Red blood cell transfusions in newborn infants: Revised guidelines

In general, health care professionals taking care of high risk infants in neonatal intensive care units have become more restrictive in their use of red blood cell transfusion over the past 10 years. The present statement is intended for those caring for high risk newborn infants (preterm to one month of age). The objectives of this statement are to provide guidelines to reduce the incidence of anemia in preterm and term infants, to identify strategies to decrease the need for red blood cell transfusions and to limit donor exposure in this population. Recommendations for red blood cell transfusions are included.     

Kinetics of erythropoiesis in dialysis patients receiving recombinant erythropoietin treatment

In eleven patients with uraemia on intermittent haemodialysis treatment, recombinant human erythropoietin (rHuEpo) was used at a dosage schedule of 100 IU/kg bodyweight thrice weekly. Erythrokinetic studies (blood volume, RBC survival and iron kinetics) were performed in nine cases before and after 6 months of treatment. The remaining two patients had only RBC and plasma volume determinations before and after treatment. Although total blood volume remained unchanged, RBC volume was increased in all cases. Red cell loss was not modified, and quantitative improvement of RBC production was noted in all cases. No qualitative defect of erythroid maturation or release was observed in the treated patients. In conclusion, rHuEpo treatment improves the anaemia of haemodialysis patients by normalising circulating RBC volume only through an increase in red cell production.     

重组人促红细胞生成素对颅脑损伤患者的神经保护作用

目的评价促红细胞生成素用于颅脑损伤患者的临床意义。方法对两组条件相似的颅脑损伤患者共40例进行随机配对的前瞻性研究；其中治疗组于入院后24h开始使用重组人促红细胞生成素（rhEPO）；采用6000U／次，皮下给药，隔日1次共2w。对照组不给予rhEPO处理，其他处理同治疗组，高压液相色谱法（HPLC）测定两组患者脑脊液谷氨酸含量，并将两组的治疗结果进行对比分析。结果两组患者脑脊液谷氨酸含量及预后有明显差异，治疗组脑脊液谷氨酸含量低于对照组（P〈0．01），预后优于对照组（P〈0．01）。结论颅脑损伤患者使用rhEPO可减轻损伤后谷氨酸的兴奋性毒性作用，对颅脑损伤患者有神经保护作用。     

促红细胞生成素对急性脑损伤的保护作用

目的观察重组人促红细胞生成素(r-Epo)对大鼠急性脑损伤后脑细胞凋亡及脑水肿的影响。方法30只大鼠分为A、B、C 3组,B、C 2组用自由落体打击器制作脑外伤模型,C组r-Epo预处理,48 h后断头取脑。制作石蜡切片,TUNEL法检测细胞凋亡,同时用干湿重法测定各组大鼠脑组织含水量。结果与B组比较,C组外伤侧脑组织含水量明显降低(P<0.01),细胞凋亡数明显减少(P<0.01)。结论r-Epo能显著降低急性脑损伤后脑水肿,减少水肿区神经细胞凋亡,对急性损伤后脑组织有良好的保护作用。     

Clinical and basal aspects of anemia during antiviral therapy for hepatitis C

Background and Rationale. Anemia is a major side effect of combination therapy for chronic hepatitis C. In this study, severity, potential risk factors for and potential underlying mechanisms of anemia were evaluated.Patients and methods. 44 chronic hepatitis C patients on interferon-ribavirin treatment were included. Anemia-related parameters were measured before and during treatment. Potential changes in membrane phospholipids composition of erythrocytes of patients on anti-viral treatment and potentially increased erythrocyte susceptibility to osmotic or bile salt induced stress were explored.Results. Anemia was almost universal during treatment, with evidence of hemolysis. Decrease of Hb after six months of therapy was 2.1 ± O.I mmol/L (range -0.6-4.1). Higher pre-treatment Hb, highest ribavirin dose (1S-17.S mg/kg) and lower pre-treatment platelet level were independent risk factors for decrease of Hb. Serum erythropoietin levels increased during treatment with negative correlation to Hb levels at week 12 (r = -0.70, p = 0.002) and 24 (r = -0.72, p = 0.002). Erythrocyte membrane phospholipid composition did not differ between anemic patients and healthy controls. Also, resistance to osmotic or bile salt induced stress was normal in anemic patients. Phosphatidylserine exposure at the outer membrane leaflet did not change upon 24 hrs ex vivo incubation with pharmacological ribavirin concentration.Conclusions. Anemia is almost universal during anti-HCV treatment. The extent of anemia correlates with pre-treatment levels of thrombocytes and Hb and with high ribavirin dosing. Although we found hemolysis as contributing factor, our data do not indicate that altered membrane phospholipids composition is an important factor in pathogenesis of anemia.     

新的红细胞生成刺激蛋白体内生物学活性检测(英文)

本文建立了一种新的红细胞生成刺激蛋白体内生物学活性测定方法。将新的红细胞生成刺激蛋白单剂量注射给小鼠后, 小鼠外周血网织红细胞含量随注射剂量增加而升高。在3.125 200 ng/只的剂量范围内, 外周血网织红细胞的含量与注射剂量呈很好地线性关系, 满足量-反应平行线法定量的要求。本文对方法的准确性、精密度、检测范围、采血时间等进行了研究。结果表明, 该方法准确、重现性好, 可用于新的红细胞生成刺激蛋白生物学活性检测。     

Efficacy and Safety of Oral Lactoferrin Supplementation in Combination with rHuEPO‐β for the Treatment of Anemia in Advanced Cancer Patients Undergoing Chemotherapy: Open‐Label,Randomized Controlled Study

Advanced‐stage cancer patients often suffer from anemia that closely resembles the anemia of chronic inflammatory diseases characterized by specific changes in iron homeostasis and absorption. i.v. iron improves the efficacy of recombinant human erythropoietin (rHuEPO) in anemic cancer patients undergoing chemotherapy. We report the results of an open‐label, randomized, prospective trial aimed at testing the efficacy and safety of treatment with oral lactoferrin versus i.v. iron, both combined with rHuEPO, for the treatment of anemia in a population of 148 advanced cancer patients undergoing chemotherapy. All patients received s.c. rHuEPO‐β, 30,000 UI once weekly for 12 weeks, and were randomly assigned to ferric gluconate (125 mg i.v. weekly) or lactoferrin (200 mg/day). Both arms showed a significant hemoglobin increase. No difference in the mean hemoglobin increase or the hematopoietic response, time to hematopoietic response, or mean change in serum iron, C‐reactive protein, or erythrocyte sedimentation rate were observed between arms. In contrast, ferritin decreased in the lactoferrin arm whereas it increased in the i.v. iron arm. In conclusion, these results show similar efficacy for oral lactoferrin and for i.v. iron, combined with rHuEPO, for the treatment of anemia in advanced cancer patients undergoing chemotherapy.     

Effects of different treatment methods on renal anemia in maintenance hemodialysis patients with hyperparathyroidism secondary to uremia

Objective To observe the effects of three treatment methods on renal anemia in maintenance hemodialysis patients with hyperparathyroidism secondary to uremia and analyze the influencing factors of erythropoietin (EPO) dosage. Methods A total of 55 maintenance hemodialysis patients with secondary hyperparathyroidism at the hemodialysis center of Huashan Hospital affiliated to Fudan University from January 2015 to December 2016 were retrospectively divided into three groups according to different treatment methods, parathyroidectomy +forearm transplantation group (surgery group, n=16), cinacalcet treatment group (n=6), and calcitriol treatment group (n=33), respectively. The hemoglobin level and erythropoietin dosage were measured before treatment and in the 3rd month, the 6th month and the 12th month after treatment. The changes of hemoglobin and erythropoietin dosage in the three groups before and after treatment were observed, and the mixed effect model was used to analyze the difference of the change of hemoglobin and erythropoietin dosage among three groups. Multiple linear regression analysis was used to analyze the influencing factors of EPO dosage after one year. Results The levels of intact parathyroid hormone (iPTH) in the surgery group and the cinacalcet group before treatment were significantly higher than that in the calcitriol group (both P＜0.05). In the 12th month after treatment, the levels of iPTH decreased significantly in the patients of surgery group and the cinacalcet group compared with those before treatment (both P＜0.05). The levels of serum alkaline phosphatase, serum calcium and serum phosphorus in the surgery group also decreased significantly compared with those before treatment (all P＜0.05). The mixed effect model analysis showed that the hemoglobin level of surgery group was on an upward trend after the treatment, and the overall level was significantly higher than cinacalcet and calcitriol treatment group (P=0.007). There was no significant difference in the dosage change of erythropoietin (EPO) in the three groups over time. However, the intra-group comparison of the mixed effect model showed that the dosage of EPO in the 12th month was significantly lower than that of before the treatment in surgery group (P=0.007). Multiple linear regression analysis showed that dialysis vintage (B=-0.064, P=0.012) and ferritin ≥ 500 μg/L (B=0.645, P=0.032) were independent influencing factors of EPO dosage. The longer the dialysis vintage, the less EPO dosage, and more EPO dosage were observed in patients with ferritin ≥ 500 μg/L. Conclusions Parathyroidectomy and forearm transplantation is more effective in reducing EPO dosage and improving renal anemia in maintenance hemodialysis patients with secondary hyperparathyroidism. Dialysis vintage and ferritin are independent influencing factors for the dosage of EPO.     

肿瘤坏死因子α和干扰素γ对癌性贫血患者红细胞生成素生成和红系增生的影响

目的探讨癌性贫血患者EPO生成及红系增生的变化，以及TNF、IFN等负调控细胞因子对EPO生成及红系增生的影响。方法对50例癌性贫血患者、15例癌症无贫血患者及对照组采用放射免疫法检测血清EPO水平，ELISA方法检测血清可溶性转铁蛋白受体（sTfR）、TNF-α、IFN-γ水平，用直线回归方法及相关分析定量分析体内EPO生成、红系增生情况及其与TNF-α、IFN-γ的关系。结果癌性贫血患者血清EPO水平为（23．11±10．00）IU／L，明显低于同等程度贫血的缺铁性贫血患者的（43．00±22．00）IU／L（P〈0．01）；实测值／预估值（O／P）EPO为0．88（0．54～1．10），明显低于对照组及癌症无贫血患者，后二者之间的O／PEPO差异无统计学意义。癌性贫血患者的血清sTfR水平（30．8±16．95）nmol／L，高于健康对照组的（17．82±6．76）nmol／L，而低于溶血性贫血患者的（65．75±29．12）nmol／L，差异均有统计学意义（P〈0．05）；O／PsTfR为0．89（0．57～1．22），明显低于对照组及癌症无贫血患者，后二者之间O／PsTfR差异无统计学意义。正常情况下存在于log（EPO）与血红蛋白浓度之间以及log（sTfR）与血红蛋白浓度之间的反比关系消失。癌性贫血患者血清TNF-α、IFN-γ水平分别为（25．75±26．71）ng／L、（50．49±42．12）ng／L，均显著高于正常对照组及癌症无贫血组。TNF-α、IFN-γ水平与血红蛋白浓度之间呈负相关关系。TNF-α与O／PEPO、O／PsTfR之间呈负相关。血清IFN-γ水平与O／PEPO之间无相关关系，与O／PsTfR呈负相关。结论TNF-α、IFN-γ等负调控因子的作用下，内源性EPO对贫血的反馈性增生相对不足，以及骨髓红系对EPO的反应性增生相对不足参与癌性贫血的发病机制。     

护理干预对促红细胞生成素两种注射方式转变的影响

目的:利用护理干预的方法观察人类重组红细胞生成素(rhu-EPO)由静脉注射方式转变为皮下注射方式的疗效。方法:采用健康教育、实际操作等护理干预实现两种不同途径的转变。结果:两组患者红细胞、血红蛋白、红细胞比容均有明显上升,6周后两组之间比较差别有显著性(P<0.05),90%患者由静脉注射转变为皮下注射。结论:合理的护理干预可有效地改变患者的从医行为,选择更有效的治疗方式。