scholarly journals Safety of Uncrossmatched ABO-Compatible RBCs in Alloimmunized Patients with Bleeding: Data from Two Decades: Results of a Systematic Analysis in 6,109 Patients

2021 ◽  
pp. 1-5
Author(s):  
Frauke Ringel ◽  
Helge Schoenfeld ◽  
Said El Bali ◽  
Jalid Sehouli ◽  
Claudia Spies ◽  
...  

<b><i>Introduction:</i></b> Uncrossmatched ABO-compatible red blood cells (RBCs) are generally recommended in patients with life-threatening massive bleeding. There is little data regarding RBC transfusion when patients are transfused against clinically significant alloantibodies because compatible RBCs are not immediately available. <b><i>Methods/Patients:</i></b> All patients reviewed in this study (<i>n</i> = 6,109) required emergency blood transfusion and were treated at the Charité – Universitätsmedizin Berlin between 2001 and 2015. Primary uncrossmatched O Rh(D)-positive or -negative RBC units were immediately transfused prior to complete regulatory serological testing including determination of ABO group, Rhesus antigens, antibody screening, and crossmatching. <b><i>Results:</i></b> Without any significant change in the protocol of emergency transfusion of RBCs, a total of 63,373 RBC units were transfused in 6,109 patients. Antibody screening was positive in 413 patients (6.8%), and 19 of these patients received RBC units against clinically significant alloantibodies. None of these patients appeared to have developed significant hemolysis, and only one patient with anti-D seems to have developed signs of insignificant hemolysis following the transfusion of three Rh(D)-positive units. One patient who had anti-Jk<sup>a</sup> received unselected units and did not develop a hemolytic transfusion reaction. <b><i>Conclusion:</i></b> Transfusion of uncrossmatched ABO-compatible RBCs against alloantibodies is highly safe in patients with life-threatening hemorrhage.

1970 ◽  
Vol 9 (2) ◽  
Author(s):  
Bertha Wong MD ◽  
Maria Bagovich MD ◽  
Ivan Blasutig PhD ◽  
Simon Carette MD MPhil

This article describes a patient presenting with a sensory polyneuropathy and multiple autoantibodies, leading to the diagnosis of hepatitis C virus (HCV) infection. His widely positive autoantibody profile in the absence of clinically significant rheumatic disease illustrates the importance of interpreting autoimmune serology in the appropriate clinical context and the concept of HCV being a non-specific activator of the immune system. In addition, it highlights the importance of considering untreated HCV infection in the differential diagnosis of rheumatic complaints, particularly if the workup reveals multiple autoantibodies, as HCV is a potentially severe and life-threatening disease, which can be appropriately managed with effective antiviral therapy.


Healthcare ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 117
Author(s):  
Massimiliano Esposito ◽  
Angelo Montana ◽  
Aldo Liberto ◽  
Veronica Filetti ◽  
Nunzio Di Nunno ◽  
...  

Anaphylaxis is a life-threatening or fatal clinical emergency characterized by rapid onset, and death may be sudden. The margin of certainty about the diagnosis of anaphylactic death is not well established. The application of immunohistochemical techniques combined with the evaluation of blood tryptase concentrations opened up a new field of investigation into anaphylactic death. The present study investigated eleven autopsy cases of anaphylactic death, carried out between 2005 and 2017, by the Departments of Forensic Pathology of the Universities of Foggia and Catania (Italy). An analysis of the medical records was carried out in all autopsies. Seven autopsies were carried out on males and four on females. Of the eleven cases, one showed a history of asthma, one of food ingestion, two of oral administration of medications, six did not refer any allergy history, and one subject was unknown. All cases (100%) showed pulmonary congestion and edema; 7/11 (64%) of the cases had pharyngeal/laryngeal edema and mucus plugging in the airway; only one case (9%) had a skin reaction that was found during external examination. Serum tryptase concentration was measured in ten cases, and the mean value was 133.5 µg/L ± 177.9. The immunohistochemical examination using an anti-tryptase antibody on samples from the lungs, pharynx/larynx, and skin site of medication injection showed that all cases (100%) were strongly immunopositive for anti-tryptase antibody staining on lung samples; three cases (30%) were strongly immunopositive for anti-tryptase antibody staining on pharyngeal/laryngeal samples; and eight cases (80%) were strongly immunopositive for anti-tryptase antibody staining on skin samples. We conclude that a typical clinical history, blood tryptase level >40 µg/L, and strongly positive anti-tryptase antibody staining in the immunohistochemical investigation may represent reliable parameters in the determination of anaphylactic death with the accuracy needed for forensic purposes.


Author(s):  
Gerard Lambe ◽  
Peter Hughes ◽  
Louise Rice ◽  
Caoimhe McDonnell ◽  
Mark Murphy ◽  
...  

AbstractCT colonography has emerged as the investigation of choice for suspected colorectal cancer in patients when a colonoscopy in incomplete, is deemed high risk or is declined because of patient preference. Unlike a traditional colonoscopy, it frequently reveals extracolonic as well as colonic findings. Our study aimed to determine the prevalence, characteristics and potential significance of extracolonic findings on CT colonography within our own institution. A retrospective review was performed of 502 patients who underwent CT colonography in our institution between January 1, 2010 and January 4, 2015. Of 502 patients, 60.63% had at least one extracolonic finding. This was close to other similar-sized studies (Kumar et al. Radiology 236(2):519–526, 2005). However, our rate of E4 findings was significantly higher than that reported in larger studies at 5.3%(Pooler et al. AJR 206:313–318, 2016). The difference may be explained by our combination of symptomatic/screening patients or by the age and gender distribution of our population. Our study lends support to the hypothesis that CT colonography may be particularly useful in identifying clinically significant extracolonic findings in symptomatic patients. CT colonography may allow early identification of extracolonic malignancies and life-threatening conditions such as an abdominal aortic aneurysm at a preclinical stage when they are amenable to medical or surgical intervention. However, extracolonic findings may also result in unnecessary investigations for subsequently benign findings.


Vaccines ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 211
Author(s):  
Anna Malkova ◽  
Dmitriy Kudlay ◽  
Igor Kudryavtsev ◽  
Anna Starshinova ◽  
Piotr Yablonskiy ◽  
...  

According to an analysis of published data, only 20% of patients with the new coronavirus infection develop severe life-threatening complications. Currently, there are no known biomarkers, the determination of which before the onset of the disease would allow assessing the likelihood of its severe course. The purpose of this literature review was to analyze possible genetic factors characterizing the immune response to the new coronavirus infection that could be associated with the expression of angiotension-converting enzyme 2 (ACE-2) and related proteins as predictors of severe Corona virus disease 2019 (COVID-19). We analyzed original articles published in Medline, PubMed and Scopus databases from December 2019 to November 2020. For searching articles, we used the following keywords: New coronavirus infection, Severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), COVID-19, severe course, complications, thrombosis, cytokine storm, ACE-2, biomarkers. In total, 3714 publications were selected using the keywords, of which 8 were in congruence with all the criteria. The literature analysis of the association of immunogenic characteristics and the expression of ACE-2 and related proteins with the development of severe COVID-19 revealed following genetic factors: HLA-B*46:01 genotype, CXCR6 gene hypoexpression, CCR9 gene expression, TLR7, rs150892504 mutations in the ERAP2 gene, overexpression of wild-type ACE-2, TMPRSS2 and its different polymorphisms. Genes, associated with the severe course, are more common among men. According to the analysis data, it can be assumed that there are population differences. However, the diagnostic significance of the markers described must be confirmed with additional clinical studies.


1992 ◽  
Vol 13 (10) ◽  
pp. 371-378
Author(s):  
Thomas C. Putnam

Many lesions involving the skin or subcutaneous tissues alarm parents and, often fearing cancer, they bring their child to a physician. Most lesions are benign and rarely life-threatening. The physician faces the problem of determining which characteristics suggest only observation of a lesion and which make biopsy necessary. Because many lesions have a predilection for certain areas of the body, this is a useful form of categorization (Table 1). On first inspection of a superficial lesion, several questions must be asked, including the known duration, change in size, presence of pain or other signs of inflammation, and any noted multiplicity. The examination includes an accurate measurement of the size and, most importantly, a determination of the level of the lesion. This will help establish the diagnosis and help to determine whether the possibility of malignancy exists. Essentially all lesions originating in the skin of children are benign. Some are obvious, such as a wart, while others may not be so clear-cut, especially if the epidermis is not altered in appearance. Upon palpation of a cutaneous mass, the skin does not move over the surface and puckers when the adjacent skin and tissues are compressed and elevated. If the skin moves freely over the mass, the nature of the lesion is not so readily apparent.


2017 ◽  
Vol 8 (4) ◽  
pp. 64-72
Author(s):  
Anastasia V. Koziy ◽  
Alexander I. Olesin ◽  
Vadim A. Litvinenko ◽  
Irina V. Konstantinova

Aim. The aim of the study was a clinical assessment of the integrated determination of predictors of life-threatening ventricular arrhythmias (LVA) in patients with ventricular extrasystole (VE) without structural changes in the heart to predict the development of cardiovascular disease in a prospective study. Material and methods. From 1997 to 2014 199 patients with neurocirculatory dystonia (NCD), complicated with VE II-V class EE at the age of 18-35 years (mean 27.3-2.6 years) were observed in District Military Clinical Hospital of the Ministry of Defense of the Russian Federation, City Hospital named after St. Martyr Elizabeth. All patients, in addition to a general clinical examination, determined late potentials of the ventricles (LPV), QT interval variability (QTd), heart rate turbulence (HRT), and also indicators reflecting the possible mechanism of VE development. Results. The results of the study showed that in patients with NCD complicated by VE, the detection of indicators reflecting the presence of VE caused by the mechanisms of early post-depolarization and re-entry is a predictor of the development of coronary heart disease (CHD) and hypertension (HB). The positive prognostic significance of the indicators showing the presence of VE with these development mechanisms for the development of CHD and HB averaged 74% and 44% respectively, and with the appointment of сlass III drugs for elimination of VE and (or) development of unstable ventricular tachycardia, the risk of developing CHD increased to an average of 93%. Identification of NDC patients with indicators reflecting the presence of VE due to delayed post-depolarization is a predictor of the development of gastrointestinal tract (GT) diseases with positive prognostic significance, averaging 61%. Positive prognostic significance with respect to the development of CHD, HB, GT diseases for the detected LPV, QTd > 80 ms, pathological values of HRT VE did not exceed 30%. Indicators and predictors, which characterize the mechanism of development of VE and the risk of LVA occurrence in patients with NCD complicated by VE, were highly correlated (r > 0.50) with risk factors for cardiovascular and gastrointestinal system diseases.


Author(s):  
Ronen Levi ◽  
Justin Silver

Ionized calcium is essential for several physiological functions, including neuromuscular activation, endocrine and exocrine secretions, integrity of cellular bilayers, plasma coagulation, immune functions and bone metabolism. Extracellular fluid (ECF) calcium is uniquely controlled by its own calcium-sensing receptor, regulating the secretion of parathyroid hormone (PTH), synthesis of 1,25-dihydroxyvitamin D, and the renal reabsorption of filtered calcium (see Chapter 4.1). With the advent of the autoanalyser and routine determination of serum calcium levels, recognition of hypercalcaemia has become common. However, the clinical spectrum of hypercalcaemia varies from a laboratory-detected, asymptomatic mineral disorder to a life-threatening state.


Author(s):  
Melissa Langhan ◽  
Seth Wolf

There is a lack of data about the benefits of cardiovascular monitoring with continuous 3-lead electrocardiography (ECG) and intermittent noninvasive cuff blood pressure (BP) during procedural sedation and analgesia (PSA) in the pediatric population. However, these two safe modalities are important for patients during higher levels of PSA because of the risk of rare life-threatening conditions and to help identify possible medication side effects and drug interactions of common sedative medications. These monitoring modalities can also aid in determining the adequacy of sedation. It is generally accepted that a baseline determination of heart rate and BP should be obtained prior to any sedative administration. With deeper levels of sedation and throughout recovery, continuous 3-lead ECG and intermittent BP monitoring are recommended, in addition to other modalities such as pulse oximetry and capnography, to monitor the safety of the patient.


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