Red cell exchange in sickle cell disease.
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Red cell exchange transfusions remain an effective but possibly underutilized therapy in the acute and chronic treatment of sickle cell disease. In sickle cell disease, increased blood viscosity can cause complications when the hemoglobin exceeds 10 g/dL even if this is due to simple transfusion. Red cell exchange can provide needed oxygen carrying capacity while reducing the overall viscosity of blood. Acute red cell exchange is useful in acute infarctive stroke, in acute chest and the multi-organ failure syndromes, the right upper quadrant syndrome, and possibly priapism. Neither simple or exchange transfusions are likely to hasten resolution of an acute pain episode. (+info)
Steroid treatment in children with sickle-cell disease.
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Given the controversy concerning the effects of steroids in patients with sickle cell disease (SCD), we evaluated the tolerability of long-term steroid treatment in 16 children with SCD and autoimmune and/or systemic diseases. The steroid treatment was poorly tolerated. (+info)
Recombinant hemoglobins as artificial oxygen carriers.
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This paper describes the approaches we have taken to construct a) mutant hemoglobins with different oxygen affinities, and b) mutant hemoglobins and myoglobins that polymerize to high molecular weight aggregates in an effort to prevent extravasation and the associated vasoactivity. In vivo testing indicates that exchange transfusion of polymeric hemoglobins in mice does not result in vasoactivity and that polymeric hemoglobins are effective oxygen carriers to ischemic tissues irrespective of their oxygen affinity and cooperativity. (+info)
Complications and outcome in childhood acute lymphoblastic leukemia with hyperleukocytosis.
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Hyperleukocytosis (greater than or equal to 100 x 10(9) leukocytes/L) was identified at diagnosis of acute lymphoblastic leukemia in 64 of 358 patients enrolled on St Jude Total Therapy Study XI from February 1984 to September 1988. These children received a seven-drug induction regimen followed by high-dose methotrexate, cranial irradiation at 1 year of remission, and 120 weeks of continuation therapy with rotational administration of four drug pairs. The 27 patients with leukocyte counts greater than or equal to 200 x 10(9)/L underwent initial cytoreduction via leukapheresis or exchange transfusions. The complete remission rate for patients with hyperleukocytosis (94%) was similar to that for the overall series (96%). Stepwise regression analysis showed that hyperleukocytosis was significantly associated with age less than 1 year at diagnosis, T-cell immunophenotype, leukemic cell ploidy less than or equal to 50 chromosomes, organomegaly, and elevated lactic dehydrogenase. The 27 patients with extreme hyperleukocytosis (greater than 200 x 10(9)/L) different from the other 37 children only in a higher frequency of French-American-British (FAB) L2 morphology. Estimated 4-year event-free survival (EFS) was 52% +/- 8% (SE) for patients with hyperleukocytosis versus 79% +/- 4% for patients with leukemic counts less than 100 x 10(9)/L (P less than .0001). Patients with leukocyte counts of 100 to 200 x 10(9)/L had a significantly better EFS than those with counts greater than 200 x 10(9)/L (64% +/- 10% v 34% +/- 14%; P = .04). Thus, the therapy in this trial proved satisfactory for children with leukocyte counts of 100 to 200 x 10(9)/L; further study is needed to improve the outlook for children with counts greater than 200 x 10(9)/L. (+info)
Exchange transfusion in neonatal hyperbilirubinaemia: experience in Isfahan, Iran.
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INTRODUCTION: This study aims to determine the aetiology and complications of exchange transfusion (ET) performed for neonatal hyperbilirubinaemia in Isfahan, Iran. METHODS: A retrospective chart review of 68 term and near-term newborns who underwent ET at two perinatal centres in Isfahan, Iran between January 2001 and January 2004, was performed. RESULTS: Of the 68 patients who underwent ET, nine (13.2 percent) required more than one ET. The most common causes of ET overall were ABO incompatibility (22.1 percent) and glucose-6-phosphate dehydrogenase deficiency (19.1 percent). The maximum total serum bilirubin concentration was 25.9 +/- 7.5 mg/dL. ET complications occurred in 14 neonates (20.9 percent), the most common being thrombocytopenia (6 percent). One (1.5 percent) of the 68 patients died of complications, probably attributable to ET. CONCLUSION: ET causes high morbidity, even in term and near-term newborns. Therefore, it should be initiated only when the benefit of preventing kernicterus outweighs the complications associated with the procedure. (+info)
A decline in the frequency of neonatal exchange transfusions and its effect on exchange-related morbidity and mortality.
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OBJECTIVE: Our goal was to identify trends in patient demographics and indications for and complications related to neonatal exchange transfusion over a 21-year period in a single institution using a uniform protocol for performing the procedure. METHODS: A retrospective chart review of 107 patients who underwent 141 single- or double-volume exchange transfusions from 1986-2006 was performed. Patients were stratified into 2 groups, 1986-1995 and 1996-2006, on the basis of changes in clinical practice influenced by American Academy of Pediatrics management guidelines for hyperbilirubinemia. RESULTS: There was a marked decline in the frequency of exchange transfusions per 1000 newborn special care unit admissions over the 21-year study period. Patient demographics and indications for exchange transfusion were similar between groups. A significantly higher proportion of patients in the second time period received intravenous immunoglobulin before exchange transfusion. There was a higher proportion of patients in the 1996-2006 group with a serious underlying condition at the time of exchange transfusion. During that same time period, a lower proportion of patients experienced an adverse event related to the exchange transfusion. Although a similar percentage of patients in both groups experienced hypocalcemia and thrombocytopenia after exchange transfusion, patients treated from 1996-2006 were significantly more likely to receive calcium replacement or platelet transfusion. No deaths were related to exchange transfusion in either time period. CONCLUSIONS: Improvements in prenatal and postnatal care have led to a sharp decline in the number of exchange transfusions performed. This decline has not led to an increase in complications despite relative inexperience with the procedure. (+info)
Thrombotic thrombocytopenic purpura treated with plasma exchange or exchange transfusions.
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Of 40 patients with thrombotic thrombocytopenic purpura, 17 were treated with plasma exchange, 15 with exchange transfusions, and 6 with both types of therapy. One patient died before being treated and another patient was seen but not treated. Plasma exchange was performed daily for a mean of seven exchanges per patient. The replacement fluid during plasma exchange was fresh frozen plasma in all cases. The complete response rates for each type of treatment were as follows: 88% for plasma exchange (15 patients), 47% for exchange transfusions (7 patients), and 67% for exchange transfusions and plasma exchange (4 patients). Clinical and laboratory factors were examined for any statistically significant association with therapy response. Treatment with plasma exchange was statistically the initial factor most strongly associated with prognosis. Paresis, paresthesias, seizures, mental status change, and coma showed no association with response to treatment. Some of the laboratory factors that did not show significant association with treatment response were the initial creatinine, hemoglobin, platelet count, lactate dehydrogenase, and total bilirubin. This study supports the hypothesis that plasma exchange has significantly improved the prognosis of patients with thrombotic thrombocytopenic purpura. These patients should be treated aggressively regardless of the severity of their symptoms. (+info)
Exchange transfusion using peripheral vessels is safe and effective in newborn infants.
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