Beitrage zur Infusionstherapie = Contributions to infusion therapy最新文献

The optimum and critical hemoglobin concentrations are determined by the oxygen demand of the tissues and several oxygen transport parameters (i.e., blood flow, arterial oxygen saturation, oxygen affinity of hemoglobin, and the critical venous oxygen pressure). Most of the oxygen transport parameters change markedly during the first weeks after birth. Oxygen consumption and cardiac output in neonates are three times those of adults on a body weight basis. Due to the high oxygen affinity of fetal hemoglobin, the oxygen unloading capacity of hemoglobin in neonates is about 50% less than in adults. From oxygen transport parameters and oxygen consumption we have calculated the optimum and the critical hemoglobin concentrations for preterm and full-term neonates during the first weeks after birth. A hemoglobin concentration of 15 g/dl appears optimal for preterm and full-term infants at birth as well as for adults. The calculated minimum acceptable hemoglobin concentration is 6 g/dl for children and adults, 12 g/dl for preterm infants and 11 g/dl for full-term neonates at birth. Due to the postnatal decrease in oxygen affinity, the minimum acceptable hemoglobin concentration decreases by approximately 1 g/dl/week for the first 5-6 weeks until the minimum value of 6 g/dl for children and adults is reached. The minimum hemoglobin concentration should be 2 g/dl higher in patients who require increased oxygen or suffer from other serious disorders. A minimum hemoglobin concentration of 10 g/dl is recommended in children with leukemia or other oncological disease. In infants and children with chronic hypoxemia (cyanotic congenital heart disease) the minimum hemoglobin concentration should be increased by the percentage of arterial oxygen desaturation.

We studied the influence of storage (1-5 days) and gamma irradiation (0, 25, 50, 100 Gy) on the in vitro aggregability of stored platelets. Platelet aggregation was measured using the method of Born and Breddin and the aggregating agents ADP, collagen, ristocetin and arachidonic acid. With increasing time of storage the ADP-, collagen- and ristocetin-induced platelet aggregation was significantly diminished. On the other hand, the irradiation even with 100 Gy had no additional effect.

We performed a meta-analysis of 6 randomized clinical trials to study the efficacy of passive immunization against CMV in solid organ transplantation. The results indicate that passive immunization against CMV prevents (fatal) CMV disease in CMV seronegative recipients of a CMV seropositive allograft, even when treated with additional immunosuppression in case of rejections. Passive immunization with anti-CMV immunoglobulin preparations did not reduce the incidence of CMV infection or disease in CMV seropositive recipients.

The section 'Plasmatic Blood Constituents' of DGTI (German Society for Transfusion Medicine and Immunohematology) performed four ACA (anticomplementary activity) ring tests with human immunoglobulins for intravenous application (IVIG). The laboratories carrying out the analyses presented relatively consistent ACA results for IVIG commercial preparations that were obtained by means of the ACA method elaborated based on these tests. The tolerance trials evaluating the IVIGs solely by means of in vitro tests are not sufficient to serve as safety controls since there is no clear correlation existing between the ACA values and their compatibility in the animal model (rat).

With regard to the controversial issue of a reduction of transfusion-associated infections by non-remunerated donations, epidemiological data on the prevalence of HIV-1, HIV-2 and hepatitis C virus (HCV) are of particular interest in our country. We investigated four sample categories: (1) healthy employees and workers from Hamburg; (2) hemodialysis patients; (3) hemato-oncological patients, and (4) blood donors, and tried to differentiate between the three disputed vectors of community-acquired (sexually or pregnancy-transmitted), nosocomial and transfusion/transplantation-associated HCV infections. We conclude from our results that--prior to the implementation of blood screening--our carefully selected 'paid blood donors' conferred no higher HCV risks than the general (working) population (0.66 vs. 0.82% HCV antibody prevalence). Besides transfusions/transplantations, significant nosocomial risks apparently exist in hemodialysis units (21.0 vs. 9.5% HCV seroprevalence in polytransfused patients). Preventive measures, e.g. separate dialysis machines for HCV-positive patients, seem to be advisable.

In this study, we compared the ability of serum and of 5 additive solutions for the liquid storage of red blood cells to preserve the cellular contents of 2,3-BPG and the adenylate nucleotides ATP, ADP and AMP. As to the adenylates, PAGGS-M showed the best results. However, the difference to SAG-M was significant only after 7 weeks. On the other hand, serum appears to be the best medium for the conservation of 2,3-BPG. Between the 1st and 3rd week of storage, the decrease of 2,3-BPG was somewhat slower in PAGGS-M and SAG-M compared with the other 3 additive solutions.

A variety of antibody screening tests are available to detect immunization in patients' sera. However, antibodies can be observed only if corresponding antigens are present on test cells used by an antibody screen. By comparing available test cell kits of different manufacturers we revealed various specificities of antigens present or absent on these cells. Using by an antibody screen Wr(a+), Co(b+) and Kp(a+) test cells additionally to available test cells, we detected in 1000 sera of patients 13 anti-Wr(a) and 1 anti-Co(b) besides 17 antibodies with different specificities.

A new ELISA test system for screening antibodies directed against Treponema pallidum is presented. The ELISA is based on a recombinant DNA-derived T. pallidum membrane protein A (TmpA). It makes the production of the kit easier as it abandons the necessity to culture T. pallidum in living animals. The specificity and sensitivity of the ELISA are comparable with those of the TPHA and FTA-ABS. The test gives only a positive result when there are antibodies against the TmpA antigen and, therefore, it gives in screening (e.g. blood donors) no false-positive reaction in persons who, due to an old well-treated infection, have a so-called serological scar. As these donors are noninfective, they should be concerned as negative in syphilis screening.

In the past 10 years 201 HLA-identical bone marrow transplantations (BMT) were performed with major ABO incompatibility in 41 (20%) and minor ABO incompatibility in 35 (18%) patients. ABO compatibility between donor and recipient showed no influence on granulocyte and platelet recovery after BMT. Erythrocyte reconstitution was significantly (p < 0.01) delayed for about 1 week in major ABO-incompatible BMT. In addition, a pure red cell aplasia lasting for 2-5 months occurred in 6 out of 21 blood group 0 patients who received transplants of group A. The rate of graft rejection, incidence of graft-versus-host disease as well as the leukemic relapse rate were similar in ABO-compatible and ABO-incompatible BMT. The probability of a 10-year survival after BMT is independent of ABO compatibility between donor and recipient.

A patient with non-Hodgkin's lymphoma was treated by ambulant lymphocytapheresis once a month over a period of 2 years and 8 months. The cytoreductive effect resulted in a decrease of white blood cells from 410/nl to 130/nl. The patient tolerated the procedure, which lasted 3-4 h, without any side effects. He could be kept in good condition by monthly apheresis. So lymphocytapheresis is a means to reduce hyperleukocytosis in patients with non-Hodgkin's lymphoma.