Patterns of use of group O, Rh-negative red cells in a large metropolitan area and an action plan to control utilization

BACKGROUND: In southeastern Michigan, the group O, Rh-negative (O-) red cell supply was below emergency levels during one-sixth of 1994, despite 43-percent overcollection of O- red cell units relative to the size of the O- patient population. O- red cell units are overutilized because of their universal ABO and Rh compatibility. This study evaluated how hospitals in a large metropolitan area utilized O- red cell units, so that strategies could be devised to reduce O- usage. STUDY DESIGN AND METHODS: Through an O- red cell utilization survey, 56 hospitals were encouraged to collect three months' worth of transfusion data, either prospectively or retrospectively. O- usage was compared to total red cell usage and categorized into transfusions to O- patients, those to non-O- patients, and the number of O- units that outdated. RESULTS: Of 40,616 units transfused in 38 hospitals, 3,535 (8.7%) were O-; 71 percent of the O- units were transfused to O- patients, 28 percent were transfused to non-O- patients, and 1 percent outdated. Hospital transfusions to O- patients appeared to correlate with the racial makeup of the patient population, while hospital transfusions to non-O- patients appeared to correlate with hospital size and the hospital's transfusion practices. CONCLUSION: O- red cell usage in a hospital is dependent on the racial and ethnic mix of the hospital's patient population, the amount of transfusion activity, and the hospital's transfusion practices. An understanding of the dynamics of O- usage allowed the development of strategies to decrease O- utilization.     

Home-based subcutaneous immunoglobulin G replacement therapy under real-life conditions in children and adults with antibody deficiency

Background

Subcutaneous immunoglobulin (SCIG) therapy is an alternative to intravenous immunoglobulin (IVIG) therapy.

Methods

We evaluated the efficacy and safety of the SCIG Vivaglobin^® (formerly known as Beriglobin^® SC) under real-life conditions in a post-marketing observational study in 82 patients with primary or secondary antibody deficiencies. Health-related quality of life (HRQoL) was evaluated in a subset of 30 patients previously treated with IVIG (including 11 children < 14 years) using the Short Form 36 (SF-36) for patients ≥ 14 years of age (adults) and the Child Health Questionnaire - Parental Form 50 (CHQ-PF50) for children < 14 years of age. Treatment preferences were assessed in adults.

Results

The mean serum immunoglobulin G (IgG) trough level during SCIG treatment (7.5 g/L) was higher than during previous IVIG treatment (6.6 g/L; p < 0.01). The investigators assessed the efficacy of SCIG therapy as "excellent" in 89% of patients. No systemic adverse drug reactions were observed. Improvements by ≥ 5 points were observed in 5 of 8 SF36 subscales and in 6 of 12 CHQ-PF50 subscales. Statistically significant improvements (p ≤ 0.05) were observed for the SF-36 subscales of bodily pain, general health perceptions, and vitality (adults), and for the CHQ-PF50 subscales of general health perceptions, parental impact - time, parental impact - emotional, and family activities (children). Patients preferred SCIG over IVIG therapy (92%) and home therapy over therapy at the clinic/physician (83%).

Conclusion

This study confirms that therapy with Vivaglobin^® at home is effective, safe, well tolerated, and improves quality of life in patients with antibody deficiency.     

老年阻塞性睡眠呼吸暂停综合征与心血管疾病的研究进展

0 引言 睡眠呼吸暂停综合征(sleep apnea syndrome, SAS)是指每晚7 h睡眠中出现持续10 s以上的呼吸暂停大于30次或睡眠呼吸暂停/低通气指数(AHI,即平均每小时呼吸暂停次数 低通气次数)≥5,60岁以上老年人AHI≥10.SAS分为三型,即阻塞性(obstructive sleep apnea, OSA)、中枢性(central sleep apnea, CSA)和混合性(mixed sleep apnea, MSA).