventional methods for the detection of red cell antigens, the use of microplates has various advantages either as a solid-phase assay (enzyme immunoassay) or as native microplate. Microplates may also be used for the detection of red cell antibodies in 'pooled-cell solid-phase assays' of the second generation and for antibody screening. Blood donors and patients are the two main fields which are to be examined in immunohematology. There are various advantages in using the microplate in blood group serology: (i) if there is hardware already available, like sample processors and microplate readers, the use of microplates in blood group serology reduces the costs even if the equipment has to be purchased for this purpose only; (ii) low quantities of reagents are used in microplate assays; (iii) the application of bar codes on tubes and microplates guarantees the most security in sample identification; (iv) it is possible to investigate blood samples selectively depending on the available software if antibody detection is done as the sixth test beside anti-HIV, anti-HCV, HBsAG, lues antibodies and ALT, and (v) recording of data will be easy if electronic data processing is used.

Transfusion-associated graft versus host disease (ta-GvHD) is a rare but almost lethal complication of blood transfusion in immunocompromised patients. To prevent ta-GvHD, irradiated blood products should be given to patients at risk: patients after bone marrow transplantation, newborns and children in the 1st year, patients with severe combined immunodeficiency, and patients receiving blood from first-degree relatives. Blood products should be irradiated at least with 30 Gy just before transfusion. With this regime in practice for 4 years, no complications and side effects were seen.

Today, in addition to the classical test tube technology to determine red blood cell antigens and antibodies, not only the microtitration plate is increasingly used, but also the gel card. Since this new technology is easy to practice and since it further provides a higher specificity and sensitivity, we investigated whether, and if so to what extent, the gel card can be automated. On the basis of our own experience spanning many years, we were able to show that antigen determinations and antibody screening can be automated. Once the samples to be tested and the tests to be performed have been recorded by electronic data processing and combined in a job list, any sampler can distribute liquids, such as reagents and serum and/or plasma as well as red blood cell suspensions, on the basis of these data. A positive sample identification is made feasible by bar coding sample tubes and gel cards; the pipetting action is organized via the bar codes. Incubation and centrifugation are of secondary importance for automation. At this time, an automatic evaluation of gel cards is not yet possible so that result interpretation must be visual and the input of results must be manual. For documentation, however, laboratory books and result interpretation reports can be printed out automatically.

Worldwide, platelet transfusions have increased substantially, especially in hematological patients. The prophylactic and therapeutic indications for platelet substitution as well as the choice of platelet preparation are discussed for patients with acute leukemia or aplastic anemia who need the highest platelet support. Here we present our current strategy, i.e., prophylactic transfusions with random platelets in acute leukemia and therapeutic transfusions with filtered random platelets in aplastic anemia patients only.

Only multicenter studies on cell separators give valid data to compare different cell separators. The aim of the 2nd multicenter study was to evaluate the separation protocol, software version V 4.61, of the Fresenius AS-104 cell separator for efficiency and deviation from predicted yields. Plateletpheresis data from twelve hemapheresis centers, using identical apheresis protocols and cell counting methods, were registered and statistically analyzed. Additionally, the counting methods of the centers were controlled by a ring study with biweekly external cell count trials. To get a comparison, the apheresis data, which depend on the center effects, were corrected by the values from the ring study. Preliminary results of 380 runs are 45.2 +/- 8.1% for the separation effectivity, 1.95% deviation from the predicted yield, whereby 90% of all runs deviated less than 20% from the predicted yield. 50% of products had a WBC contamination below 6 x 10(6).

Drug-induced immune hemolytic anemia is a serious hematological disorder which results from increased red blood cell destruction due to the production of autoantibodies, drug (metabolite)-dependent antibodies (DDAb) or both types of antibodies, even in one patient by the same drug. One of the major problems related to DDAb is that the causative drug (metabolite) usually does not bind tightly to target cells, and the antibodies are completely removed from the cells by conventional washing procedures, i.e. by the antiglobulin test. We have recently shown that the microtube geltest, by which the antiglobulin test is performed without washing the cells, is a highly sensitive and reliable alternative method for the detection of all kinds of DDAb. The results obtained with different DDAb are discussed.

From the anesthetist's point of view the following safety measures regarding autologous blood donation have to be considered: [1] inclusion/exclusion criteria for the patient's selection; [2] quality control of the autologous product itself and [3] adequate technical standards of the equipment applied. There is no doubt, the criteria used for the patient's selection of an autologous predeposit program have a great impact both on the number and the severity of complications that might occur. Anesthetists consider a patient eligible for an autologous predeposit program if he/she is considered eligible for an elective operative procedure, too; since this means that this patient demonstrates compensated organ functions (e.g. of the cardiovascular system, of the pulmonary function as well as of the metabolic and hematopoietic system). As shown by data in the literature, these criteria even hold true in patients with serious (but compensated) concomitant diseases. In contrast to the routine procedure of homologous donation, monitoring of a patient during the autologous predeposit procedure as well as an adequate replacement of the volume of the autologous predeposit donated appear to be reasonable, especially in patients with serious risk factors. Following this concept, the number of undesired side effects during the autologous donation is in the same order as it is known from healthy volunteers for homologous donation. It appears wise to apply the same safety and quality standards for an autologous predeposit as for the comparable homologous products. Most important and without any restriction, the autologous product has to be safe for the patient: there should be no bacterial contamination of the autologous product, and the corpuscular content of the autologous plasma should not exceed a definite limit.(ABSTRACT TRUNCATED AT 250 WORDS)