Pub Date : 2010-05-14DOI: 10.1111/J.1778-428X.2010.01125.X
N. Usoro, Samuel Inwang, I. Ilori
Bloodless surgery was introduced initially for the care of patients who refused blood transfusion. Recently however, adverse outcome with blood transfusion has been reported in virtually all subspecialties of surgery and conversely, improved outcome with non-transfusion surgery. Thus blood conservation is the standard of care because it is evidence-based. Thyroid surgery is historically associated with blood loss, and a lower hematocrit would be expected postoperatively. We report a case of subtotal thyroidectomy for a large simple multinodular goiter using planned blood-conservation techniques tailored to the patient that resulted in maintenance of a normal hematocrit throughout the perioperative period. The patient received oral hematinics preoperatively, while acute normovolemic hemodilution and other techniques were used to minimize intraoperative blood loss. The outcome was an optimized hematocrit preoperatively, minimal blood loss intraoperatively, and hematocrit which remained optimal on the third postoperative day and 3 weeks postoperatively. No allogeneic blood was used at any stage. This suggests that maintenance of normal hematocrit can be regarded as an achievable goal in high-risk surgery through blood-conservation techniques. Avoiding allogeneic blood transfusion is possible in a resource-poor setting, where HIV prevalence is high and screening of blood may be suboptimal, and it is the ideal clinical approach as demonstrated in this case report.
{"title":"Maintenance of normal hematocrit in high-risk thyroid surgery without allogeneic blood transfusion: a case report: THYROID SURGERY WITHOUT BLOOD TRANSFUSION","authors":"N. Usoro, Samuel Inwang, I. Ilori","doi":"10.1111/J.1778-428X.2010.01125.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2010.01125.X","url":null,"abstract":"Bloodless surgery was introduced initially for the care of patients who refused blood transfusion. Recently however, adverse outcome with blood transfusion has been reported in virtually all subspecialties of surgery and conversely, improved outcome with non-transfusion surgery. Thus blood conservation is the standard of care because it is evidence-based. Thyroid surgery is historically associated with blood loss, and a lower hematocrit would be expected postoperatively. We report a case of subtotal thyroidectomy for a large simple multinodular goiter using planned blood-conservation techniques tailored to the patient that resulted in maintenance of a normal hematocrit throughout the perioperative period. The patient received oral hematinics preoperatively, while acute normovolemic hemodilution and other techniques were used to minimize intraoperative blood loss. The outcome was an optimized hematocrit preoperatively, minimal blood loss intraoperatively, and hematocrit which remained optimal on the third postoperative day and 3 weeks postoperatively. No allogeneic blood was used at any stage. This suggests that maintenance of normal hematocrit can be regarded as an achievable goal in high-risk surgery through blood-conservation techniques. Avoiding allogeneic blood transfusion is possible in a resource-poor setting, where HIV prevalence is high and screening of blood may be suboptimal, and it is the ideal clinical approach as demonstrated in this case report.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2010.01125.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63389525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-05-14DOI: 10.1111/J.1778-428X.2010.01130.X
W. Horstmann, R. Slappendel, G. V. Hellemondt, R. Castelein, C. Verheyen
SUMMARY Autologous retransfusion of filtered drained blood is widely used after total hip (THA) and knee arthroplasty (TKA) in many countries. Despite its wide use, prospective studies on clinical side effects with a substantial number of patients have not been published. In this prospective clinical trial, 1819 consecutive patients in 38 hospitals were retransfused using a low-suction drainage autologous blood transfusion system, after THA (n = 995) or TKA (n = 824). The occurrence of adverse events during retransfusion of the filtered shed blood was studied. An average of 460 mL of drained blood (THA, 374 mL; TKA, 563 mL) was retransfused within 6 hours postoperatively. The frequency of serious adverse events was 0.1%, which concerned two patients: one had a short asystole during reinfusion that responded quickly to medication; and the other with a history of deep vein thrombosis had pulmonary embolism. By way of non-serious adverse events, febrile reactions (fever, shivering) were observed in 3.1% of the patients during retransfusion. Clot formation was observed in the drained blood in six (0.3%) patients; therefore, retransfusion was not carried out. These minor adverse events were seen more often after TKA (5.8%) than after THA (1.5%). Nine (0.5%) patients were retransfused with volumes above 1500 mL (average 1657, range 1550–1900), without adverse events. Additional allogenic blood transfusions were required by 18% of the THA and 9% of the TKA patients. In this study, few adverse events were detected during retransfusion. The frequency of serious (0.1%) and minor (3.5%) adverse events was similar to other smaller clinical studies. Based on the low incidence of side effects in this large cohort of orthopedic patients, postoperative cell salvage with such a retransfusion system is considered to be safe.
{"title":"Safety of retransfusion of filtered shed blood in 1819 patients after total hip or knee arthroplasty: SAFETY OF RETRANSFUSION","authors":"W. Horstmann, R. Slappendel, G. V. Hellemondt, R. Castelein, C. Verheyen","doi":"10.1111/J.1778-428X.2010.01130.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2010.01130.X","url":null,"abstract":"SUMMARY \u0000Autologous retransfusion of filtered drained blood is widely used after total hip (THA) and knee arthroplasty (TKA) in many countries. Despite its wide use, prospective studies on clinical side effects with a substantial number of patients have not been published. In this prospective clinical trial, 1819 consecutive patients in 38 hospitals were retransfused using a low-suction drainage autologous blood transfusion system, after THA (n = 995) or TKA (n = 824). The occurrence of adverse events during retransfusion of the filtered shed blood was studied. An average of 460 mL of drained blood (THA, 374 mL; TKA, 563 mL) was retransfused within 6 hours postoperatively. The frequency of serious adverse events was 0.1%, which concerned two patients: one had a short asystole during reinfusion that responded quickly to medication; and the other with a history of deep vein thrombosis had pulmonary embolism. By way of non-serious adverse events, febrile reactions (fever, shivering) were observed in 3.1% of the patients during retransfusion. Clot formation was observed in the drained blood in six (0.3%) patients; therefore, retransfusion was not carried out. These minor adverse events were seen more often after TKA (5.8%) than after THA (1.5%). Nine (0.5%) patients were retransfused with volumes above 1500 mL (average 1657, range 1550–1900), without adverse events. Additional allogenic blood transfusions were required by 18% of the THA and 9% of the TKA patients. In this study, few adverse events were detected during retransfusion. The frequency of serious (0.1%) and minor (3.5%) adverse events was similar to other smaller clinical studies. Based on the low incidence of side effects in this large cohort of orthopedic patients, postoperative cell salvage with such a retransfusion system is considered to be safe.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2010.01130.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63389725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-03-01DOI: 10.1111/J.1778-428X.2009.01116.X
R. Chaudhary, S. Das, D. Khetan, S. Ojha, S. Verma
SUMMARY The practice of high-yield or double-dose platelet (DDP) collection through automated apheresis is gradually increasing. Very few studies have examined donor safety issues in DDP collection. The present study highlights the process of DDP donor selection as well as the product quality and donor safety issues on 67 donors. All procedures were performed following the departmental standard operating procedure. We observed a significantly higher mean platelet yield with the Amicus separator than the Fresenius separator (5.4 × 1011vs. 5.1 × 1011, P = 0.03). The Fresenius separator processed a mean blood volume of 3974 mL and collected a mean platelet amount of 444.9 mL, and these were significantly higher when compared with Amicus (P < 0.0001). Mean values of procedure-related parameters, such as acid-citrate-phosphate volume, donation time, needle time, processing time and whole blood processed, and donor-related parameters, like citrate toxicity and vasovagal reactions, were significantly higher during DDP than single-dose platelet collection (P < 0.05). We conclude that obtaining eligible donors for DDP from a shrinking donor population with low normal platelet values is a difficult task. Therefore, each transfusion service should set their own guidelines for DDP collection with the objectives of donor safety and optimal product quality.
{"title":"Donor safety issues in high-dose platelet collection using the latest apheresis systems","authors":"R. Chaudhary, S. Das, D. Khetan, S. Ojha, S. Verma","doi":"10.1111/J.1778-428X.2009.01116.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2009.01116.X","url":null,"abstract":"SUMMARY \u0000The practice of high-yield or double-dose platelet (DDP) collection through automated apheresis is gradually increasing. Very few studies have examined donor safety issues in DDP collection. The present study highlights the process of DDP donor selection as well as the product quality and donor safety issues on 67 donors. All procedures were performed following the departmental standard operating procedure. We observed a significantly higher mean platelet yield with the Amicus separator than the Fresenius separator (5.4 × 1011vs. 5.1 × 1011, P = 0.03). The Fresenius separator processed a mean blood volume of 3974 mL and collected a mean platelet amount of 444.9 mL, and these were significantly higher when compared with Amicus (P < 0.0001). Mean values of procedure-related parameters, such as acid-citrate-phosphate volume, donation time, needle time, processing time and whole blood processed, and donor-related parameters, like citrate toxicity and vasovagal reactions, were significantly higher during DDP than single-dose platelet collection (P < 0.05). We conclude that obtaining eligible donors for DDP from a shrinking donor population with low normal platelet values is a difficult task. Therefore, each transfusion service should set their own guidelines for DDP collection with the objectives of donor safety and optimal product quality.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2009.01116.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63389389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-03-01DOI: 10.1111/J.1778-428X.2010.01127.X
Costantino Balestra, P. Germonpré, P. Lafère, Y. Ciccarella, P. Linden
Dear Sir, There is increasing concern regarding the inherent hazard of blood transfusions, host–graft reactions and transfusion-related acute lung injury. Considering the increasing population age, the increased need for blood products when reaching older age, and an already chronic shortage of blood products today, the need for alternative techniques to blood transfusion, and for new blood substitutes or blood salvage techniques is becoming more and more pressing. The use of blood cell progenitor enhancers like exogenous erythropoietin (EPO) is extensively recognized, and in patients with appropriate medical followup, a relatively low rate of adverse effects has been reported. However, the price of such medications is very high and in some countries, their availability is limited. A recently described phenomenon called the ‘normobaric oxygen paradox’ (NOP) may have clinical applications. The technique consists in a simple administration of high oxygen concentration to spontaneously breathing subjects. This has been shown to trigger a Transfusion Alternatives in Transfusion Medicine TATM
{"title":"The ‘normobaric oxygen paradox’: a simple way to induce endogenous erythropoietin production and concomitantly raise hemoglobin levels in anemic patients","authors":"Costantino Balestra, P. Germonpré, P. Lafère, Y. Ciccarella, P. Linden","doi":"10.1111/J.1778-428X.2010.01127.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2010.01127.X","url":null,"abstract":"Dear Sir, There is increasing concern regarding the inherent hazard of blood transfusions, host–graft reactions and transfusion-related acute lung injury. Considering the increasing population age, the increased need for blood products when reaching older age, and an already chronic shortage of blood products today, the need for alternative techniques to blood transfusion, and for new blood substitutes or blood salvage techniques is becoming more and more pressing. The use of blood cell progenitor enhancers like exogenous erythropoietin (EPO) is extensively recognized, and in patients with appropriate medical followup, a relatively low rate of adverse effects has been reported. However, the price of such medications is very high and in some countries, their availability is limited. A recently described phenomenon called the ‘normobaric oxygen paradox’ (NOP) may have clinical applications. The technique consists in a simple administration of high oxygen concentration to spontaneously breathing subjects. This has been shown to trigger a Transfusion Alternatives in Transfusion Medicine TATM","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2010.01127.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63389616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-03-01DOI: 10.1111/J.1778-428X.2009.01118.X
G. Inghilleri
SUMMARY Preoperative estimation of transfusion requirements in patients scheduled for surgery is critical to optimize blood management, including costs, and to appropriately select patients who can benefit from alternatives to allogeneic blood transfusion. Three groups of methods for transfusion requirement prediction have been developed. The simplest methods are those that identify patients at risk of requiring transfusion support on the basis of the surgical procedure they are scheduled for and one or two clinical parameters. Preoperative hemoglobin concentration (or red blood cell mass) and age are the most reliable parameters that have emerged from the studies. A second group of methods includes approaches based on the calculation of a risk score obtained by totaling predefined values assigned to the presence or absence of a number of predictors proven to be relevant in affecting transfusion requirements in a given surgical setting. The third group is based on mathematical approaches that define transfusion requirements by comparing the two elements that determine them: the reduction in red blood cell mass induced by surgery (blood loss) and the maximum red blood cell mass that a patient, according to their clinical condition, can tolerate to lose. Experiences reported to date show these methods can all be helpful in clinical practice for predicting transfusion requirements in the individual patient. Selection of the strategy to be used depends on the precision required, the intended use and hospital organization.
{"title":"Prediction of transfusion requirements in surgical patients: a review","authors":"G. Inghilleri","doi":"10.1111/J.1778-428X.2009.01118.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2009.01118.X","url":null,"abstract":"SUMMARY \u0000 \u0000 \u0000Preoperative estimation of transfusion requirements in patients scheduled for surgery is critical to optimize blood management, including costs, and to appropriately select patients who can benefit from alternatives to allogeneic blood transfusion. Three groups of methods for transfusion requirement prediction have been developed. The simplest methods are those that identify patients at risk of requiring transfusion support on the basis of the surgical procedure they are scheduled for and one or two clinical parameters. Preoperative hemoglobin concentration (or red blood cell mass) and age are the most reliable parameters that have emerged from the studies. A second group of methods includes approaches based on the calculation of a risk score obtained by totaling predefined values assigned to the presence or absence of a number of predictors proven to be relevant in affecting transfusion requirements in a given surgical setting. The third group is based on mathematical approaches that define transfusion requirements by comparing the two elements that determine them: the reduction in red blood cell mass induced by surgery (blood loss) and the maximum red blood cell mass that a patient, according to their clinical condition, can tolerate to lose. Experiences reported to date show these methods can all be helpful in clinical practice for predicting transfusion requirements in the individual patient. Selection of the strategy to be used depends on the precision required, the intended use and hospital organization.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2009.01118.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63389480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-03-01DOI: 10.1111/J.1778-428X.2010.01129.X
R. Moog, D. Knop, F. Wenzel
SUMMARY Fresh frozen plasma (FFP) should be stored at temperatures > −30°C according to national and international guidelines to maintain the stability of clotting factors and inhibitors. In the present report, FFP was accidentally stored at < −30°C due to icing of the freezer. To ensure the quality of the FFPs a battery of tests of clotting factors and inhibitors was performed. Our data demonstrate that temporary storage of FFP at temperature < −30°C does not negatively affect the quality of FFPs. The European requirement of 70% activity of factor VIII was met by all units.
{"title":"Temporary storage of fresh frozen plasma above −30°C has no negative impact on the quality of clotting factors and inhibitors","authors":"R. Moog, D. Knop, F. Wenzel","doi":"10.1111/J.1778-428X.2010.01129.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2010.01129.X","url":null,"abstract":"SUMMARY \u0000 \u0000Fresh frozen plasma (FFP) should be stored at temperatures > −30°C according to national and international guidelines to maintain the stability of clotting factors and inhibitors. In the present report, FFP was accidentally stored at < −30°C due to icing of the freezer. To ensure the quality of the FFPs a battery of tests of clotting factors and inhibitors was performed. Our data demonstrate that temporary storage of FFP at temperature < −30°C does not negatively affect the quality of FFPs. The European requirement of 70% activity of factor VIII was met by all units.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2010.01129.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63389667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-03-01DOI: 10.1111/J.1778-428X.2009.01117.X
L. Vecchio, F. Locatelli
SUMMARY Anemia, which is a common complication of chronic kidney disease (CKD), may significantly impair quality of life, increase cardiovascular risk and reduce long-term survival if left untreated. Today, erythropoiesis-stimulating agents (ESAs) are the main tool for anemia correction; they can be differentiated on the basis of mean serum half life on short- and long-acting molecules, the latter requiring longer administration intervals. According to international guidelines, the target hemoglobin to be obtained by treatment is between 11 and 12 g/dL. In general, the intravenous route is more convenient for hemodialysis patients, whereas the subcutaneous one is preferable in all other CKD patients. ESA dose requirements are rarely predictable in the individual patient and thus need to be titrated according to hemoglobin increases. In order to achieve ESA effectiveness, patients often need iron supplementation, either orally or intravenously. The intravenous route is the most widely used, especially in hemodialysis patients.
{"title":"Erythropoietin and Iron Therapy in Patients with Renal Failure","authors":"L. Vecchio, F. Locatelli","doi":"10.1111/J.1778-428X.2009.01117.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2009.01117.X","url":null,"abstract":"SUMMARY \u0000 \u0000Anemia, which is a common complication of chronic kidney disease (CKD), may significantly impair quality of life, increase cardiovascular risk and reduce long-term survival if left untreated. Today, erythropoiesis-stimulating agents (ESAs) are the main tool for anemia correction; they can be differentiated on the basis of mean serum half life on short- and long-acting molecules, the latter requiring longer administration intervals. According to international guidelines, the target hemoglobin to be obtained by treatment is between 11 and 12 g/dL. In general, the intravenous route is more convenient for hemodialysis patients, whereas the subcutaneous one is preferable in all other CKD patients. ESA dose requirements are rarely predictable in the individual patient and thus need to be titrated according to hemoglobin increases. In order to achieve ESA effectiveness, patients often need iron supplementation, either orally or intravenously. The intravenous route is the most widely used, especially in hemodialysis patients.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2009.01117.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63389470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-03-01DOI: 10.1111/J.1778-428X.2010.01128.X
J. Meier, P. Lauscher, H. Kertscho, O. Habler
SUMMARY Application of high inspiratory oxygen concentrations is an established method to improve arterial oxygen content, oxygen transport and tissue oxygenation. However, in the past years a considerable amount of data have emerged challenging this approach: hyperoxic ventilation (ventilation with pure oxygen, HV) and subsequent hyperoxemia have been accused of inducing unfavorable effects on microcirculation and tissue perfusion, resulting in regional tissue hypoxia. Interestingly, these disadvantegous properties of HV seem to occur predominantly in patients with physiological hemoglobin concentrations and probably play a minor role in anemic patients. In animal experiments the effect of HV on tissue oxygenation and on outcome of several severe pathologic conditions essentially depends on the hemoglobin concentration: HV failed to have a considerable impact on survival of severe hypovolemia or methemoglobinemia (physiological hemoglobin concentration), whereas it convincingly improves outcome of severe normovolemic anemia. The present review discusses a perspective on the effects of HV at different hemoglobin concentrations and its potential to improve oxygen transport and tissue oxygenation especially during moderate and severe anemia.
{"title":"The effects of hyperoxic ventilation on tissue oxygenation","authors":"J. Meier, P. Lauscher, H. Kertscho, O. Habler","doi":"10.1111/J.1778-428X.2010.01128.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2010.01128.X","url":null,"abstract":"SUMMARY \u0000 \u0000 \u0000Application of high inspiratory oxygen concentrations is an established method to improve arterial oxygen content, oxygen transport and tissue oxygenation. However, in the past years a considerable amount of data have emerged challenging this approach: hyperoxic ventilation (ventilation with pure oxygen, HV) and subsequent hyperoxemia have been accused of inducing unfavorable effects on microcirculation and tissue perfusion, resulting in regional tissue hypoxia. Interestingly, these disadvantegous properties of HV seem to occur predominantly in patients with physiological hemoglobin concentrations and probably play a minor role in anemic patients. In animal experiments the effect of HV on tissue oxygenation and on outcome of several severe pathologic conditions essentially depends on the hemoglobin concentration: HV failed to have a considerable impact on survival of severe hypovolemia or methemoglobinemia (physiological hemoglobin concentration), whereas it convincingly improves outcome of severe normovolemic anemia. The present review discusses a perspective on the effects of HV at different hemoglobin concentrations and its potential to improve oxygen transport and tissue oxygenation especially during moderate and severe anemia.","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2010.01128.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63389629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-12-01DOI: 10.1111/J.1778-428X.2009.00122.X
M. Muñoz, Dafydd Thomas
{"title":"Editorial: to drain or not to drain after hip replacement surgery?","authors":"M. Muñoz, Dafydd Thomas","doi":"10.1111/J.1778-428X.2009.00122.X","DOIUrl":"https://doi.org/10.1111/J.1778-428X.2009.00122.X","url":null,"abstract":"","PeriodicalId":90375,"journal":{"name":"Transfusion alternatives in transfusion medicine : TATM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/J.1778-428X.2009.00122.X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"63389340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-12-01DOI: 10.1111/J.1778-428X.2009.00123.X
G. Préfontaine, Martin Darveau, C. Ahnadi, P. Lachance, O. Lesur, Christine Drouin, P. Lamarre, C. Vézina
SUMMARY In the presence of inflammation, iron availability for erythropoiesis is decreased, and hemoglobin production is reduced in reticulocytes. The reticulocyte hemoglobin content (CHr) provides a real picture of bone marrow status and could be useful to evaluate iron metabolism in critically ill patients. We conducted a preliminary study to evaluate the feasibility to measure the CHr in the intensive care units of two university hospitals and to evaluate the impact of C-reactive protein on CHr values. The CHr was measured in 14 consecutive critically ill patients hospitalized in the intensive care unit between 48 and 96 hours. One patient with a ferritin concentration < 100 mg/L was excluded to eliminate a possible coexistence of iron deficiency with inflammation. A statistically signifi- cant correlation was observed between C-reactive protein concentrations and CHr values (r =- 0.588; P = 0.03, n = 13). The results observed in this preliminary study are interesting and could be useful to establish the research protocol for a future study evaluating iron metabolism in criti- cally ill patients. A larger study is feasible and warranted given the results observed in this preliminary study.
在炎症存在的情况下，用于红细胞生成的铁可用性降低，网状红细胞中的血红蛋白生成减少。网织红细胞血红蛋白含量(CHr)提供了骨髓状态的真实图像，可用于评估危重患者的铁代谢。为了评估在两所大学附属医院重症监护病房测量CHr的可行性，并评估c反应蛋白对CHr值的影响，我们进行了初步研究。在重症监护病房连续住院48至96小时的14例危重患者中测量CHr。排除1例铁蛋白浓度< 100mg /L的患者，以排除铁缺乏与炎症共存的可能。c反应蛋白浓度与CHr值之间存在统计学上显著的相关性(r =- 0.588;P = 0.03, n = 13)。这项初步研究的结果是有趣的，可以为未来评估危重病人铁代谢的研究建立研究方案。鉴于本初步研究的结果，进行更大规模的研究是可行的和必要的。
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