Evaluation of platelet concentrates prepared from buffy coats and stored in a glucose-free crystalloid medium

Comparison was made between platelet concentrates prepared from pools of buffy coats removed from standard blood donations and stored in a glucose-free, commercially available crystalloid solution (BC-PCs) and standard platelet concentrates prepared from platelet-rich plasma (PRP-PCs). Platelet yield in BC-PCs and PRP-PCs was 59 and 75 percent of donated platelets, respectively. The number of total white cells in 1 BC-PC unit, prepared from a pool of 7 buffy coats, was 21 x 10(6), i.e., 50 times lower than that of 7 units of PRP-PCs. The in vitro values of adequate platelet quality were maintained for 10 days in BC-PCs stored in 1000-mL polyolefin bags. Prolonged bleeding times were reduced or corrected in three of three thrombocytopenic leukemic patients evaluated before and after transfusion of stored BC-PCs. Pretransfusion and 1- and 24-hour posttransfusion median platelet counts in 57 leukemic recipients during 4 months of routine transfusion of BC-PCs (n = 93) were 14, 35, and 27 x 10(9) per L, while those of PRP-PCs (n = 246) were 13, 37, and 31 x 10(9) per L, respectively. No reactions to BC-PCs were reported, but a 1.3 percent rate of reaction to PRP-PC transfusions was reported. This study indicates that BC-PCs are a good alternative to PRP-PCs for platelet support of thrombocytopenic patients.     

Prophylaxe und Management von Komplikationen bei perforierender Keratoplastik

Besides routine postoperative follow-up the prophylaxis of complications in penetrating keratoplasty (PKP) includes special preoperative and intraoperative aspects. Preoperative prophylaxis consists of the therapy of systemic diseases and eyelid abnormalities, determining individual optimal graft size, avoiding PKP in cases of uncontrolled intraocular pressure, avoiding PKP in cases of corneal hydrops, pretreatment of vascularized cornea, amniotic membrane transplantation before PKP in cases of ulcerative keratitis, quality controlled organ-cultured transplants and preoperative counselling by the surgeon to ensure patient compliance. Intraoperative prophylaxis consists of controlled arterial hypotension and complete relaxation during general anesthesia, avoidance of decentration, horizontal torsion and vertical tilt using a non-contact trephination technique (preferably excimer laser) with double-running cross-stitch sutures and application of Flieringa rings in aphakic vitrectomized eyes. Postoperatively, periodical control examinations using fluorescein and blue light are indispensable. All loose sutures have to be removed as early as possible. In cases of herpetic eye disease 2?×?400 mg of oral acyclovir should be administered for at least 1 year. In cases of therapy-resistant epithelial defects 100?% autologous serum eyedrops or amniotic membrane patches are valid options. Immune reactions must be diagnosed and treated immediately with high doses of corticosteroids.     

Implementation of a multidisciplinary guideline‐driven approach to the care of the extremely premature infant improved hospital outcomes

Aim: To test the hypothesis that implementing guidelines for the standardized care of the extremely premature infant (<27 weeks) in the first week of life would improve patient outcomes in an all referral NICU. Methods: Data were collected on all infants <27 weeks gestational age and <7 days of age on admission cared for using these small baby guidelines (SBG), as well as on all age‐matched infants admitted the year prior (comparison). Results: Thirty‐seven patients were cared for utilizing the SBG and 40 patients were in the comparison group. There were no differences between the groups in gestational age, birthweight or age on admission. There was no difference in survival to discharge (73% SBG, 70% comparison). The mean length of stay for survivors was 112 ± 38 days SBG and 145 ± 76 days (p < 0.05) comparison group. Survival without BPD was greater in the SBG group (24%) than in the comparison group (9%; p < 0.05), and survival without severe IVH was greater in the SBG group (65%) than in the comparison group (38%; p < 0.01). Conclusions: These data demonstrate that applying a unified approach to the care of the extremely premature infant in the first week of life resulted in a decrease in the length of hospitalization and improved patient outcomes.     

Serum levels of IGF1 are a useful predictor of retinopathy of prematurity

Objective: To ascertain whether insulin‐like growth factor 1 (IGF1) is associated with retinopathy of prematurity (ROP) and is a useful predictor of the disease. Although its aetiopathogenesis is multifactorial, development of the disease appears to be related to a deficiency in IGF1, a hormone that acts together with vascular endothelial growth factor in the normal angiogenesis in the retina. Design: Prospective study for a 30‐month period. Participants: A total of 74 premature newborn babies, of less than 1500 g and/or 32 weeks’ gestational age or less. Testing: To determine the development and severity of ROP. Main outcome measures: Serum levels of IGF1 were measured once a week from birth until 40 weeks corrected gestational age in each subject. Results: Of our subjects, 32.4% developed some form of ROP, and all those ROP patients had the following characteristics at birth (median ± standard deviation scores): low weight (1098 ± 188 vs. 1393 ± 285 g), short length (36.74 ± 1.77 vs. 38.89 ± 3.08 cm), small cranial perimeter (26.03 ± 1.74 vs. 27.93 ± 1.81 cm) and young gestational age (29.7 ± 1.78 vs. 31.3 ± 1.79 weeks) (p < 0.05). Other factors previously associated with ROP that were also observed with statistically significant frequency in our ROP patients were bronchopulmonary dysplasia, intracranial haemorrhage, the need for erythrocyte transfusion or treatment with erythropoietin and sepsis (all p < 0.05). Levels of IGF1 at the 3rd week post‐partum, independent of gestational age at birth, were clearly lower in the group who developed ROP (29.13 vs. 43.16 ng/mL, p < 0.05). A value of 30 ng/mL of IGF1 in the third week post‐partum was found to have a 90% sensitivity in the diagnosis of ROP. A rapid rise in IGF1 levels between the 3rd and 5th weeks appeared to be related to the development of a higher stage of ROP. Conclusion: Determination of IGF1 serum levels in the 3rd week post‐partum, independent of gestational age at birth, provides a sufficient and reliable prognostic tool and allows the identification of a group of patients at high risk of developing the disease.     

Belgian legislation and the effect of elective single embryo transfer on IVF outcome

In order to reduce the number of multiple pregnancies following IVF, the Belgian government agreed to reimburse laboratory expenses for six IVF cycles up to the age of 42 years, in exchange for restriction of the number of embryos replaced. Data on assisted reproduction outcome before and after the introduction of this new legislation were analysed retrospectively in terms of implantation, pregnancy and multiple pregnancy rates. After the introduction of the new law, the percentage of single embryo transfer increased from 14 to 49%. Implantation rates were 25.9 and 23% respectively. There was no difference in the overall pregnancy rate before and after the introduction (36 versus 37%). Twin pregnancies, however, decreased from 19 to 3%. These findings indicate that elective single embryo transfer significantly decreases the twin pregnancy rate without a reduction in the overall pregnancy rate.