术前单用静脉铁剂对胃肠肿瘤相关性贫血的治疗作用

目的评估术前单用静脉铁剂对升高胃肠肿瘤合并贫血患者的治疗作用。方法收集2010年6月-2012年2月北京协和医院基本外科住院并接受手术治疗的胃肠肿瘤合并术前贫血的患者,对贫血合并缺铁的患者给予静脉铁剂治疗,在手术当日晨起或铁剂治疗后第14天晨起复查血常规、血清铁、铁蛋白水平、转铁蛋白以及肝肾功能的检查,记录围手术期患者接受输血剂量,与同期住院合并贫血患者的围手术期输血量进行比较。结果共有121例患者入组。术前静脉铁剂的应用能迅速的提高血色素水平,升高红细胞数量,改善红细胞的MCV、MCHC和MCH指标。静脉铁剂治疗后短期内血清铁以及血清铁蛋白水平显著升高(P<0.05)。治疗前血色素水平≥100 g/L的患者对静脉铁剂的反应较差。铁剂治疗组与同期未行铁剂治疗的胃肠肿瘤并贫血患者围手术期平均输血量差别比较明显(P<0.05)。结论在胃肠肿瘤合并贫血患者中,单用静脉铁剂能安全、快速提高患者的血色素水平以及机体缺铁状态,并降低贫血患者围手术期输血量。静脉铁剂的疗效可能受贫血程度影响。     

接受逝世器官捐献肾移植与亲属活体肾移植受者围移植期输血的差异

背景：尿毒症患者肾移植前均处于不同程度的贫血状态,围移植期贫血对机体肾移植中、后恢复以及移植肾功能恢复均产生不利影响。 目的：观察接受逝世者器官捐献肾移植与亲属活体肾移植围移植期贫血程度及输血总量对肾移植的影响。总结二者围手术期药物抗贫血治疗及输血原则。 方法：回顾性研究郑州大学第一附属肾移植中心2012年1月至2013年12月接受逝世器官捐献肾移植115例为试验组,对照组为同期亲属活体肾移植92例,分析两组贫血程度的相关指标以及围移植期输血总量、输血12 h内电解质的变化,记录输血后不良反应事件发生情况等。 结果与结论：2组患者贫血发生率差异无显著性意义(P > 0.05);而试验组患者移植中及移植后输血比率、平均输血总量高于对照组(P < 0.05),移植前红细胞水平、血红蛋白值、红细胞压积、平均血红蛋白值含量、平均血红蛋白值浓度均明显低于对照组(P < 0.05)。2组患者输血过程中主要不良事件为发热反应(5.5%),未见严重的过敏反应及电解质酸碱平衡紊乱等。提示接受逝世者器官捐献肾移植受者较亲属活体肾移植围移植期贫血程度高;移植前抗贫血药物应用,纠正机体贫血状态至关重要;应严格按照围移植期输血原则进行移植中和(或)移植后输血治疗。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

Alloimmunization in sickle cell anemia and transfusion of racially unmatched blood

Transfusion therapy for sickle cell anemia is limited by the development of antibodies to foreign red cells. To evaluate the frequency and risk factors associated with such alloimmunization, we determined the transfusion history, red-cell phenotype, and development of alloantibodies in 107 black patients with sickle cell anemia who received transfusions. We compared the results with those from similar studies in 51 black patients with sickle cell disease who had not received transfusions and in 19 nonblack patients who received transfusions for other forms of chronic anemia. We assessed the effect that racial differences might have on the frequency of alloimmunization by comparing the red-cell phenotypes of patients and blood-bank donors (n = 200, 90 percent white). Although they received transfusions less frequently, 30 percent of the patients with sickle cell anemia became alloimmunized, in contrast to 5 percent of the comparison-group patients with other forms of anemia (P less than 0.001). Of the 32 alloimmunized patients with sickle cell anemia, 17 had multiple antibodies and 14 had delayed transfusion reactions. Antibodies against the K, E, C, and Jkb antigens accounted for 82 percent of the alloantibodies. Comparison of red-cell phenotypes in the three study groups (the patients with sickle cell anemia, the patients with other forms of anemia, and the blood donors) revealed statistically significant differences between the patients with sickle cell anemia and the donors but not between the patients with other forms of anemia and the donors. These differences are most likely racial. We conclude that alloimmunization is a common, clinically serious problem in sickle cell anemia and that it is partly due to racial differences between the blood-donor and recipient populations.     

Fatal delayed transfusion reaction in a sickle cell anemia patient with Serratia marcescens sepsis

Patients with sickle cell anemia may require repeated red cell transfusion, putting them at risk for minor blood group alloimmunization and the development of delayed hemolytic transfusion reactions. Although Streptococcus pneumoniae is the most common cause of life-threatening infection in patients with sickle cell anemia, those who have been recently hospitalized are at risk for infection with resistant hospital-associated organisms, and blood transfusion may put the patient at risk of infection with transfusion-associated organisms such as Serratia marcescens and Yersinic enterocolitica. We recently cared for an adolescent with sickle cell anemia who presented to the emergency department with a severe, delayed hemolytic transfusion reaction and Serratia marcescens infection. The patient had been discharged from the hospital five days previously, and had been transfused and treated with antibiotics while hospitalized. In addition to demonstrating the potential severity of delayed hemolytic transfusion reactions, our case illustrates the importance of providing relatively broad-spectrum antibiotic coverage to patients with sickle cell anemia and possible infection who have recently been hospitalized.     

Erythropoietin treatment of anemia associated with multiple myeloma

Anemia is a common complication of multiple myeloma. It resolves early in the disease if chemotherapy induces a complete remission, but persists if the disease progresses, causing disabling symptoms and often requiring blood transfusions. We treated 13 patients with myeloma-associated anemia by administering recombinant human erythropoietin three times a week for six months. Eleven patients (85 percent) had steady increases in hemoglobin levels and eventual correction of the anemia. Their symptoms of anemia subsided, and they reported a heightened sense of well-being. No patient had any adverse side effects, particularly episodes of hypertension. Monitoring of the serum M component showed a predominantly stable tumor load without apparent interaction between the underlying disease and the response to erythropoietin therapy. The number of erythroid burst-forming units in the bone marrow and peripheral blood and the level of erythropoiesis in bone marrow smears increased significantly during therapy. Pretreatment serum levels of erythropoietin were higher in the patients who did not respond and in those who required more than two months of treatment before they responded. Serum iron, ferritin, and transferrin concentrations reflected responses to treatment. We conclude that recombinant human erythropoietin is a promising therapeutic tool for treating myeloma-associated anemia.     

Assessment of the use of transfusion therapy and complications in orthopedic surgery in patients with sickle-cell anemia: retrospective study]

Red blood cells (RBCs) transfusion is a common practice in the treatment or for the prevention of complications of patients with sickle-cell disease. In surgery, pre-operative transfusions are frequently given to prevent peri-operative complications. There is no consensus however on the best regimen of transfusion for this purpose. The transfusion techniques are muliple. In addition, pre-operative transfusion therapy is reported to be largely responsible for an increased morbidity and mortality in patients with sickle cell anemia undergoing surgery. During the period 1990-2000, 16 patients (4 men and 12 women) with a mean age of 37 years and various major sickle cell hemoglobinopathies underwent 32 total hip arthroplasty for femoral head necrosis. Nine patients with sickle-cell trait were included as control group. Twelve of them had haemoglobin SS (HbSS), 2/16 had HbSC, 2/16 had HbS/betathalassemia. Operative transfusion were given in only 12/32 procedures, 4 were performed pre-operatively and 8 intra-operatively. Simple transfusion (mean: 2.5 packed red cells) were administered in all the procedures. The main complications observed in our patients were anemia by hemolysis and haemorrhagic shock, vaso-occlusive crisis and chest syndrome. Anemia requiring transfusions was significatively related to the procedures with pre-operative transfusion. In the light of our result, we would like to propose transfusional protocol--if needed--only intra-operatively.     

The relationship between fetal hemoglobin and disease severity in children with sickle cell anemia

A study was conducted in a sample of 140 children with sickle cell anemia to evaluate the relationship between hematological variables (%HbF, %HbA2, %Hb, and mean cell volume) and disease severity. A patient's severity status was determined by whether he/she was hospitalized, had a transfusion, and/or had a pain crisis at 2 evaluation periods; the first was based on a patient's history taken at the initial assessment visit to the Wayne State Comprehensive Sickle Cell Center, and the second was based on a 1-3 year follow-up at the center. Fetal hemoglobin was a strong predictor of a patient's hospitalization and transfusion status. A decrease in %HbF of 4.76% (one SD of %HbF) was associated with a 3.58 fold (95% confidence interval, 1.18-7.28) greater odds of being hospitalized both prior to initial assessment and on follow-up, compared to not being hospitalized at either evaluation. Similarly, a decrease in %HbF of 4.76% was associated with a 5.56 fold (95% confidence interval, 1.67-18.96) greater odds of having a transfusion both prior to initial assessment and on follow-up compared to not having a transfusion at either evaluation. Patients who were both hospitalized and transfused at initial assessment and on follow-up (n = 12) had a mean %HbF of 7.59%, while patients who were not hospitalized or transfused at either evaluation (n = 19) had a mean %HbF of 13.61%. Fetal hemoglobin was not a significant predictor of pain crises in this sample of patients. None of the other hematological variables were significant predictors of disease severity in this study. The strong relationship between %HbF and disease severity identified in this study suggests that a single %HbF measurement may be useful in predicting important aspects of the clinical course of children with sickle cell anemia.     

A practice guideline and decision aid for blood transfusion

An attempt was made to reduce exposure of patients to blood products by using a point-of-ordering decision support system and strict adherence to a practice guideline, by observing physician behavior in the multidisciplinary intensive-care unit (ICU) of a tertiary-care medical center. Hemoglobin (Hg) level at the time of transfusion, total units of red blood cells (RBCs) per admission, units per patient per ICU day, fraction of patients receiving no transfusions, and incidence of single-unit transfusions covering 628 patients were measured. In Phase 1, RBC transfusion behavior was observed without intervention. In Phase 2, a special order form for RBCs that suggested a transfusion threshold of 8.6 g/dL of Hg was introduced. In Phase 3, the suggested threshold was lowered to 7.0 g/dL and required all transfusions that did not meet the new guideline to be prospectively reviewed by a transfusion medicine physician. The Hg level at transfusion fell from 8.5 g/dL to 8.2 g/dL (p = 0.008). The use of single-unit transfusions fell from 32 percent to 17 percent (p = 0.001), but there was no change in the number of patients receiving any blood, the total units per admission, or units per patient per day. In this setting, a practice guideline with a point-of-decision support system did not influence blood usage. Intermediate outcomes (such as the level of anemia at transfusion or compliance to a guideline) should not substitute for     

Anemia in patients on chronic hemodialysis in Cameroon: prevalence,characteristics and management in low resources setting

BackgroundAnemia is a common complication of chronic kidney disease. We investigated the prevalence, characteristics and management of anemia in patients on chronic hemodialysis and assessed the response to blood-transfusion based management in Cameroon.MethodsThis was a cohort study of five months'' duration (August–December 2008) conducted at the Yaoundé General Hospital''s hemodialysis center, involving 95 patients (67 men, 70.5%) on chronic hemodialysis by a native arteriovenous fistula. A monthly evaluation included full blood counts, number of pints of red cell concentrates transfused, and vital status.ResultsAt baseline, 75 (79%) patients had anemia which was microcytic and hypochromic in 32 (43%). Anemia was corrected in 67 (70.5%) patients using blood transfusion only, while 28 (29.5%) patients were receiving erythropoietin (11 regularly, 39%). Only 77.2% of 342 pints (median 3.0, range 0–17 per patients) of red cell concentrates prescribed were effectively received during the follow-up at an unacceptably high cost to patients and families. Mean hemoglobin and mean corpuscular hemoglobin levels remained stable during follow-up, while mean corpuscular volume increased. Erythropoietin treatment was the main determinant of favorable trajectories of hematological markers.ConclusionsPatients on chronic hemodialysis have predominantly microcytic hypochromic anemia, with limited capacity for correction using blood transfusion.     

Leukocyte reduction of red cells when transfusing patients with autoimmune hemolytic anemia: a strategy to decrease the incidence of confounding transfusion reactions

Autoimmune hemolytic anemia (AIHA) presents a difficult challenge to clinicians and blood bankers alike. Autoantibodies in the serum significantly complicate serologic evaluation, and necessitate performing procedures such as adsorptions to eliminate the possibility of underlying alloantibodies. In many instances the blood that is issued may be phenotypically similar but remains crossmatch incompatible, generating a considerable degree of anxiety among the clinical staff who are responsible for transfusing the patient. We report a case of warm autoimmune hemolytic anemia (WAIHA) in which the transfusion of red cells was complicated by a febrile transfusion reaction. Evaluation of the reaction resulted in a significant delay in transfusion therapy. Subsequent administration of leukocyte-poor red cells resulted in uneventful transfusions with a good therapeutic response. Retrospective analysis of the pretransfusion sample demonstrated significant levels of anti-neutrophil antibodies. This case resulted in the establishment of our policy to administer all red cell transfusions to patients with autoantibodies (warm or cold) as leukocyte- poor red cells.     

Cerebrovascular accident during a delayed hemolytic transfusion reaction in a patient with sickle cell anemia

A 28-year-old woman with sickle cell anemia suffered a left hemispheric cerebrovascular accident associated with severe right-sided weakness during a delayed hemolytic transfusion reaction owing to anti-rh' (C) and anti-S. The anti-rh' (C) had been identified four years earlier at a different hospital but neither the patient, her family, nor any member of the staff of the hospital where she was transfused was aware of this information. It is postulated that spherocytes, formed during hemolysis, could slow capillary flow, thereby increasing red cell sickling and producing vaso-occlusion. The patient had no clinically apparent neurologic complications during the preceding 24 years and has had no further neurologic events during the subsequent 20 months. This patient's reaction underscores the compelling need for sensitive pre-transfusion tests as well as the obligation to inform patients and their families of the presence and potential consequences of alloantibodies in the event of future transfusion.     

外周血造血干细胞移植治疗3例重型β地中海贫血和1例特发性溶血性贫血

目的探讨异基因外周血造血干细胞移植(allogeneic peripheral blood stem cell transplantation,Allo-PBSCT)治疗遗传性溶血性贫血(hereditary haemolytic     

Management of preoperative anemia: The NATA consensus statements

Preoperative anemia is highly prevalent in major surgery. The haemoglobin (Hb) level is the main independent risk factor for allogeneic blood transfusion (ABT) in surgeries with moderate to high risk of bleeding. Transfusion and preoperative anemia have been associated with worse postoperative outcome and higher mortality in patients undergoing major surgery. On the other hand, hematinic deficiency without anemia may blunt the recovery from postoperative anemia. Thus, early detection and appropriated treatment of anemia in the preoperative setting may reduce the need for transfusion and its negative consequences. Two multidisciplinary panels of physicians were convened by the ‘Network for the Advancement of Transfusion Alternatives’ (NATA) with the aim of developing practice guidelines for the detection and management of preoperative anemia, reviewing the role of intravenous iron, and formulating recommendations using the GRADE working group methodology. The panels recommend that: (1) elective orthopedic surgical patients should have an Hb level determination 4 weeks before surgery, if possible (Grade 1C); (2) further laboratory testing for differential diagnosis in those with anemia (Grade 1C) and (3) nutritional deficiencies should be treated to rising Hb before surgery to be within the normal range (Grade 1C). Finally, the panels suggest that: (1) erythropoiesis-stimulating agents be used for anaemic patients in whom nutritional deficiencies have been ruled out, corrected, or both (Grade 2A) and (2) intravenous iron administration during the preoperative period for patients undergoing orthopedic surgery who are expected to develop severe postoperative anemia (Grade 2B).     

Idiopathic pulmonary hemosiderosis: alveoli are an answer to anemia

Idiopathic pulmonary hemosiderosis (IPH) is a rare disorder (triad of iron-deficiency anemia, hemoptysis, and alveolar infiltrates). A 3-year-old male presented with mild fever, breathlessness, dry cough, and bluish nail discoloration for 8 days. He had required five blood transfusions in the past 1 year (last transfusion was given 4 months ago). He had a respiratory rate of 58/min with respiratory distress, cyanosis, and grade III clubbing. Respiratory system examination was normal. Several previous reports of hemoglobin were as low as 3.6 g/dl with hypochromic and microcytic anemia. There were transient increases in the hemoglobin and normalization of red cell morphology with blood transfusions. Serum iron, G6PD enzyme assay, hemoglobin electrophoresis, the sickling test, Coomb's test, stool and urine analysis, and a Meckel's scan were normal. HIV antibody and dsDNA were negative. The chest radiograph revealed symmetrical patchy infiltrates sparing lung apices (confirmed on high-resolution computed tomography). Lung biopsy diagnosed pulmonary hemosiderosis (interstitial lung disease with hemosiderin-laden macrophages scattered in the alveoli and areas of fibrosis in the alveolar septa). The patient showed marked clinical improvement in 10 days of therapy with prednisolone. IPH should be listed in the differential diagnosis of a child presenting with unexplained hypochromic, microcytic anemia and respiratory symptoms.     

Case of fatal sickle cell intrahepatic cholestasis despite use of exchange transfusion in an African-American patient

Sickle cell intrahepatic cholestasis (SCIC) is a rare complication of sickle cell anemia, characterized by marked hyperbilirubinemia and acute hepatic failure with an often fatal course. However, the few reported adult cases that were treated with exchange transfusion had a favorable outcome. We herein describe a 48-year-old African-American man with hemoglobin S/B thalassemia and previously treated hepatitis C with compensated cirrhosis, who presented with a total bilirubin of 59.7 mg/dL and direct bilirubin of 43.6 mg/dL in the absence of choledocholithiasis. Despite an exchange transfusion and aggressive packed red blood cell transfusions, which successfully decreased the hemoglobin S levels to <15%, he perished from progressive hepatic and renal failure. Autopsy demonstrated extensive intrahepatocellular and intracanalicular cholestasis in a background of cirrhosis. Our case suggests that poor prognostic factors for adult SCIC patients treated with exchange transfusion may include older age and underlying hepatic disease.     

The issues in autologous transfusion

Autologous transfusion should be recognized by patients and physicians as an important measure to provide safer transfusion therapy. This should be suggested to patients in general good health (who are not obviously frail) who have no significant medical problems and no likelihood of severe reaction, who can take iron supplements, and who have at least a 10% chance of using blood during surgery or are having surgery in which the average use is one or more units. Such patients should receive iron supplementation beginning 1 week before the first autologous donation, and should donate one to five units on a weekly basis, but no more frequently than every 72 hours, with their last unit donated 72 hours before surgery. Elderly individuals may donate if the risk of donor reaction seems low. In children and adults, the amount of blood removed should be reduced in proportion to the blood volume if the individual does not meet the standard weight of 50 kg for a 450-mL donation. "Fail-safe" identification systems should be used; these will insure that the correct donor/patient receives the transfusion. Processing of the units is preferred but still optional. Use of these units as homologous units should not be done unless the donor has a hematocrit level acceptable to an autologous donor, meets all the criteria for recipient safety, the unit is processed and negative for all viral markers, and the donor has recently (eg, within 3 years) participated in the volunteer donor program. The unit should be transfused to the patient in situations in which homologous blood would be indicated. Safeguards to prevent volume overload are needed when the unit is stored as whole blood. Future research objectives should include the use of recombinant erythropoietin to prevent donation-induced anemia, delineation of medical conditions which should contraindicate the donation, and determination of the real costs involved in autologous transfusion. Education of the general public, patients, and physicians about the desirability of autologous transfusion should proceed. Third-party carriers also need to be educated about the cost implications and the need to pay for this activity. However, such education should also stress that autologous units will only cover planned, elective surgery and that major blood needs for emergency surgery, trauma, and chronic transfusion will still need to be met by homologous blood from altruistic community blood donors.     

Cardiorespiratory adjustments in chronic sickle cell anemia

During the intercrisis periods, patients homozygous for sickle cell anemia (SS) show clinical symptoms of severe impairment of oxygen transport mechanisms. We have determined respiratory lung function tests, arterial and venous blood gases and cardiocirculatory parameters in 39 SS patients (mean age 22 +/- 5 yr) at distance from any vaso-occlusive crisis or blood transfusion. The patient group was compared to subjects homozygous for HbA (AA) of the same ethnic origin. Determinations were made at rest and after a 5 min mild exercise period. The main alterations in oxygen transport parameters observed in SS patients were: 1) a moderate reduction in vital capacity and maximal ventilation (pure restrictive syndrome), 2) an arterial hypoxemia which worsened the already low oxygen content of blood due to anemia, and 3) a low arterio-venous oxygen saturation difference which is very surprising in anemic patients. The normal oxygen consumption rate was thus insured by a 70% increase of the cardiac output at rest. A particular abnormality found in SS patients was the high Po2 in mixed venous blood. The decreased affinity of blood for oxygen resulting from the polymerization of HbS in the erythrocytes led to an almost normal venous blood unsaturation and thus a decreased release of oxygen from this anemic blood. These results indicate that peripheral blood flow was permanently increased in SS patients. This may be in part at the origin of the arterial hypoxemia induced by an increased pulmonary blood shunting. Sickle cell anemia is more severe than other anemias of comparable intensity as, due to the sickling process, these patients appear to be at the upper limit of physiological compensatory mechanisms usually encountered in chronic anemia.     

Anemia and transfusion of red blood cells

The red cells transfusion is a mainstay in the treatment of anemic patients. These blood transfusions are not without risks. The risk-benefit profile for red cell transfusions to treat anaemia is uncertain, but they may contribute to adverse patient outcomes in some situations. The ability of a patient to tolerate anaemia depends on their clinical condition and the presence of any significant co-morbidity; maintenance of circulating volume is of paramount importance. There is no universal transfusion trigger. Advances in the development and validation of physiological, accessible, practical and reliable markers to guide therapy are expected. To improve patients'' outcomes, further study is required to more fully explore the risk of anemia, optimal hemoglobin level, and the risk and efficacy of RBC transfusion. Future clinical investigations with high priority should determine the efficacy of transfusion in those classified as uncertain scenarios. In the absence of data, it is prudent that transfusion is administered with caution in these clinical scenarios.     

Autoimmune hemolytic anemia in Philadelphia positive chronic myeloid leukemia with t(7;14) anomaly after 5 years of interferon alpha treatment

A 41-year-old woman, Philadelphia positive chronic myeloid leukemia patient, had progressive decline in hemoglobin levels. She had been receiving interferon alpha treatment for five years. Autoimmune hemolytic anemia was diagnosed. Subsequent bone marrow examination revealed translocation t(7;14). She was placed on prednisone treatment. The patient responded to prednisone as treatment for the hemolytic process. The result of a direct Coombs' test remained positive. The patient died shortly after the diagnosis of autoimmune hemolytic anemia. Autoimmune hemolytic anemia should be considered in the evaluation of chronic myeloid leukemia patients with a sudden decrease in hemoglobin levels.     

Fluosol-DA as a red-cell substitute in acute anemia

We assessed the safety and efficacy of Fluosol-DA as a red-cell substitute in acute anemia. Twenty-three surgical patients with blood loss and religious objections to receiving blood transfusions were evaluated. Fifteen moderately anemic patients with a mean hemoglobin level (+/- SE) of 7.2 +/- 0.5 g per deciliter had no evidence of a physiologic need for increased arterial oxygen content and did not receive Fluosol-DA. Eight severely anemic patients with a mean hemoglobin level of 3.0 +/- 0.4 g per deciliter met the criteria of need and received the drug until the physiologic need disappeared or a maximal dose of 40 ml per kilogram of body weight was reached. We observed no adverse reactions to Fluosol-DA. The average peak increment in arterial oxygen content with the drug was only 0.7 +/- 0.1 ml per deciliter. There were no appreciable beneficial effects of Fluosol-DA, perhaps because of the small increase in arterial oxygen content, the brief half-life of the drug (24.3 +/- 4.3 hours), and the limited total dose. Six of the eight patients receiving Fluosol-DA died. One of the survivors received red-cell transfusions against his wishes, under a court order, after his total Fluosol-DA dose. Fourteen of the 15 moderately anemic patients survived. The data in this select group of patients refusing blood products suggest that, after blood loss, Fluosol-DA is unnecessary in moderate anemia and ineffective in severe anemia.