Beitrage zur Infusionstherapie = Contributions to infusion therapy最新文献

There are two main forms of factor XII deficiency: patients with immunological cross-reacting material (CRM+) and patients without (CRM-). For 1 case of CRM+ an amino acid substitution (Cys571-->Ser) has been described. We are currently investigating two families of Hageman CRM- trait with the typical hemostaseological pattern: one member with virtually no factor XII activity and antigen, whose sisters and children have about 50% of activity and antigen. To elucidate the genetic defect, primers were synthesized for both exon-intron borders for each of the 14 exons. Polymerase chain reaction (PCR) was performed for each single exon and for any two exons in a row with the intron in between (double-exon screening). We were able to demonstrate that homozygous patients do not have major rearrangements, deletions or insertions of the factor XII gene. To localize the molecular defect, the complete gene was sequenced by cloning the PCR products into pBS. In 1 patient, a single base deletion in exon 12, leading to a nonsense protein, was detected. The propositus was shown to be heterozygous for this defect by a deletion-specific restriction fragment length polymorphism of the PCR product.

The overall risk of autologous hemotherapy, consisting of the risks due to donation and transfusion, has to be lower than that of homologous hemotherapy. To maintain the advantage of autologous blood, for example preoperative blood deposit, it has to be collected and prepared according to the guidelines on the production of homologous blood, except some obvious deviations concerning donor criteria. In this paper we recommend measures for the quality assurance in autologous predeposits from the point of view of transfusion medicine.

Modern haemotherapy is equivalent to restrictive use of blood components. Therefore, transfusion of whole blood in homologous transfusion generally cannot be accepted. In autologous blood transfusion blood components also are preferable if they can be separated appropriately. In order to have broad application of preoperative autologous blood deposits, close cooperation to transfusion services should be established guaranteeing optimal production of blood components. If this cooperation is impossible there are no objections against the use of autologous whole blood as long as the expected blood consumption is less than 3 red cell units. Additionally, in this case storage of more than 3 weeks mostly is not necessary. The fact that whole blood is not further part of the 'Monographien' of the Federal Health Administration (BGA) does not forbid the use of autologous whole blood since the 'Monographien' only concern generally available homologous blood components.

Peripheral blood stem cells are an alternative to bone marrow-harvested stem cells. We report on the feasibility of predicting optimal timing for leukapheresis by means of blood monitoring for CD34-positive cells by flow cytometry. In addition to monitoring, determinations of CD34-positive cells also are predictive for the hemopoietic potency of cells harvested by leukapheresis, as close correlations of numbers of CFU-GM and of CD34-positive cells, respectively, in leukapheresis samples are determined. Our data are indicating that flow-cytometrical determinations of CD34-positive cells are helpful in the setting of blood stem cell harvesting by leukapheresis, both for optimal timing of the procedure and for real-time estimation of the hemopoietic potency of cells harvested.